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Valuable  Medical  Works 


DA  COSTA'S  MEDICAL  DIAGNOSIS. 

MKPK'AI.    DIAGNOSIS,   with    Special    Helen-nee   to   Practical    Medicine.     A   (iuido   to   flu 
Knowledge  ami  OiM-riniinat  ion  of  Diseases.     My  .[.  M.  I>A  ( ''  >STA,  M.D.,  Lecturer  on  Clinical 
Medicine,  and  Physician  to  the  Philadelphia  Hospital;   Follow  of  tin-  Colli-icr  of  Physician:- 
i -ideiphia.  AC.  AC.    Hlustrated  with  Numerous  Engravings,    l  vol.  svo.    .-o.no. 


"No 
luanu; 
pivpai 
at  Un- 
made : 
styli-  < 
.  .  .  T< 
it^  n:i- 

"Th, 

style 
The  ai 
intclli 

or  vi-i-1 

short  < 

oil)  )>r; 


Fro 

ai'.lhoi 


££^^ 


Presented  by 
George  L  Hampton,   D. 


0. 


COLLEGE  OF  OSTEOPATHIC  PHYSICIANS 
AND  SURGEONS  •  LOS  ANGELES,  CALIFORNIA 


in  an 

thor,  as  i  ii- 
its  or  recent 
M-C  are  that 
will  find  it 
:  well  meets 
;  the  reader 

knowledge 

o  the  dian- 
he  may  be 

nl  it  to  our 
•d  to  hold  ;i 
dical  litera- 
we  can  only 


•e  us  is  ,-,  r- 
•fact  ilioiier. 
!S  teaclihm-s 

If  Mich  was 
result 

and  profe-- 
i  .jeopardy. 

his  manual 
•vice.  Kach 
'.ed.  and  the 
'  plain,  that 
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RKPOKTfflR. 

y,  ami  c\a- 
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"  111  tin-  li"  i;ilo\vlc(l«r 

:ili'l  <1:  ,-,•(!  in 

:    illllal 
every 

i-\   iio 
ctlng- 


merit,   exhitiitini;   a    close 

oul\   with  the  philosophy  of  disease  in  neiie- 

ral,  but   a   familiarity  with   the  detailed  evi- 

dences  of  1he   derangements  of  the    various 

nd  functions,  indicativeof  a  Iar^ei-\- 

••  and  accurate  study.  The  /.ylonraph  ic 

illustrations  of  the  anatomical  lesions  which 

Hive    rise    to   various    sinus   of  disease    of    the. 

ire  well  drawn,  and  gi 
lacilitate  the  explanation  of  the  I. 


From  the  Press  of  J.  B.  Lippincott  &  Co. 


^* 
THOMAS'^TtfONOU^ING  MEDICAL  DICTIONARY. 

A  COMPKKI1KNSIYK  MKDH'AL  DICTIONARY.    <  oiitaining  the  Promtncia' '  ,logj-,     \ 

"aiuLSigniticjition  of  the  Terms  made  use  of  in  Medicine  and  [lie  Kindred  Scieii'-,  -      \v; 

. 
Appendix,  comprising*^  Complete  List  or  all  the  more  important  Article- 


Mcdica,  arranged  according  to  their    Medicinal    Properties.     Also,  an    i 

Latin  Terms  and  Phrases  occurrnm  in  Anatomy,  Pharmacy,  Are.    Together  with  soi  , 

sary  Directions  for  writing  Latin  Prescriptions.  A.-C.       I'.v  .I.THOMAs,  M.D.,  Auth 

Qf  Pronunciation  in  "Lippincott's  Pronounchu  of  the  World."     Demi 

svo.    cloth,  >.v>o.    sneep_.  S.-J.T.-,..  ^  *  v 


WASH  i  xi  rrox  <  'rrv.  D.  c. 

February  10,  !MM.     I 

'Siu:— In     accordance     with     the     ivcom- 
,    mendation    of  the  Army   Medical    Hoard,  re- 
nt ly   convened  at    Philadelphia,    the    issue 
the  Mi-iii,'nl   /Hi-tii>iiitrj/,  of  which   you  are 
ie  audio.-,   to  medical   officers    in    I  he    tield, 
will    be  authorized    in    the    Revised    Supply 
ible   soon  to   lie    published  by  this    Depart- 
ment. 

"  P>y  order  of  the  surire. >n-<  General: 
"  \'ery  resi>eet  fully, 

"  Your  obedient  servant, 

'•W.  C.  SPKXCKK, 
•'.1W.  Snri/rnii  I'.S.  A  nni/. 
"Di:.  .1.  TlfoM  AS. 

"Philadelplria." 


VOr.  If.  VAN  P,ri:i-:x.  M.D.,  Professor  of 

mil  in  tin'  Cuii-i'i-xiti/  of  A'rf  Ynrl;. 

Dr.  Thomas's  Comprehensive 
Medical  Dictionary,  recently  published  by 
.1.  P>.  Lippincott  i\;  Co.,  as  the  best  Dictionary 
ot  !(•<  si/.e  within  the  reach  of  the  student 
and  practitioner.  Its  directions  for  the  pro- 
nunciation of  Latin  terms, and  for  the  correct 
writing  of  pre<criptions,  are  especially  valu- 
able and  complete.  In  typography  and  ar- 
•  •!'  matter  it  is  admirable." 


itiiTiAitD  McSiiKi:i:v,  M.D., 

thi'   t~iiii-<-i-xity  <><   .!/</,  - 

' 

"Itlnd  the  work  to  be  useful,  con venie:>.i 
and    accurate,    and    I    have    already    : 

mended  it  to  the  medical  class  of  the  T'nive; 
Maryland." 


From  D.  HAVKS  A(;NKW,  M.D.,f  7//I/V"/  Lectun  r 

"ii  Hnri/i  i-i/,  I..'rhii-<  r  an  Ainifmni/,  <(•<•.  ",: 

"1    have   examined    Dr.  Thomas's    Medical     ''. 

Dictionary  with   no  small  degree  of  care,     i 

have  n.  i.»re  industry,  research,  and     ; 

scholarship  compressed   into  so  small  a  com-     | 

In  my  ran  ire  of  readimr,  I  know  of  no     •'*.' 
book  which  combines  so  pre-eminently  tho-     '•' 
roughness  with  brevity,  conciseness  with  p. 
spicuity    and     copiousness     without     redu; 
dancy,  as   this    work.     I  anticii 
of  no  ordinary  chani' 


in  tli' 


::.  A.  !•'.  PKNKOSK,  M.D.,  /'-•• 
xMricx  in  lh>>  {.'i>ii-"rxitif  of  ]>,„,< 

"I  have  evamined  Dr.  Thomas's  Pro 
iiiii  M.-.lical  Dictionary  thoroughly. 

"I  tind  it  eharacteri/.e-l  by  con  r 
eom]ileteness:  while  its  arra 
excellent. 

"AS  a  work  for  daily  reference,  I  pi, 
to  all  other  medical  dictiona 


Dm  "ioi::—  I  thank  you  for  th. 
of  your  Comprehensive  Medical  Dictionary 
I    have   given    ii    an    attentive   examii 
and  have  been   so   much   pleased   therewith 
ihat   I  shall    recommend   it   to   my  students. 
From  its  convenient  si/.e,  the  eoncisen 
its  definitions,  and    the    pronunciation   ami 
i,  it  must  prove  a  useful 
medical  student.    The  Ap- 
pendi-  ly  important  addition; 

•arts  relating  to  • 
:i  termsand  phrases,and  the 
!,.:     presi-;-i]iti<ins    whii-b 
an    invalnal'l      aid    '• 
not  had  the  advanta- 
in." 


0 


&        — . 


A  TREATISE 


THEEAPEUTICS, 


PHARMACOLOGY 


\ 


MATERIA    MEDICA. 


BY 

GEORGE    B.  WOOD,  M.D., 

PRESIDENT  OF  THE  AMERICAN  PHIL6SOPHICAL  SOCIETY;  PRESIDENT  OF  THE  COLLEGE  OF  PHYSICIANS 

OF  PHILADELPHIA;  EMERITUS  PROFESSOR  OF  THE  THEORY  AND  PRACTICE  OF  MEDICINE 

IN  THE  UNIVERSITY  OF  PENNSYLVANIA;  ONE  OF  THE  AUTHORS  OF  THE 

UNITED  STATES  DISPENSATORY;   AUTHOR  OF  A  TREATISE 

ON  THE  PRACTICE  OF  MEDICINE,  ETC.  ETC. 


IN     TWO     VOLUMES. 
"VOL.     I. 


PHILADELPHIA: 
J.    B.    LIPPINCOTT    &    CO. 

1868. 


Entered,  according  to  the  Act  of  Congress,  in  the  year  1867,  by 
GEORGE   B.  WOOD,  M.D., 

In  the  Clerk's  Office  of  the  District  Court  of  the  United  States  in  and  for  the 
Eastern  District  of  Pennsylvania. 


TO 

t 

MY     DEAR     FRIEND, 

FRANKLIN    BACHE,   M.D., 

PROFESSOR    OF    CHEMISTRY 

IN  THE 

JEFFERSON    MEDICAL    COLLEGE    OF    PHILADELPHIA; 
LATE    PRESIDENT 

OF  THE 

^ 

AMERICAN    PHILOSOPHICAL    SOCIETY; 

MY   PARTNER  IN   MUCH  LABOUR; 
MY   COMPANION  IN   MANY   SOCIAL   HOURS; 

WHOM, 
IN    THE    COURSE    OF   AN    INTIMATE    ACQUAINTANCE    OF    MORE    THAN    THIRTY   YEARS, 

I  HAVE  NEVER  KNOWN 
TO    DO    AN    UNJUST   ACT,   OR   CHERISH    AN    UNJUST    THOUGHT  ; 

THE  ACCURATE  MAN  OF  SCIENCE; 

THE  SKILFUL  TEACHER; 
THE  UPRIGHT  AND  HONOURABLE  MAN; 

AND, 

IN    ALL    POINTS,    THE    GENTLEMAN, 

I  Insmte  this  ^'orfe, 

IN  TESTIMONY  OF 
MTT   PROFOUND    ESTEEM    AND    SINCERE    AFFECTION. 

GEO.   B.   WOOD. 

PHILADELPHIA,  AUQCST,  1856. 


PREFACE 


THE  work  now  offered  to  the  medical  public,  while  it  aims  to  present 
whatever  in  Therapeutics  and  Pharmacology  is  directly  and  practically 
important  to  the  physician,  is  intended  also  to  be  an  exponent  specially 
of  what  the  author  himself  knows  and  believes  on  the  subjects  of  which 
it  treats.  Its  value,  therefore,  must  depend  greatly  on  the  opportunities 
which  he  has  possessed  of  acquiring  knowledge,  and  forming  just  views 
upon  these  subjects;  and  upon  this  point,  consequently,  they  for  whom 
the  work  is  intended  have  a  right  to  be  informed. 

Almost  from  the  commencement  of  his  professional  life,  the  author 
has  given  peculiar  attention  to  this  branch  of  medical  knowledge.  For 
a  period  of  about  thirty  years,  before  1850,  when  he  was  transferred  to 
the  professorship  which  he  now  occupies,  he  was  engaged  in  teaching 
Materia  Medica,  first  as  a  private  lecturer,  and  afterwards  successively 
in  the  Philadelphia  College  of  Pharmacy,  and  the  University  of  Penn- 
sylvania. His  position,  therefore,  rendered  constant  investigation  into 
the  properties,  effects,  and  uses  of  remedies  necessary,  in  order  at  once 
to  do  justice  to  his  pupils,  and  avoid  discredit  to  himself.  Most  of  those 
:  whom  he  now  addresses  are  probably  aware  that  he  is  one  of  the  authors 
of  the  U.  S.  Dispensatory.  To  provide  the  original  materials  for  his 
portion  of  that  work,  and  to  gather  from  time  to  time  the  knowledge 
>  requisite  for  its  maintenance  upon  a  level  with  the  progressive  condition 
of  medical  science,  unremitting  diligence  was  essential  in  prosecuting 
inquiry  and  investigation  in  the  whole  field  of  Pharmacology.  In  addi- 
tion to  the  ordinary  professional  opportunities,  he  has,  for  about  twenty 
years,  held  the  office  of  one  of  the  physicians  of  the  Pennsylvania  Hos- 
»^j  pital,  which  has  given  him  facilities  for  testing  the  value  of  remedies 
greater  than  any  amount  of  private  practice  could  afford.  Few  persons 
have  had  greater  advantages  or  stronger  inducements  than  himself  for 
acquiring  the  knowledge  requisite  for  the  production  of  a  work  of  this 

(v) 


vi  PREFACE    TO    THE   FIRST    EDITION. 

kind.  Of  the  extent  to  which  he  has  availed  himself  of  these  oppor- 
tunities, and  his  ability  to  make  a  proper  use  of  them,  the  reader  will 
form  his  own  opinion,  either  from  what  he  may  find  in  this  Treatise,  or 
from  what  he  may  know  of  former  works  of  the  author. 

In  preparing  the  present  work  for  the  press,  the  author  claims  to  have 
been  actuated,  in  part  at  least,  by  motives  higher  than  those  of  personal 
credit,  or  pecunrary  advantage.  Though  he  pretends  to  no  insensibility 
to  these  ordinary  influences,  he  believes  that  he  is  obeying  a  call  of  duty 
in  laying  before  the  profession  those  results  of  his  research,  experience, 
and  reflection  upon  the  subject  of  Therapeutics,  which  have  heretofore 
been  confined  to  the  narrower  limits  of  classes  of  medical  students.  His 
former  lectures  constitute  the  chief  substance  of  the  present  Treatise, 
though  considerably  extended,  and  much  elaborated.  Perhaps  he  may 
be  laying  himself  open  to  a  charge  of  overweening  self-estimation,  in 
supposing  that  he  can  add  to  the  existing  mass  of  knowledge,  or  improve 
existing  views  in  this  department  of  medicine,  in  a  degree  which  may 
justify  the  publication  of  a  book  like  the  present;  but  he  is  unwilling 
to  leave  the  world  without  giving  some  degree  of  permanency  to  what 
he  has  so  long  taught,  and  consoles  himself  with  the  consideration  that. 
should  the  work  prove  of  less  value  to  the  profession  than  he  ventures 
to  hope  or  anticipate,  it  is  not  likely  to  do  serious  injury,  and,  at  the 
worst,  will  be  merely  superfluous. 

A  few  words  of  explanation  may  be  necessary  to  a  correct  appreciation 
of  the  character  of  the  Treatise.  Though  aiming  at  considerable  fulness 
in  all  that  concerns  the  effects  of  remedies,  the  nature  of  their  operation, 
and  their  therapeutic  application,  it  has  no  pretension  whatever  to  be 
considered  as  a  complete  exposition  of  the  Materia  Medica,  properly  so 
called.  Of  the  natural  and  commercial  history,  the  sensible  and  chemi- 
cal properties,  and  the  pharmaceutical  preparation  of  drugs,  the  author 
has  endeavoured  to  select  such  parts  as  are  of  direct  and  immediate 
interest  to  the  medical  practitioner,  and  without  a  knowledge  of  which, 
he  can  scarcely  be  said  to  be  prepared  to  enter  upon  the  duties  of  his 
profession.  All,  therefore,  that  is  said  on  these  points  may  be  considered 
as,  in  the  opinion  of  the  author,  requiring  the  particular  notice  of  the 
student.  He  has  given  much  attention  €o  this  branch  of  the  subject,  in 
reference  both  to  the  general  value  and  the  accuracy  of  the  facts  stated  ; 
having,  in  many  doubtful  instances,  practically  verified  their  correctness. 
In  the  prosecution  of  investigations  for  this  purpose,  he  has  pleasure  in 
acknowledging  his  indebtedness  to  Professor  William  Procter,  Jr.,  who 
has,  at  his  suggestion  and  request,  performed  many  experiments  in  rela- 
tion to  the  chemical  properties,  reactions,  and  incompatibilities  of  the 
medicines  described. 

The  work  will  not  be  found  rich  in  formulas.     Nothing  would  have 


PREFACE   TO   THE   FIRST   EDITION.  Vll 

been  easier  than  to  attach  numbers  of  prescriptions  to  every  important 
medicine  described.  But  the  author  has  always  considered  that  a  mul- 
tiplication of  these  precise  combinations  is  productive  of  much  more  in- 
jury than  good.  It  leads  to  an  indolent  reliance  on  mere  authority,  by 
sparing  the  trouble  of  thought ;  and  greatly  conduces  to  an  empirical 
and  routine  practice,  neither  creditable  to  the  physician,  nor  profitable 
to  the  patient.  The  author  has  preferably  sought  to  give  principles,  by 
which  the  physician,  himself  may  construct  formulas,  suitable  to  each 
special  occasion.  He  has  endeavoured  to  point  out,  in  reference  to  each 
medicine,  the  peculiar  circumstances  which  render  its  use  appropriate, 
and  the  modifications  in  dose  or  form  which  it  must  undergo,  to  adapt  it 
to  the  varying  circumstances  of  different  cases,  or  of  the  same  case  at 
different  times.  He  has  also  Called  attention  to  the  medicines  with 
which,  in  each  special  case,  it  may  be  appropriately  combined,  to  aid  or 
qualify  its  operation.  'With  this  knowledge,  and  that  of  the  patholog- 
ical condition  to  be  corrected,  the  educated  physician  will  be  qualified 
to  form  much  more  appropriate  associations  or  combinations  of  medi- 
cines, and  to  regulate  much  more  correctly  the  proportions  of  the  several 
ingredients  in  correspondence  with  the  indications,  than  any  formulary 
can  possibly  do  for  him  ;  nor  can  any  medical  man  be  considered  as  duly 
instructed,  until  he  is  capable  of  constructing  such  formulas  for  his  own 
purposes. 

To  any  one  familiar  with  the  author's  Treatise  on  the  Practice  of 
Medicine,  it  will  be  obvious,  in  the  perusal  of  the  present  work,  that  the 
same  great  principles  of  pathology  pervade  both,  and  constitute  in  fact 
the  very  basis  of  whatever  belongs  to  the  general  subject  of  Therapeu- 
tics in  the  latter.  The  author  has  avoided  an  elaborate  representation 
of  these  principles  on  the  present  occasion ;  as  it  would  render  neces- 
sary a  repetition  of  much  that  is  contained  in  his  observations  on  gen- 
eral pathology  in  the  former  Treatise,  to  which,  therefore,  he  would  re- 
spectfully invite  the  attention  of  the  reader,  if  desirous  of  information  on 
the  subject. 

Finally,  it  is  proper  to  state  that,  on  a  comparison  of  this  work  with 
the  Treatise  on  the  Practice,  upon  the  one  hand,  and  the  U.  S.  Dispen- 
satory on  the  other,  there  will  be  found  not  a  little  that  is  common  to  it 
and  one  or  both  of  the  others ;  but  this  overlapping,  at  the  borders,  of 
Treatises  on  closely  allied  subjects  is  absolutely  essential  to  a  full  and 
consistent  view  of  each,  and  is  nothing  more  than  is  found  in  all  con- 
terminous sciences,  not  only  in  the  great  complex  science  of  medicine, 
but  throughout  the  whole  circle  of  human  knowledge. 

This  is  probably  the  last  professional  Treatise  of  the  author;  as,  with 
its  publication,  he  will  have  exhausted  what  he  has  had  to  communicate 
in  those  departments  of  medicine  to  which  he  has  given  a  special  atten- 


vili  PREFACE   TO   THE   FIRST   EDITION. 

tion ;  and  advancing  years  warn  him  that  the  time  is  fast  approaching, 
when  a  failure  of  faculties,  or  the  termination  of  life,  will  render  labour 
in  any  new  field  impracticable.  He  asks  for  it  only  the  same  kindly  con- 
sideration which  he  has  had  occasion  to  acknowledge  for  his  other  works, 
and  which  has  bound  him  to  the  profession  by  the  strong  ties  of  grati- 
tude, in  addition  to  those  of  duty  and  affection. 

PHILADELPHIA,  August,  1856. 


PREFACE 

TO  THE  THIRD  EDITIOX 


I\  consequence  of  pressing  engagements  in  the  revision  of  his  other 
works,  which  could  not  with  propriety  be  postponed,  the  author  has 
been  compelled  in  some  degree  to  neglect  the  present,  which  has  now 
for  several  months  been  out  of  print.  About  seven  years  have  elapsed 
since  the  second  edition  was  given  to  the  public ;  and,  as  this  period 
has  been  one  of  extraordinary  activity  in  the  cultivation  of  medicine,  it 
will  be  readily  perceived  that  much  labor  was  necessary,  on  the  part 
of  the  author,  to  bring  the  work  fully  up  to  the  level  of  the  present  time. 
For  nearly  a  year,  with  a  short  intermission  rendered  unavoidable  by 
family  affliction  and  his  own  impaired  health,  he  has  devoted  most  of 
his  time  to  this  object ;  and  the  reader  will  perceive,  by  the  additions 
made  to  the  Treatise,  and  the  numerous  modifications  necessary  to  keep 
pace  with  the  advance  of  the  science  and  the  change  of  opinion,  that 
the  task  of  revision  has  been  no  sinecure.  Besides  many  of  minor  im- 
portance, the  following  remedial  substances  have  been  treated  of,  and 
some  at  considerable  length ;  to  wit,  coca,  nitrous  oxide,  antimoniated 
hydrogen,  gelsemium,  calabar  bean,  bromine  and  its  preparations, 
lithia  and  its  carbonate  and  citrate,  ozone,  peroxide  of  hydrogen,  per- 
manganate of  potassa,  and  sulphurous  acid  and  the  sulphites  with  car- 
bolic acid  in  their  antizymotie  relations.  The  progress  of  the  science 
has  rendered  advisable  the  formation  of  two  new  classes,  in  order  prop- 
perly  to  arrange  several  substances  of  peculiar  powers ;  one  embracing 
the  disinfectants,  which  now  hold  an  important  place  among  the  means 
of  encountering  disease;  and  the  other  named  antizymotics,  because 
endowed  with  extraordinary  powers  in  arresting  fermentative  pro- 
cesses, which  are  recognized  as  exercising  a  most  noxious  influence  in 
the  causation  of  disease.  The  size  of  the  type  used  in  the  former  editions 
has  been  so  much  reduced  in  the  present,  as  to  enable  the  quantity  of 
matter  contained  in  each  page  to  be  increased  at  least  one-tenth ;  and 
yet,  to  accommodate  the  new  material,  it  has  been  found  necessary  to 
add  considerably  to  the  bulk  of  the  book.  The  subjects  of  subcutaneous 
injection,  and  of  the  introduction  of  liquids  into  the  air-passages  by 

1*  (ix) 


X  PREFACE   TO   THE   THIRD    EDITION. 

bringing  them  to  the  state  of  fine  spray,  which  are  now  for  the  first 
time  fully  considered  in  this  Treatise,  involve  so  large  a  number  of  sub- 
stances in  their  practical  application,  that  a  constant  watchfulness  was 
necessary,  in  the  revision,  not  to  allow  important  medicines  to  pass  un- 
noticed in  this  relation.  The  author  is  not  aware  that  any  topic,  having 
a  direct  bearing  upon  the  subject  of  the  work,  has  been  neglected  in 
preparing  it  for  the  press;  and  he  thinks  he  may  justly  say  that,  what- 
ever may  have  been  the  merits  of  the  former  editions,  as  exhibiting  the 
condition  of  the  Materia  Medica  at  the  periods  respectively  when  they 
were  issued,  the  present  will  not  be  found  to  have  deteriorated  as 
representative  of  the  existing  state  of  the  science.  The  author  wishes 
once  more  to  repeat  the  assurance  of  his  warm  interest  in  the^advancc- 
ment  of  the  profession  and  its  prosperity  in  all  respects,  and  of  his 
grateful  feelings  towards  its  members  personally  for  the  kindness  which 
his  labours  have  always  received  at  their  hands. 

PHILADELPHIA,  Oct.  15th,  1867. 


There  are  a  few  abbreviations  used  throughout  the  work  which  require  explana- 
tion. The  letters  U.S.,  attached  to  a  medicinal  name  or  process,  are  to  be  under- 
stood as  referring  to  the  authority  of  the  existing  United  States  Pharmacopoeia ; 
Br.,  to  that  of  the  first  British  Pharmacopeia  published  in  1864;  and  Lond.,Ed., 
Dub.,  to  that  of  the  last  Pharmacopoeias  published  by  the  London,  Edinburgh,  and 
Dublin  Colleges  respectively,  but  now  superseded  by  the  British. 

In  an  Appendix  will  be  found  tables  showing  the  differences  between  the  British 
Pharmacopoeia  recently  published,  and  tho  first  edition  of  that  work,  published  in 
1864,  which  has  been  recognized  throughout  this  Treatise  as  the  British  standard. 

The  reader  is  requested  to  supply  two  omissions,  from  inadvertence,  in  the  fol- 
lowing pages;  one,  of  Moschus  Moschiferua,  the  name  of  the  animal  described  as 
furnishing  musk  (vol.  i.  p.  690),  and  the  second,  of  Cephaelis  Ipecacuanha,  as  the 
botanical  title  of  the  ipecacuanha  plant  (vol.  ii.  p.  465). 


TABLE    OF    CONTENTS. 


PART  I. 
GENERAL   THERAPEUTICS  AND   PHARMACOLOGY. 

CHAPTER  I. 

OPERATION  OF  MEDICINES. 

Section  I. 

PRIMARY   OPERATION   OP   MEDICINES. 
Subsection  I. 

PRIMARY    OPERATION    THROUGH    THE    CIRCULATION,  OR    BY    ABSORPTION. 

Subsection  IT. 

PRIMARY  OPERATION  THROUGH  THE  KERVES. 

Subsection  III. 
PRIMARY  LOCAL  OPERATION. 

Subsection  IV. 

MODES    OF    PRIMARY    OPERATION. 

1.  Mechanical  or  Physical.  —  2.  Chemical. — 3.  Physiological,  Vital,  or  Dynamic. 

Section  II. 

SECONDARY   OPERATION   OP   MEDICINES. 

1.  By  Depression  after  Excitement.  —  2.  By  Reaction  following  Depression.  —  3. 
Through  Dependence  of  Function.  —  4.  Through  Sympathy  or  Nervous 
Transmission.  —  5.  Through  Revulsion  or  Derivation.  —  6.  Through  the 
Repair  of  Injuries.  —  7.  Through  the  Removal  of  the  Cause. 

CHAPTER  II. 

EFFECTS  OF  MEDICINES. 

> 

Section  I. 

ESTIMATION   OP   THEIR  POWERS  OR  EFFECTS. 

1.  Through  their  Sensible  Properties.  —  2.  Through  their  Chemical  Relations. — 
3.  Through  their  Botanical  Affinities.  —  4.  By  Experiments  and  Observations 
on  the  Lower  Animals.  — 5.  By  Observations  of  their  Effects  on  Man. 


Xli  TABLE    OF    CONTENTS. 

Section  II.  • 

WHETHER  THE   EFFECTS   ARE   ORGANIC   OR   FUNCTIONAL. 

Section  III. 

CHARACTERISTIC   EFFECTS   OF   MEDICINES. 

Section  IV. 

INFLUENCES   MODIFYING   THE   EFFECTS   OF    MEDICINES. 

1.  Age.  —  2.  Sex. —  3.  Temperament.  —  4.  Idiosyncrasy.  —  5.  Disease.  —  6.  Cli- 
mate.—7.  Habit.  —  8.  Modes  of  Living.  —  9.  Mental  Action. 

CHAPTER  III. 

APPLICATION  OF  MEDICINES. 
Section  I. 

MODES  OF   THERAPEUTIC   ACTION,  OR  THERAPEUTIC   PROCESSES. 

1.  Depletion. — 2.  Repletion.  —  3.  Dilution  — 4.  Elimination.  —  5.  Stimulation. — 
6.  Sedation  or  Depression. —  7.  Revulsion,  Derivation,  and  Counter-irriia- 
tion.  —  8.  Supersession  or  Substitution.  —  9.  Alteration.  — 10.  Contra-causa- 
tion.  —  11.  Chemical  Influence.  —  12.  Mechanical  Influence. 

Section  II. 

FORMS  IN   WHICH   MEDICINES   ARE    USED. 
Subsection  I. 

SOLID    FORMS. 

1.  Powders.  —  2  Electuaries.  — 3.  Conserves.  —  4.  Pills.  —  5.  Lozenges.  —  6.  Cata- 
plasms.—  7.  Ointments,  Cerates,  and  Plasters.  —  8.  Extracts. 

Subsection  II. 

LIQUID    FORMS. 

1.  Mixtures.  —  2.  Solutions.  —  3.  Waters.  —  4.  Infusions.  —  5.  Decoctions.  —  6. 
Tinctures.  —  7.  Spirits.  —  8.  Wines.  —  9.  Vinegars  —  10.  Syrups.  —  11. 
Honeys.  — 12.  Oxymels.  — 13.  Fluid  Extracts.  — 14.  Glyceratesor  Glyceroles. 
— 16.  Spray. 

Subsection  III. 

IN    THE    AERIFORM    STATE. 

Section  III. 

PARTS  TO  WHICH    MEDICINES   ARE  APPLIED,  AND  MODES  OF   APPLICATION. 

Subsection  I. 

TO    THE    ALIMENTARY    CANAL. 

1.  to  the  Stomach.  —  2.  To  the  Rectum. 

Subsection  II. 

TO  THE  EXTERNAL  SURFACE  OF  THE  BOOT. 

1.  By  Contact  with  the  Sound  Skin. — 2.  By  Friction. — 3.  Endermic  Application. 


TABLE    OF    CONTENTS.  Xlll 


Subsection  III, 

TO    THE    LUNGS. 

1.  By  Inhalation.  — 2.  Use  of  Liquids  in  the  form  of  Spray. 

Subsection  IV. 

TO    THE    SUBCUTANEOUS    ABEOLAE   TISSUE. 

Hypodermic  or  Subcutaneous  Injection. 

Subsection  V. 

TO  VARIOUS  OTHEK  SURFACES. 

1.  The  Eyes. — 2.  Nostrils.  —  3.  Mouth. — 4.  Blood-vessels. 

CHAPTER  IV. 

CLASSIFICATION  OF  MEDICINES. 
1.  Uses  of  Classification.  —  2.  Plan  of  Classification. 


PART  II. 
SPECIAL   THERAPEUTICS   AND   PHARMACOLOGY. 

Division  I. 

SYSTEMIC  REMEDIES. 

Subdivision  L 

GENERAL  REMEDIES. 

CHAPTER  L 

GENERAL  STIMULANTS. 
Section  I. 

PERMANENT   STIMULANTS. 

CLASS  I. 
Astringents. 

I.  General  Observations,  including  the  consideration  of  Cold  as  an  Astringent. 
II.  VEGETABLE  ASTRINGENTS.  —  Galls  with  Tannic  and  Gallic  Acids;  Oak  Barks; 

Kino;  Catechu  with  Gambir;  Rhatany  ;  Logwood;   Cranesbill;  Blackberry  and 

Dewberry  Roots;  UvaUrsi;  Pipsissewa;  Red  Roses;   Tormentil;  Water  Avens; 

Hardhack;  Pomegranate  Rind;  Bistort;  Alum  Root;  Marsh  Rosemary;   and 

Persimmon. 
III.  MINERAL  ASTRINGENTS.  —  Alum;  Lead  and  its  Preparations  ;  Sulphates  of  Iron, 

Zinc,  and  Copper,  and  other  salts  of  the  same  metals ;  and  various  other 

mineral  substances,  as  Nitrate  of  Silver,  Corrosive  Sublimate,  Sulphuric  Acid, 

and  Lime  with  its  Carbonate. 


xiv  TABLE    OF    CONTEXTS. 

CLASS  II. 
Tonics. 

I.  General  Observations,  including  the  consideration  of  Diet,  Exercise,  Pure  Air, 
Mental  Influence,  Travelling,  Cold,  and  Transfusion  of  Blood,  as  tonic  agencies. 
II.  TONICS  OF  ANIMAL  ORIGIN,  of  which  only  Cod-liver  Oil  is  considered. 

III.  VEGETABLE  TONICS,  subdivided  into,  1.  Pure  or  Simple  Bitters,  comprising  Quas- 

sia, Simaruba,  Gentian,  Star-grass  or  Aletris,  Chiretta,  American  and  European 
Centaury,  American  Columbo,  Columbo,  Goldthread,  and  Yellow  Root;  2.  Pecu- 
liar Sitters,  comprising  Peruvian  Bark  with  Qiiinia  and  its  other  preparations, 
Nectandra,  Dogwood,  Willow  Bark,  Hydrastis,  Barberry,  Hops,  Wild  Cherry  Bark, 
Chamomile,  German  Chamomile  or  Matricaria,  Eupatorium,  Serpentaria,  Arnica, 
Myrrh,  Angustura  Bark,  Cascarilla,  Contrayerva,  Wormwood,  Tansy,  Horehound, 
Catnep,  and  Yarrow;  and  3,  Aromatics,  comprising  Orange-peel,  Lemon-peel, 
Bergamot  Oil,  Cinnamon,  Canella,  Winter's  Bark,  Cloves,  Xutmeg,  Black  Pepper, 
Cubebs,  Matico,  Pimento,  Cardamom,  Fennel-teed,  Caraway,  Coriander,  Anise,  Star 
Aniseed,  Dill,  Lavender,  Rosemary,  Peppermint,  Spearmint,  European  and  Amer- 
ican Pennyroyal,  Horsemint,  Marjoram,  Thyme,  Sage,  Balm,  Partridge  Berry,  Gin- 
ger, Zedoary,  Turmeric,  Calamus,  Wild  Ginger,  and  Vanilla. 

IV.  MINERAL  TONICS,  subdivided  into,  1.  those  acting  specially  on  the  Stomach  and 

Bowels,  to  which  belong  the  Mineral  Acids,  comprising  the  Sulphuric,  JTitric, 
Muriatic,  Nitromuriatic,  Phosphoric,  and  Carbonic  Acids;  2.  those  operating  on 
the  System  generally  through  its  Vital  Properties,  comprising  the  Preparations  of 
Silver,  Copper,  Zinc,  and  Bismuth;  and  3.  the  Reconstructive  Tonics,  to  which 
belong  Iron  and  its  Preparations. 

Section  If. 

DIFFUSIBLE   STIMULANTS. 

1.  General  Observations.  —  2.  Division  of  these  Stimulants  into  the  Arterial,  Nerv- 
ous, Cerebral,  and  Spinal.  —  3.  Consideration  of  Heat  and  Electricity  as  Dif- 
fusible Stimulants. 

CLASS  I. 

Arterial  Stimulants. 

I.  Cayenne  Pepper. — 2.   Oil  of  Turpentine.  —  8.   Carbonate  of  Ammonia  with   the 

Water,  Spirit,  and  Aromatic  Spirit  of  Ammonia.  — 4.  Phosphorus. 

CLASS  II. 

Nervous  Stimulants. 

I.  General  Observations,  with  the  consideration  of  Emotional  and  Sensational  Influ- 
ences, including  those  of  Cold  and  Electricity  as  Nervous  Stimulants. 

II.  Medicinal  Nervous  Stimulants  —  Musk,  Castor,  Assafetida,  Sagapenum,  Galbanum, 

Ammoniac,  Valerian,  Valerianate  of  Ammonia,  Garlic,  Coffee,  Tea,  Rectified  Oil 
of  Amber,  Draconlium,  Cypripedium,  Saffron,  Cochineal,  and  Coca. 


CLASS  III. 
Cerebral  Stimulants. 


I.  General  Observations. 


TABLE    OF   CONTENTS.  XV 

II.  Individual  Cerebral  Stimulants — Alcohol  and  its  Preparations;  Ether;  Nitrous 
Oxide;  Camphor;  Opium  and  its  Preparations,  including  Morphia,  Codeia,  and 
Narcotina;  Hemp  of  India;  Hyoscyamus;  Belladonna  with  Atropia,  and  Stra- 
monium. 

CLASS  IV. 
Spinal  Stimulants. 
Nux  Vomica  and  Be  an  of  St.  Ignatius,  with  Strychnia  and  Brucia. 

CHAPTEE  II. 

GENERAL  SEDATIVES. 

General  Observations,  with  the  consideration  of  Cold,  Water,  and  Depletion,  direct 
and  indirect,  as  sedative  agents.  - 

CLASS  I. 
Arterial  Sedatives,  or  Eefrigerants. 

1.  Preparations  of  Antimony,  including  Tartar  Emetic,  Oxysulphuret  of  Antimony, 
Oxide  of  Antimony,  and  Antimoniated  Hydrogen.  —  2.  Refrigerant  Salts,  with  a 
particular  account  of  Nitrate  of  Potassa. — 3.  Vegetable  Acids,  comprising  the 
Citric,  Acetic,  and  Tartaric  Acids. 

CLASS  II. 
Nervous  Sedatives. 

1.  Digitalis  with  digitalin.  —  2.  Tobacco. — 3.  Lobelia. — 4.  Aconite  with  Aconitia. — 
5.  American  Hellebore.  — 6.  Veratria,  with  White  Hellebore  and  Cevadilln.  —  7. 
Black  Snakeroot  or  Cimicifuga. — 8.  Gelsemium. 

CLASS  III. 
Cerebral  Sedatives. 

I.  General  Observations,  with  the  consideration  of  Mental  Influence,  including  Arti- 

ficial Somnambulism,  as  a  Cerebral  Sedative. 

II.  Medicinal  Cerebral  Sedatives — 1.  Hydrocyanic  Acid,  with  Bitter  Almonds,  Cherry 

Laurel  Leaves,  and  Cyanide  of  Potassium;  2.  Chloroform;  3.  Conium  or  Hem- 
lock; and  4.  Lactucarium. 

CLASS  IV. 

Spinal  Sedatives. 
Calabar  Bean. 

CHAPTER  III. 

ALTERATIVES. 
I.  General  Observations. 

II.  Mercury  and  its  Preparations. 

III.  Preparations  of  Arsenic. 
IV.  Iodine  and  its  Preparations. 

V.  Chlorine  and  its  Preparations,  comprising  Gaseous  Chlorine,  Chlorine  Water, 
Chlorinated  Lime,  Solution  of  Chlorinated  Soda,  Solution  of  Chloride  'of  Cal- 
cium, Solution  of  Chloride  of  Barium,  Chloride  of  Sodium  or  Common  Salt,  Mu- 
riate of  Ammonia,  and  Chlorate  of  Potas&a. 


XVI  TABLE    OF    CONTENTS. 

VI.  Bromine  and  its  Preparation!,  including  Bromide  of  Potassium  and  Bromide  of 

Ammonium, 

VII.  Sulphur  and  its  Preparations — Washed  Sulphur  and  Precipitated  Sulphur,  Sul- 
phurous Acid,  Hydrosulphuric  Acid,  and  Sulphuret  of  Potassium. 
VIII.  VEGETABLE  ALTERATIVES —  Colchicum,  Sarsaparilla,  Guaiacum,  Mezereon,  Sassa- 
fras, Bittersweet  or  Dulcamara,  Stillingia,  False  Sarsaparilla,  and  Hemidesmus. 

Subdivision  II. 

LOCAL  REMEDIES. 

CHAPTER  I. 

LOCAL  REMEDIES  AFFECTING  THE  FUNCTIONS. 

CLASS  I. 
Emetics. 

I.  General  Observations  on  Emetics,  and  Auxiliary  Emetic  Measures. 
II.  VEGETABLE  EMETICS  —  Ipecacuanha,  Gillenia,  Bloodroot,  Euphorbia  Ipecacuanha 

and  Corollata,  Lobelia,  Mustard,  Squill,  and  Tobacco. 

III.  MINERAL  EMETICS  —  Tartar  Emetic,  Sulphate  of  Zinc,  Sulphate  of  Copper,  and 
Turpeth  Mineral. 

CLASS  II. 
.  Cathartics. 

I.  General  Observations,  with  the  division  into  Laxatives,  Purges,  and  Drastic 

Purges. 

II.  LAXATIVES,  subdivided  into,  1.  those  which  operate  physically,  as  White  Mus- 
tard Seed,  Wheat  Bran,  and  Metallic  Mercury;  and  2.  those  operating  dynami- 
cally, as  Sugar,  Saccharine  and  Acidulous  Fruits,  Manna,  and  Cassia  Fistula, 
among  vegetable  substances,  and  Sulphur,  Carbonate  of  Magnesia,  and  Mag- 
nesia among  the  mineral. 

III.  PURGES,  subdivided  into,  1.  the  Vegetable,  which  comprise  Castor  Oil,  Rhubarb, 

Butternut,  Aloes,  Senna,  American  Senna,  Jalap,  and  May-apple  or  Podophyl- 
lum;  2.  the  Saline,  to  which  belong,  Sulphate  of  Magnesia,  Sulphate  of  Soda, 
Sulphate  of  Potassa,  Bitar Irate  of  Potassa,  Tartrate  of  Potassa  and  Soda,  Tar- 
trait  of  Potassa,  Phosphate  of  Soda,  and  Citrate  of  Magnesia ;  and  3.  the  Mer- 
curial, of  which  Calomel  or  the  Mild  Chloride  of  Mercury  is  the  only  one  con- 
sidered. 

IV.  DRASTICS  or  DRASTIC  PURGES  —  Scammony,  Colocynth,  Black  Hellebore,  Gamboge, 

Elaterium,  and  Croton  Oil. 
V.  Cathartic  Enemata. 

CLASS  III. 
Diuretics. 

I.  General  Observations,  with  the  consideration  of  various  diuretic  agencies,  as 
Gold,  Vascular  Fulness,  Arterial  Stimulation,  and  Menial  Emotion. 

II.  Individual   NON-STIMULATING  VEGETABLE   DIURETICS — comprising   Digitali^, 
Squill,  Broom,  Juniper,  Parsley  Root,  Dandelion,  Fleabane,  Carrot  Seed,  etc. 


TABLE    OF    CONTENTS.  XV11 

III.  REFRIGERANT  DIURETICS  —  Bitartrate  of  Potassa  or  Cream  of  Tartar,  Nitrate  of 

Potassa  or  Nitre,  Acetate  of  Potassa,  and  the  Carbonates  and  Bicarbonates  of 
Potassa  and  Soda,  to  which  may  be  added  Spirit  of  Nitric  Ether  or  Sweet  Spirit 
of  Nitre. 

IV.  STIMULATING  DIURETICS  —  Turpentine  with  its  volatile  oil,  Tar,  Creasoie,  Copaiba, 

Buchu,  Pareira  Brava,  Cantharides,  Horse-radish,  Mustard,  and  Garlic. 

CLASS  IV. 
Diaphoretics  or  Sudorifics. 

I.  General  Observations,  with  the  consideration  of  Heat  and  Water  as  diaphoretic 
agents. 

II.  NAUSEATING  DIAPHORETICS — Tartar  Emetic,  Ipecacuanha,  the  Powder  of  Ipeca- 
cuanha and  Opium  or  Dover's  Powder,  etc. 

III.  REFRIGERANT  DIAPHORETICS  —  Citrate  of  Potassa  in  the  forms  of  Neutral  Mixture 

and  Effervescing  Draught,  Solution  of  Acetate  of  Ammonia,  Nitrate  of  Potassa, 
and  Spirit  of  Nitrous  Ether  or  Sweet  Spirit  of  Nitre. 

IV.  STIMULANT  DIAPHORETICS  —  Sarsaparilla,  Guaiacum,  Mezereon,  Sassafras,  Prickly 

Ash,  and  Serpentaria,  with  Asclepias  or  Pleurisy  Root,  though  not  stimulating. 

CLASS  V. 
Expectorants. 

I.  General  Observations. 

II.  NAUSEATING  or  DEPRESSING  EXPECTORANTS — Ipecacuanha,  Tartar  Emetic,  and 

other  nauseating  Emetics. 

III.  STIMULANT  EXPECTORANTS  —  Squill,  Seneka,  Ammoniac,  Assafetida,  Garlic,  Bal- 
sam of  Tolu,  Balsam  of  Peru,  Benzoin  with  Benzoic  Acid,  Storax,  Copaiba,  the 
Turpentines,  Tar,  Creasote,  and  Resin. 

CLASS  VI. 

Cholagogues. 

General  Observations,  and  reference  to  the  particular  articles  of  the  Class,  described 
under  other  heads. 

CLASS  VII. 

Emmenagogues. 
I.  General  Observations. 
II.  TONIC  EMMENAGOGUES — Iron,  Myrrh,  and  Tansy. 

III.  PURGATIVE  EMMENAGOGUES  — Aloes  and  Black  Hellebore. 

IV.  STIMULANT  DIURETICS  WITH  EMMENAGOGUE  PROPERTIES  —  Cantharides. 
V.  SPECIAL  EMMENAGOGUES — Savine,  Rue,  Seneka,  Guaiac,  etc. 

CLASS  VIII. 
Uterine  Motor- Stimulants. 
I.  General  Observations. 

II.  Individual  members  of  the  Class — Ergot,  and,  with  less  certainty,  Extract  of 

Hemp,  Tansy,  Root  of  the  Cotton  Plant,  etc. 

CLASS  IX. 

Sialagogues. 

al  Observations,  and  reference  to  special  articles  described  elsewhere,  besides 
Pellitory  particularly  described. 


Xviii  TABLE    OF    CONTENTS. 

CLASS  X. 

Errhines. 

I.  General  Observations. 

II.  Particular  Errhines — Aromatic  Powders,  Tobacco,  Atarabacca,  White  Hellebore, 
Euphorbium,  and  Turpeth  Mineral. 

CHAPTER  II. 

LOCAL  REMEDIES  AFFECTING  THE  ORGANIZATION. 

CLASS  I. 
Epispastics. 

I.  General  Observations  on  Blisters,  and  reference  to  Heat  as  a  vesicating  agent. 
II.  Particular  Epispastics — Cantharides,  and  Stronger  Water  of  Ammonia. 

CLASS  II. 

Rubefacients. 

I.  General  Observations,  and  consideration  of  Heat,  Friction,  Acupuncture,  and 

Electricity,  as  rubefacients. 

II.  SIMPLE  INFLAMMATORY  RruEFACiEXTS  — Mustard,   Cayenne  Pepper,  Oil  of  Tur- 
pentine, Burgundy  Pitch,  Canada  Pitch,  Tar,  Creosote,  Resin,  various  Aromatics 
and  Gum-resins,  Acrid  Substances,  Ranunculi,  Common  Nettle,  and  Preparations 
of  Ammonia. 
III.  PUSTULATING  RUBEFACIENTS  — Tartar  Emetic  and  Croton  Oil. 

CLASS  III. 
Escharotics. 

I.  General  Observations,  with  the  consideration  of  Heat  as  an  Escharotic,  and 

specially  of  the  Actual  Cautery,  Moxa,  and  Galvanic  Cauterization. 
II.  Particular  Escharotics — Potassa,  Potassa  with  Lime,  Nitrate  of  Silver,  Sulphate 
of  Copper,  Arsenious  Acid,  Chloride  of  Zinc,  Sulphate  of  Zinc,  Corrosive  Subli- 
mate, Solution  of  Nitrate  of  Mercury,  Sulphate  and  Iodide  of  Cadmium,  Dried 
Alum,  and  Sulphuric,  Nitric,  Muriatic,  and  Chromic  Acids. 

CHAPTER  III. 

LOCAL  REMEDIES  ACTING  MECHANICALLY. 

CLASS  I. 

Diluents. 

* 

General  Observations,  with  reference  to  Water  as  the  only  true  Diluent. 

CLASS  II. 
Demulcents. 

I.  General  Observations,  and  division  into  the  Mucilaginous,  Saccharine, 
Amylaceous  Demulcents. 


TABLE    OP   CONTENTS.  XIX 

II.  MUCILAGINOUS  DEMULCENTS  —  Gum  Arabic,  Gum  Mesquite,  Tragacanth,  Flaxseed, 

Quince  Seed,  Slippery  Elm  Bark,  Sassafras  Pith,  Benne  Leaves,  and  Marsh- 
mallow. 

III.  SACCHARINE  DEMULCENTS  —  Sugar,  Molasses,  Liquorice  and  Liquorice  Root,  and 

Glycerin. 

IV.  AMYLACEOUS  DEMULCENTS  —  Wheat  Starch,  Arrow-root  or  Maranta,  Sago,  Tapioca, 

Pearl  Barley,  Iceland  Moss,  Irish  Moss  or  Carrageen,  Sweet  Almonds,  and  Wheat 
Bran. 

CLASS  III. 

Emollients. 

I.  General  Observations,  and  reference  to  Water  as  the  main  emollient  agent. 
II.  Particular   Emollients — Bread  and  Milk,  Flaxseed  Meal,  Slippery  Elm  Bark, 
Marshmallow  Root,  Oatmeal,  Indian  Meal,  Boiled  Potatoes,  Carrots,  etc. 

CLASS  IV. 
Protectives. 

I.  General  Observations,  and  division  of  the  Protectives  into  the  Direct  and  In- 
direct. 

II.  DIRECT  PROTECTIVES  —  Olive  and  Almond  Oil,  Lard,  Suet,  Spermaceti,  Wax,  Lead 
Plaster,  Resin  Plaster,  Soap  Plaster,  Collodion,  Caoutchouc,  and  Gutta  Percha. 

III.  INDIRECT  PROTECTIVES  —  Nitrate  of  Silver,  Iodine,  and  Creasote. 


Division  II. 

NON-SYSTEMIC  REMEDIES. 

CLASS  I. 
Antacids. 

I.  General  Observations  on  the  Antacids,  and  consideration  of  the  dynamic  effects 

of  the  Alkalies. 

II.  Particular  Antacids  —  Solution  of  Potassa;  Carbonate  and  Bicarbonate  of  Potassa; 
Carbonate  and  Bicarbonate  of  Soda;  Borax;  Lithia  with  its  Carbonate  and  Ci- 
trate; Water,  Spirit,  Aromatic  Spirit,  and  Carbonate  of  Ammonia;  Lime-water; 
Precipitated  Carbonate  of  Lime ;  Prepared  Chalk  and  Prepared  Oyster-shell ;  and 
Magnesia  with  its  Carbonate  and  Bicarbonate. 

CLASS  II. 

Absorbents. 
I.  General  Observations. 

II.  Particular  Absorbents  —  Charcoal  and  Animal  Charcoal. 

CLASS  III. 

Solvents. 
I.  General  Observations. 

^L  Particular  Solvents  —  Gastric  Juice,  Rennet,  Pepsin,  Lactic  Acid,  and  Yeast. 


XX  TABLE    OF   CONTENTS. 

CLASS  IV. 

Disinfectants. 
I.  General  Observations. 

(II.  Agents  Operating  Mechanically  —  Cleanliness,  Ventilation,  Charcoal,  Lime. 
III.  Agents  Operating  Chemically  —  1.  Oxidizing  Disinfectants,  comprising  Ozone, 
Chlorine,  Bromine,  Iodine,  Permanganate  of  Polassa,  Peroxide  of  Hydrogen,  and 
Mineral  Acids  with  their  Metallic  Salts;  2.  Deoxidizing  Disinfectants,  com- 
prising Sulphurous  Acid  and  the  Sulphites,  Nitric  Oxide,  Sulphate  of  Protoxide 
of  Iron,  and  Ammonia;  3.  Neutralizing  Disinfectants,  including  Carbolic 
Acid  with  analogous  substances,  Chloride  of  Zinc,  and  Chloride  of  Iron. 

CLASS  V. 
Parasiticides. 
General  Observations,  and  Division  into  two  SUB-CLASSES,  viz.; 

SUB-CLASS  I. 

Anthelmintics. 

1.  General  Observations. 

2.  Particular  Anthelmintics  —  Pinkroot  or  Spigelia,  Wormseed,  Azedarach,  European 

Wormseed  with   Santonin,  Cowhage,  Male  Fern,  Pomegranate  Root,  Oil  of  Tur- 
pentine, Koosso,  Pumpkin  Seed,  Calomel,  Kameela,  etc. 

SUB-CLASS  II. 

Antizymotics. 

1.  General  Observations. 

2.  Particular  Antizymotics  —  Sulphur,  Sulphurous  Acid,  the  Sulphites  and  Hyposul- 

phites, Carbolic  and  Cresylic  Acids  and  Creasote,  Tar  with  Impure  Pyroligneous 
Acid,  Smoke,  Petroleum,  and  Saccharine  Solutions. 


A  TREATISE 


THERAPEUTICS 


PHARMACOLOGY. 


INTRODUCTORY    OBSERVATIONS. 

PHARMACOLOGY,  or  the  science  of  MATERIA  MEDICA,  treats  of  medi- 
cines in  all  their  relations;  THERAPEUTICS,  of  remedies  in  general,  and 
their  application  to  the'  cure  and  alleviation  of  disease. 

Medicines  are  substances  capable  of  producing,  as  an  ordinary  result, 
and  by  their  own  inherent  power,  changes  in  the  healthy  vital  functions, 
which  render  them  available  for  curative  purposes.  All  these  conditions 
are  essential.  Medicines  are  substances,  or,  in  other  words,  are  material. 
Influences  not  material,  though  efficient  in  the  cure  of  disease,  are  not 
medicines.  Substances  necessary  for  the  support  of  life,  such  as  food, 
drink,  atmospheric  air,  solar  heat  and  light,  are  capable,  if  unduly  ap- 
plied, of  deranging  the  vital  functions :  but  this  is  not  their  ordinary 
operation  ;  and  they  do  not,  therefore,  belong  to  the  category  now  under 
consideration.  Again,  bodies  which  have  no  inherent  power  of  disturb- 
ing the  functions  may  be  rendered  noxious,  or  remedial,  by  some  extra- 
neous agency.  Thus,  the  dagger  which  destroys  life  in  the  hands  of  the 
in,  and  the  knife  which  saves  it  in  the  hands  of  the  surgeon,  are 
incapable  alike  of  injurious  or  beneficial  action,  when  merely  placed  in 
contact  with  the  body  without  any  foreign  impulse.  Such  bodies  are 
evidently  not  entitled  to  the  rank  of  medicines.  There  are,  moreover, 
many  substance*  which  have  the  inherent  power  of  even  violently  dis- 
turbing the  system  when  brought  into  connection  with  it,  which,  how- 
ever, have  not  been  proved  to  possess  remedial  properties,  and  are  never 
employed  in  the  treatment  of  disease.  These  may  be  poisons,  but  they 
are  not  medicines.  It  is  thus  seen  that  all  the  conditions  stated  in  the 
definition  are  essential.  There  arc,  indeed,  a  few  substances,  usually 
denominated  medicines,  which  do  not  strictly  fulfil  these  conditions. 
Such  are  anthelmintics,  which  are  not  used  to  modify  the  functions  of 
VOL.  i. — 1 


•J  INTRODUCTORY    OBSERVATIONS. 

the  human  system,  but  to  act  on  certain  foreign  bodies  which  happen  to 
be  contained  within  it.  Such,  too,  are  the  antacids  given  to  neutralize 
acid  in  the  stomach  and  bowels.  But  it  happens  that  most  of  these 
substances  really  have  medicinal  properties,  which  render  them  useful 
for  other  purposes  ;  and,  so  far  as  they  are  employed  merely  as  anthel- 
mintics  or  antacids,  they  may  be  regarded  not  as  medicines,  but  as  sim- 
ply ranking  in  the  more  general  category  of  remedies. 

Remedies  are  agents,  or  influences  of  any  kind  whatever,  capable  of 
being  usefully  employed  in  the  treatment  of  disease.  Of  course  all  medi- 
i-ines  may  be  remedies ;  but  there  are  very  many  remedies  which  are 
not  medicines.  To  constitute  any  agent  a  remedy,  it  is  not  even  n< •• 
.-ary  that  it  should  be  material.  It  may  be  a  process  or  action  whether 
mental  or  physical,  a  state  or  condition,  a  change  of  circumstance,  even 
a  negative  quality,  or  the  absence  or  diminution  of  some  positive  agency. 
Thus,  we  may  class  with  remedies  not  only  medicines,  and  the  various 
substances,  which,  though  not  strictly  medicinal,  are  yet  employed  ther- 
apeutically,  as  water,  heat,  electricity,  etc.,  but  also  such  influenct •- 
blood-letting,  abstinence,  exercise,  rest,  position,  change  of  residence,  cold, 
darkness,  mental  emotion,  and  many  others  that  might  be  mentioned. 

Pharmacology,  which  as  before  stated  treats  of  medicines  in  all  their 
relations,  including  of  course  their  application  to  the  cure  of  disease,  has 
nothing  to  do  with  remedies  not  medicinal ;  whereas  Therapeutics,  which 
treats  of  all  remedies  in  their  remedial  capacity,  leaves  out  of  view  the 
properties  of  medicines  not  essentially  belonging  to  them  as  such ;  their 
natural  and  commercial  history,  for  example,  their  sensible  and  chemical 
properties,  and  their  various  modes  of  officinal  preparation.  There  is  an 
advantage,  therefore,  in  combining  the  two  sciences  in  one  treatise;  as 
.•arh  supplies  the  deficiencies  of  the  other,  and  both  combined  convev 
all  desirable  information  in  relation  to  the  origin,  qualities,  and  uses  of 
remedies. 

In  the  present  treatise,  however,  though  some  notice  will  be  taken  of 
those  branches  of  the  subject  peculiar  to  Pharmacology,  yet,  as  the 
l'nitcd  States.  Dispensatory,  in  the  preparation  of  which  the  author  par- 
ticipated, is  especially  devoted  to  that  science,  and  treats  in  sufficient 
detail  of  almost  everything  exclusively  belonging  to  it,  he  proposes  to 
devote  a  more  particular  attention  to  therapeutics,  which  is  but  partially 
treated  of  in  the  Dispensatory,  and  in  many  important  points  has  been 
quite  overlooked.  Indeed,  the  work  which  he  now  submits  to  the  medi- 
cal public,  may  be  looked  on  as,  in  some  measure,  supplementary  to  the 
IT.  S.  Dispensatory,  affording  by  its  arrangement  a  convenient  plan  for 
the  perusal  and  study  of  that  work,  supplying  its  therapeutical  defi- 
eiencies,  and  noticing  those  relations  and  properties  of  medicines  having 
no  immediate  connection  with  therapeutics,  only  so  far  as  may  be  essen- 
tial to  the  practical  physician  ;  reference  being  made  to  the  Dispensatory 


INTRODUCTORY    OBSERVATIONS.  3 

for  information  of  general  or  pharmaceutical  interest,  and  for  minute 
detail  on  all  exclusively  pharmacological  points. 

The  work  will  consist  of  two  parts.  As  there  are  many  subjects,  both 
in  Therapeutics  and  Pharmacology,  which  are  of  a  general  nature,  and 
cannot  without  inconvenience  of  arrangement,  or  the  necessity  for  con- 
stant repetition,  be  considered  in  connection  with  special  remedies,  or 
even  classes  of  remedies,  it  is  proposed  to  treat  of  these  preliminarily 
under  the  heading  of  General  Therapeutics  and  Pharmacology,  which 
will,  therefore,  constitute  the  first  part  of  the  work.  The  second  part, 
much  more  extensive  than  the  first,  and  forming,  indeed,  the  main  body 
of  the  treatise,  will  be  devoted  to  the  subordinate  divisions  and  special- 
ties of  the  two  sciences,  under  the  name  of  Special  Therapeutics  and 
Pharmacology. 


PART  I. 

GENERAL  THERAPEUTICS  AND 
PHARMACOLOGY. 


CHAPTER   I. 
Operation  of  Medicines. 

THE  operation  of  medicines  is  either  primary  or  secondary ;  the 
primary  operation  being  that  which  results  from  their  immediate  in- 
fluence on  the  system ;  the  secondary,  that  which  follows  their  original 
and  characteristic  impression,  in  consequence  of  certain  physiological 
laws.  Thus,  purgation  is  the  primary  operation  of  a  cathartic ;  deriva- 
tion of  blood  from  the  head,  with  the  attendant  relief  of  any  existing 
cerebral  congestion,  is  a  secondary  operation,  and  a  simple  consequence 
of  the  first,  just  as  the  same  result  would  follow  an  equal  amount  of 
intestinal  irritation  with  diarrhoea  from  other  causes. 


SECTION   I. 
Primary  Operation  of  Medicines. 

One  of  three  events  must  occur  when  a  medicine  is  applied  with  effect 
to  any  part  of  the  body.  Either  it  must  enter  the  circulation,  and  be 
carried  with  the  blood  throughout  the  system,  acting  upon  such  parts  as 
may  be  susceptible  to  its  influence ;  or  the  local  impression,  first  pro- 
duced by  it,  must  be  conveyed  through  nervous  communication  to  the 
parts,  more  or  less  distant,  in  which  its  effects  are  to  be  displayed ;  or, 
finally,  it  must  act  exclusively  in  the  vicinity  of  its  application.  Each 
of  these  modes  of  operation  requires  to  be  considered. 

(5) 


6  OPERATION    OF    MEDICINES.  [PART  I. 

SUBSECTION  I. 
Primary  Operation  through  the  Circulation. — Absorption. 

It  was  at  one  time  thought  by  many  that  medicines  never  entered 
the  circulation.  The  absorbents  were  supposed  to  afford  the  only 
avenue  of  foreign  bodies  into  the  system.  Substances  incapable  of 
being  assimilated  to  the  blood,  were  believed  to  penetrate  no  further 
than  the  absorbent  glands,  which  were  so  many  sentinels  placed  to 
guard  the  system  against  the  intrusion  of  noxious  agents.  This  notion 
was  purely  theoretical ;  and,  even  at  the  time  when  it  was  most  strenu- 
ously maintained,  was  opposed  by  known  facts  which  prevented  bs 
universal  adoption.  Subsequent  experiments  and  observations,  ex- 
tremely numerous,  and  diversified  in  almost  every  conceivable  manner, 
have  established  the  conclusion,  beyond  all  possible  doubt  or  cavil,  thai 
medicines  are  very  frequently  absorbed,  and,  entering  the  blood-vessels, 
are  circulated  with  the  blood  throughout  the  body.  The  following  proofs 
of  this  truth  may  be  adduced. 

1.  When  medicines  are  applied  directly  to  any  surface  of  the  body, 
and   produce   their  characteristic   effects   elsewhere,  it  may  often   be 
noticed  that  portions  of  them  have  disappeared,  without  any  possibility 
of  accounting  for  their  disappearance  except  by  their  absorption,  or  at 
least  their  entrance  into  the  system. 

2.  The  sensible  properties  of  the  medicine,  its  odour,  taste,  and  colour, 
are  frequently  perceptible,  either  unchanged,  or  somewhat  modified,  in 
the  breath,  the  secretions,  and  even  in  the  various  solid  tissues.     The 
effect  of  garlic  in  diffusing  its  odour  and  taste  is  universally  known ; 
rhubarb  gives  to  the  urine  the  property  of  staining  linen  yellow ;  and 
madder  not  unfrequently  imparts  its  red  colour  to  the  bones. 

3.  The  peculiar  medicinal  or  poisonous  effects  of  certain  substances 
are  occasionally  produced,  by  taking  into  the  stomach  the  liquid  secre- 
tions of  individuals  under  the  influence  of  these  substances.    Thus,  medi- 
cines given  to  the  mother  not  unfrequently  operate  on  tin-  suckling;  and 
numerous  other  illustrations  of  a  similar  kind  might  be  adduced. 

4.  Effects,  produced  by  medicines  in  distant  parts,  may  be  prevented 
by  ligatures  around  the  blood-vessels  proceeding  from  the  part  with 
which  the  medicine  is  brought  into  immediate  contact, 

5.  In  many  instances,  the  characteristic  effects  of  medicines,  exhibited 
in  the  ordinary  way,  may  be  obtained  by  injecting  them  into  the  bloud- 

"1s. 

»;.  But  the  most  irresistible  evidence  is  that  afforded  by  chemical  in- 
vestigation, which  has  in  almost  innumerable  instances  detected  medi- 
cinal substances  taken  into  the  stomach,  or  applied  to  other  parts  of  tin- 
body,  not  only  in  the  perspiration,  saliva,  urine,  and  other  secretions, 


CHAP.  I.]  PRIMARY    OPERATION    OF    MEDICINES.  7 

and  in  various  solid  tissues,  but  in  the  blood  itself.  Indeed,  the  list  of 
substances,  which  have  thus  been  proved  to  have  been  circulated  through 
the  system,  is  so  large  as  to  authorize  the  inference,  that  all  medicines, 
capable  of  extending  a  direct  action  beyond  the  original  surface  of  con- 
tact, may  be  absorbed,  and  carried  with  the  blood  to  the  part  or  organ 
which  they  affect. 

It  1ms  been  said  that  the  effects  of  some  medicines  and  poisons  are  so 
rapid,  as  to  preclude  the  idea  that  they  could  have  been  absorbed,  and 
conveyed  to  the  seat  of  their  action  by  the  ordinary  route  of  the  circu- 
lation. But  comparatively  recent  experiments,  by  proving  the  extreme 
rapidity  with  which  the  blood  makes  a  complete  circuit  in  the  body, 
have  invalidated  that  objection.  Professor  Bering,  of  Stuttgard,  found 
that  ferrocyanide  of  potassium,  injected  into  the  jugular  vein  of  a  horse, 
might  be  detected  in  the  opposite  jugular  vein  in  a  period  of  time  vary- 
ing from  twenty  to  thirty  seconds  (Zeitschrift  fur  Physiologic,  iii.  122); 
and  Dr.  James  Blake,  formerly  Professor  of  Anatomy  in  the  Saint  Louis 
University,  has  proved  that  "the  time  required  for  the  blood  to  pass 
from  the  jugular  vein,  and  to  be  circulated  through  the  body,  was,  in  the 
horse  sixteen  seconds,  in  the  dog  twelve  seconds,  in  the  fowl  six  seconds, 
and  in  the  rabbit  four  seconds."  (Am.  Journ.  Med.  Sci.,  N.  S.,  xviii.  100.) 
The  latter  experimenter  also  found  that  the  most  rapidly  fatal  poisons, 
introduced  into  the  veins  of  the  animals  referred  to,  gave  rise  to  no  signs 
of  their  action  within  less  than  the  periods  of  time  mentioned  as  occupied, 
in  the  several  animals,  by  one  round  of  the  circulation.  (Ibid.,  p.  101.) 
Having  introduced  some  hydrocyanic  acid  into  thev  mouth  of  a  rabbit, 
Dr.  Blake  noticed  that  its  first  effects  on  the  system  were  evinced  in  two 
seconds  and  a  half,  and  death  followed  in  five  seconds.  (Ibid.,  p.  106.) 
It  is  scarcely  possible  that  any  medicine  can  act  more  speedily  than  this ; 
and,  considering  that  the  acid  probably  acted  through  the  lungs,  and,  by 
entering  the  pulmonary  veins,  might  reach  the  left  side  of  the  heart  by  a 
route  much  shorter  than  that  of  the  general  circulation,  it  is  not  too  much 
to  infer,  that  the  time  mentioned  was  sufficient  for  it  to  arrive  at  the  brain 
through  the  medium  of  the  blood.  Vierordt,  after  experiments  with  a 
great  number  of  animals  of  different  species,  came  to  the  conclusion,  that 
the  mean  duration  of  a  round  of  the  circulation  in  the  several  mammalia 
is  equal  to  the  average  time  in  which  the  heart  completes  twenty-six  or 
twenty-eight  pulsations.  (B.  &  F.  Medico-chir.  Rev.,  July,  1859,  p.  167.) 
It  may  be  assumed  that  in  man  this  time  does  not  exceed  thirty  seconds. 
From  these  facts  the  inference  may  be  fairly  drawn,  that  no  medicine 
acts  with  such  rapidity  as  to  preclude  the  possibility  of  its  having  reached 
the  part  affected  through  the  circulation ;  and,  the  accuracy  of  the  state- 
ments being  admitted,  the  objection  urged  upon  this  ground  against 
the  universality  of  the  mode  of  operation  through  the  blood  must  be 
abandoned. 


8  OPERATION   OF    MEDICINES.  [PART  I. 

Medicines  are  absorbed  from  mucous  membranes,  the  areolar  tissue, 
the  skin,  the  pulmonary  air-cells,  and  probably  from  any  other  part  of 
the  body  to  which  they  may  be  applied.  The  rapidity  of  their  absorp- 
tion is  proportionate  to  the  thinness  and  delicacy  of  the  tissue  interven- 
ing between  them  and  the  blood-vessels.  Hence,  of  all  the  surfaces  with 
which  they  are  habitually  brought  into  contact,  that  of  the  pulmonary 
air-cells  affords  them  the  most  speedy  entrance  into  the  circulation. 
Every  one  knows  the  great  rapidity  with  which  ether  and  chloroform 
act  when  inhaled.  Next  to  the  air-cells  in  this  respect  are  probably  the 
areolar  tissue  and  the  alimentary  mucous  membrane,  especially  that  of 
the  stomach,  which,  as  a  general  rule,  admits  the  entrance  of  medicines 
more  readily  than  that  of  the  rectum.  Absorption  takes  place  most 
slowly  from  the  skin.  This  might  be  inferred  from  the  firmness  and 
thickness  of  the  epidermis.  It  has  indeed  been  maintained  that  this 
tissue  is  impermeable  by  medicines  in  its  healthy  state.  But  experi- 
ments have  satisfactorily  shown  that  they  do  enter  the  system  through 
the  epidermis;  and  the  constitutional  impression,  sometimes  resulting 
from  the  wearing  of  a  mercurial  plaster,  is  of  itself  a  sufficient  proof. 
There  can  be  no  doubt,  however,  that  the  epidermis  opposes  a  great 
impediment  to  absorption ;  and,  without  such  a  protection,  the  system 
would  be  constantly  exposed  to  the  most  deleterious  influences  from 
without.  The  impediment  may  be  much  diminished  by  softening  the 
tissue  with  water,  or  by  mechanically  deranging  it ;  and  hence  medi- 
cines applied  to  the  surface  by  a  local  or  general  bath,  or  in  the  form  of 
cataplasm,  or  by  means  of  friction,  may  often  be  made  to  act  efficiently 
on  the  system.*  'Deprived  of  its  epidermis,  the  skin  admits  the  en- 
trance of  medicines  with  great  facility,  though,  even  in  this  state,  some- 
what less  readily  than  the  gastric  mucous  membrane,  probably  because 
it  is  less  vascular. 

*  At  the  time  of  the  appearance  of  the  second  edition  of  this  work,  the  result  of 
recent,  experiments  had  not  been  favourable  to  the  opinion,  that  medicines  applied 
to  the  skin  by  means  of  baths,  whether  local  or  general,  can,  to  any  considerable 
extent,  find  an  entrance  into  the  system  through  absorption.  For  a  condensed 
account  of  these  experiments,  the  reader  is  referred  to  (he  British  and  Foreign 
Medico  -chirunjical  Review  fur  January,  1859  (Am.  ed.,  page  108).  Numerous  sub- 
stances, mineral  and  vegetable,  were  employed  in  baths  and  foot-baths;  and  the 
uniform  remit,  when  care  was  taken  to  prevent,  any  possible  absorption  through 
the  liinjrs,  v  a-  that  neither  the  substances  themselves,  nor  any  of  their  const  i  men  is. 
could  be  found  in  the  urine.  The  medicines  thus  experimented  with  were  iodine, 
iodide  of  potassium,  chloride  of  sodium,  ferrocyanide  of  potassium,  sulpliuret  of 
potassium,  acetate  ol  lead,  alum,  borax,  carbonate  of  potassa,  nitric  acid  and  nitre, 
sulphate  of  magnesia,  sulphate  of  quinia,  digitalis,  and  belladonna.  1.5m  I  did  not. 
at  the  time.  eon>ider  I  lie  experimenis  as  conelu--ive  against  the  absorption,  by  means 
'•'baths,  of  many  mil  ried  medicines,  noreMMi,  in  tome  degree,  of  those  tried;  for. 
though  not  detected  in  the  urine,  some  of  them  might  have  been  eliminated  by  other 


CHAP.  I.]  PRIMARY   OPERATION    OF    MEDICINES.  9 

Means  of  Absorption.  The  lymphatics  and  lacteals  were  formerly 
supposed  to  be  the  exclusive  agents  of  absorption.  Magendie  proved 
that  foreign  substances  are  also  received  from  without  directly  into  the 
blood-vessels ;  and  multiplied  experiments  have  since  shown  that  most 
medicines  enter  the  system  in  this  way.  It  is  probable  that  the  capil- 
laries, in  consequence  of  the  extreme  delicacy  of  their  walls,  are  chiefly 
concerned  in  the  process ;  and  that  medicines  enter  them  upon  the  same 
principles  of  endosmose  by  which  liquids  pass  through  dead  membrane 
out  of  the  body.  Attempts  have  even  been  made  to  establish  the  con- 
ditions based  on  the  rules  of  physical  endosmose,  upon  which  medicines 
in  contact  with  the  capillaries  will  either  enter  the  blood-vessels,  or  cause 
the  extravasation  of  the  liquid  contents  of  the  vessels  themselves,  and 
thus  to  explain  the  effects  of  a  medicine,  if  not  indeed  to  deduce  &  priori 
its  probable  operation  from  its  physical  qualities.  But,  admitting  to  a 
certain  extent  this  principle  of  operation  in  medicines,  there  are  so  many 
circumstances,  physical,  chemical,  and  vital,  which  modify  the  result,  that 
no  previous  conclusions  can  be  relied  on ;  and  even  explanations  upon 
this  basis  must  be  received  with  great  caution,  lest  they  lead  into  serious 
error.  It  must  be  remembered  that  the  condition  of  a  living  membrane 
is  very  different  from  that  of  the  same  membrane  out  of  the  body ;  and 
there  can  be  little  doubt  that  the  vital  forces  have  such  a  control  over 
the  tissues,  as  greatly  to  modify  their  endosmotic  relations  to  the  fluids 
on  opposite  sides  of  them.  For  example,  in  a  certain  condition  of  vital 
influence  the  membrane  may  be  contracted  and  firm,  in  another  relaxed 
and  loose;  and  it  is  impossible  to  say  that  some  modifying  power  may 
not  be  exerted  on  the  fluids  themselves,  in  and  around  it,  by  the  life- 
forces,  as  we  know  that  the  electric  forces  modify  chemical  conditions 
out  of  the  body.  In  the  present  state  of  our  knowledge,  therefore,  it  is 
quite  premature  to  attempt  to  explain  the  phenomena  of  medicinal  ab- 
sorption in  every  case,  or  to  anticipate  the  results  in  any  particular  case, 
on  simple  physical  principles. 

emunctories,  or  have  been  retained  in  the  system;  and,  if  not  absorbed  in  the  in- 
stances submitted  to  trial,  they  might  possibly  be  so  in  others.  Certain  substances 
had  by  former  experimenters  been  shown  to  be  absorbed  in  this  way ;  and  it  would 
require  very  numerous  experiments,  with  different  individuals,  and  under  various 
circumstances,  to  determine  positively  that  there  is  nny  soluble  substance  'which  can 
never  enter  the  system,  when  applied  by  means  of  baths  to  the- surface  of  the  body 
in  a  perfectly  sound  state.  Since  that  time,  numerous  experiments,  performed  with 
^:eat  care  to  avoid  all  sources  of  error,  by  Dr.  Willemiu.  of  Vichy,  in  France,  have 
established,  beyond  reasonable  doubt,  the  possibility  of  absorption,  by  means  of 
baths,  through  the  skin,  not  only  of  water,  but  of  various  remedial  substances. 
(Arc/iii'es  Generates,  6e  sor.,  ii.  5,  105, 177,  313.)  Nevertheless,  it  must  be  admitted, 
as  stated  in  the  text,  that  the  epidermis  opposes  a  very  strong  impediment  to  ab- 
sorption; and  tha:  Saths  do  not  offer  a  very  efficient  method  of  medicating  the 
~\  -tern.  (Note  to  the  second  and  third  editions.) 


10  OPERATION    OF    MEDICINES.  [PART  I. 

It  is  highly  probable  that  the  principle  which  governs  the  process  of 
dinlyti*,  discovered  by  Mr.  Graham,  may  have  some  influence  in  the 
absorption  of  medicines.  Crystallizable  substances  may  thus  find  an 
entrance  into  the  capillaries,  while  the  uncrystallizable  are  excluded. 
For  an  explanation  of  this  principle  the  reader  is  referred  to  the  U.  S. 
Dispensatory  (12th  ed.,  p.  896).  The  comparative  facility  with  which 
saline  substances  and  the  active  principles  of  vegetables,  which  an- 
generally  crystallizable,  enter  the  circulation,  may  be  in  some  measure 
thus  explained.* 

After  the  entrance  of  the  medicine  into  the  capillaries,  it  is  carried 
forward  in  the  course  of  the  circulation,  and  sooner  or  later  mingles  with 
the  blood  in  the  heart,  with  which  it  is  transmitted  over  the  whole  sys- 
tem, and  consequently  reaches  the  part  on  which  it  is  destined  to  act. 

But  it  may  be  asked  whether  medicines,  are  not  also  taken  up  by  the 
absorbents,  and  conveyed  by  them  into  the  blood.  It  would  seem  to  be 
the  legitimate  function  of  these  vessels,  to  select  from  the  alimentary 
liquid  in  the  bowels,  and  from  the  disintegrating  tissues  throughout  the 
body,  those  principles  which  may  assimilate  with  the  blood,  and  thus 
contribute  to  the  sustenance  of  that  fluid  in  its  requisite  state  and  quan- 
tity. In  order  that  this  function  may  not  be  interfered  with,  they  have 
the  power  to  reject  in  great  measure  noxious  substances,  and  medicino 
among  others.^  Tiedemann  and  Gmelin  found  that,  of  numerous  colour- 
ing and  odorous  substances  given  to  animals  with  their  food,  a  large  pro- 
portion imparted  their  colour  and  odour  to  the  blood  of  the  pnnul  v.'ins, 
but  not  one  to  the  chyle.  Of  a  number  of  salts  tried  in  the  same  man- 
ner, though  many  could  be  detected  in  the  veins,  a  few  only  had  entered 
the  thoracic  duct.  Drs.  Lawrence  and  Coates,  of  Philadelphia,  in  a 
series  of  carefully  conducted  experiments,  proved  that  ferrocyanide  of 
potassium  was  taken  up  from  the  bowels  both  by  the  radicles  of  the 
vena  portae  and  by  the  lacteals.  (Philad.  Journ.  of  Med.  and  Phy*.  ~- 
v.  327.)  It  has  been  subsequently  shown,  in  repeated  instances,  that 
poisons  introduced  into  the  alimentary  canal,  fail  to  produce  their  effects 
on  the  system  when  the  vena  portse  is  tied.  (Pereira,  Elcm.  of  Mat.  Med., 
3d  ed.,  i.  103.)  From  these  statements  it  is  fairly  inferrible  that,  though 
the  absorbents  are  capable  of  taking  up  a  few  saline  substances,  probably 
not  altogether  incongruous  with  the  blood,  they  are  not  the  ordinary 
agents  by  which  medicines  are  introduced  into  the  circulation. 

Circumstances  affecting  Absorption.  Various  circumstances  more  or 
less  affect  the  facility  or  rapidity  of  absorption.  Reference  has  already 


*  Isomorphism  in  chemical  compounds  has  probably  some  influence  over  the  ab- 
sorption as  well  as  the  assimilation  and  elimination  of  those  substance* ;  those  which 
have  a  similar  constitution  in  this  respect,  obeying  the  same  physiological  laws. 
This  may  be  inferred  from  the  experimeuts  of  .M.  llou-siu  on  fowls,  as  recorded  in 
the  Journal  de.  J'harmacie,  3e  si-r. ,  xliii.  liiG.  (Xote  to  the  third  edition.) 


CHAP.  I.]  PRIMARY   OPERATION    OF   MEDICINES.  11 

been  made  to  the  influence,  in  this  respect,  of  the  nature  of  the  surface 
to  which  the  medicine  is  applied.  The  following  are  other  modifying 
influences. 

1.  In  relation  to  the  blood-vessels,  it  is  highly  probable  that  the  vary- 
ing condition  of  their  coats,  under  varying  nervous  influence,  or  different 
degrees  of  vital  force,  may  considerably  modify  the  process ;  but  too 
little  is  precisely  known  on  this  subject  to  justify  any  definite  statements. 

2.  The  condition  of  the  blood  as  to  density  may  not  be  without  effect, 
upon  the  principles  of  endosmose,  in  favouring  or  opposing  the  entrance 
of  fluids  from  without. 

3.  The  fact  has  been  abundantly  proved,  that  fulness  of  the  blood- 
vessels is  opposed  to  absorption ;  and  hence,  in  a  plethoric  state  of  the 
circulation,  medicines  sometimes  act  with  difficulty,  because  not  readily 
taken  into  the  system.     It  is  well  known  that,  in  a  state  of  high  febrile 
excitement,  the  abstraction  of  blood  very  much  favours  the  action  of  dia- 
phoretics and  diuretics,  probably  in  part,  at  least,  by  removing  an  im- 
pediment to  their  absorption.     Substances,  too,  which  act  powerfully  as 
local  irritants,  by  causing  congestion  of  the  blood-vessels  in  the  part,  im- 
pede their  own  absorption,  and  thus  fail  to  act  on  the  system ;  while,  if 
applied  in  a  dilute  state,  so  as  not  to  irritate,  they  may  find  a  ready 
entrance.    Diminution  of  atmospheric  pressure  upon  the  surface  impedes 
absorption,  by  causing  distension  of  the  vessels.     Consequently  cupping- 
glasses,  placed  over  a  poisoned  wound,  delay  or  diminish  the  action  of 
poison  on  the  system.     Compression,  on  the  contrary,  is  said  to  favour 
the  process.     Whenever  the  blood-vessels  are  relatively  empty,  absorp- 
tion is  promoted.     Hence,  medicines  act  more  powerfully  after  fasting, 
and  in  reduced  states  of  the  system  generally,  than  in  its  ordinary  con- 
dition.* 

4.  Age  and  sex  have  some  influence  on  absorption.     M.  Briquet  has 
found  the  process  more  active  in  the  young  than  in  the  old,  and  in  man 
than  in  woman.      In  the  former  case,  the   greater  activity  might   be 
ascribed  to  greater  rapidity  of  the  circulation ;  but  this  explanation  will 
not  hold  in  the  latter.  (Archives  Generales,  5e  ser.,  x.  611.) 

5.  Fodera   has  proved  that  galvanism  or  electricity  promotes  ab- 
sorption. 


*  Some  experiments  recently  made  by  Kohler,  at  Marburg,  might  seem  to  invali- 
date this  conclusion.  He  found  that,  in  starving  animals,  the  symptoms  of  poison- 
ing from  strychnia,  hydrocyanic  acid,  etc.,  to  whatever  surface  applied,  are  retarded, 
instead  of  being  accelerated.  But  this,  if  true,  may  be  ascribed  to  other  causes 
than  to  diminished  absorption,  as,  for  example,  to  the  slower  circulation  of  the 
blood,  and  possibly  to  modified  susceptibilities  in  this  condition  of  the  system. 
(B.  and  F.  Med.-chirurg.  Rev.,  July,  1859,  Am.  ed.,  p.  168.)  The  nerve-centres,  oc- 
cupied by  the  agonies  of  starvation,  would  probably  resist  much  more  strongly  than 
in  their  normal  state  impressions  from  the  poison,  just  as  violent  neuralgic  pains  im- 
pede the  action  of  anodyne  remedies.  (Note  to  the  second  and  third  editions.) 


12  OPERATION    OF    MEDICINES.  [PART  I. 

6.  The  character  and  state'of  the  medicine  itself  have  also  great  effect. 
Allusion  has  been  already  made  to  the  influence  of  density  in  opposing 
the  absorption  of  medicines.     Volatility  appears  in  general  to  have  an 
opposite  effect;  the  most  volatile  medicines  usually  operating  with  great- 
est rapidity.     Hence  in  part  probably  the  very  speedy  effect  of  ether, 
chloroform,  and  hydrocyanic  acid.     Gases  are  readily  absorbed. 

7.  Greater  or  less  affinity  between  the  medicine  and  the  blood  appears 
also  to  affect  the  facility  of  absorption ;  and  substances  which  unite  with 
that  fluid  with  difficulty,  are  scarcely  admitted  into  the  system.     Castor 
oil  may  be  cited  as  an  example. 

8.  The  fluid  form  is  usually  considered  essential  to  absorption,  and 
consequently  to  medicinal  activity,  so  far  at  least  as  the  general  system 
is  concerned.     It  is  true  that  many  solid  substances,  nearly  or  quite  in- 
soluble  in  water,  are   powerful   medicines.     But   they  must   undergo 
changes  which  bring  them  into  the  liquid  state,  before  they  can  gain 
access  into  the  blood-vessels.     Such  changes  are  often  effected  by  the 
liquids  of  the  alimentary  canal.     Thus,  metals,  in  themselves  insoluble 
and  inert,  often  act  energetically  in  consequence  of  oxidation  and  union 
with  an  acid  in  the  stomach  and  bowels.     But  some  recent  experiments 
would  seem  to  show  that  this  principle  is  less  universal  than  has  been 
imagined.     Rabbits  were  fed  on  finely  powdered  wood  charcoal;  and 
fine  particles  of  this  substance  were  afterwards  found  abundantly  in  the 
blood,  the  liver,  and  the  lungs.     Starch  mixed  with  charcoal  was  given 
to  froirs;  and  the  corpuscles  of  the  former  were  observed  in  the  blood  of 
the  mi'st'iiU'ric  veins,  by  the  aid  of  the  microscope,  having  their  character- 
istic form,  and  exhibiting  their  characteristic  reaction  with  iodine.    Simi- 
lar results,  though  less  decisive,  were  obtained  with  mercury  and  sulphur, 
taken  into  the  stomach,  and  applied  by  friction  to  the  surface  of  dogs  and 
rabbits.*    It  is  conceivable  that  mercury,  being  liquid,  though  insoluble, 
should  be  able  to  penetrate  the  tissues ;  but  it  is  impossible,  with  our 
present  views  of  the  capillaries,  that  solid  visible  particles  should  enter 
them  without  some  solution  of  continuity  in  their  coats.     It  is  not  im- 
probable that  such  particles,  passing  mechanically  between  the  epithelial 
or  epidermic  cells,  and  thus  separated  from  the  blood  of  the  capillaries 
only  by  the  extremely  tenuous  coats  of  the.-  .  and  the  equally 
tenuous  basement  membrane,  may,  by  their  contact  with  this  delicate 

minute  openings  in  it,  so  as  to  admit  their  passage,  by  a 
>«>rt  of  physiological  action  such  as  that  which  causes  two  cells  in  con- 
tact to  communicate  together;  and  these  openings,  after  the  entrance  of 
the  particles,  may  close  under  the  influence  of  the  same  vital  law. 

*  These  experiments  were  made  chiefly  in  Germany.  Begun  by  Oesttrlein,  they 
were  repeated  and  varied  by  Eberhard,  Kollikcr,  .Meyer,  Donders,  an<l  Menbonides, 
all  with  more  or  less  confirmatory  results.  (London  Med.  Times  and  (,'azetK,  March 


CHAP.  I.]  PRIMARY   OPERATION    OF   MEDICINES.  13 

9.  Another  modifying  influence,  exerted  over  the  absorption  of  medi- 
cines, is  probably  their  own  power  of  altering  the  condition  of  the  inter- 
vening membrane,  either  by  a  physiological  or  chemical  action  upon  it. 
Thus,  it  may  be  readily  conceived  that  the  contraction  produced  by 
tannic  acid,  and  the  chemical  reaction  with  solution  of  nitrate  of  silver, 
might  interfere  with  the  absorption  of  these  medicines  in  an  unchanged 
state. 

Changes  in  Medicines  before  and  after  Absorption,  and  their  Elim- 
ination. Of  the  organic  medicinal  substances  none  are  probably  taken 
into  the  system  in  the  exact  state  in  which  they  are  furnished  by  nature. 
It  is  only  certain  proximate  principles  contained  in  them  that  are  ab- 
sorbed, such  as  the  volatile  oils,  vegetable  alkaloids,  bitter  and  colouring 
principles,  etc.;  the  residue  being  left  behind  when  they  are  applied 
externally,  and  either  digested,  or  thrown  off  by  the  bowels,  when  they 
are  swallowed.  Thus,  in  the  instance  of  garlic,  the  gum,  starch,  sugar, 
and  albumen  are  probably  digested,  the  lignin  passes  off  with  the  feces, 
and  the  volatile  oil  alone  is  absorbed.  In  like  manner,  Peruvian  bark 
probably  yields  its  quinia,  cinchonia,  and  other  alkaloids,  rhubarb  its 
colouring  matter,  and  aloes  its  bitter  purgative  principle  to  the  blood ; 
while  the  remaining  constituents  are  evacuated  or  destroyed. 

A  great  number  of  medicines  undergo  various  changes  in  the  stomach 
and  bowels  before  absorption,  in  consequence  of  the  chemical  reaction 
between  them  and  the  acids,  salts,  and  various  animal  principles,  intro- 
duced or  secreted,  which  abound  in  those  passages.  Alkalies,  alkaline 
earths,  and  many  metallic  oxides  are  neutralized  by  acids;  metals  are 
oxidized  and  form  salts ;  metallic  salts  form  combinations  with  albumen 
or  other  proximate  organic  principles,  or  undergo  decomposition  with 
sulphuretted  hydrogen  or  other  acids,  or  by  reaction  with  other  saline 
compounds ;  carbonates  are  decomposed,  with  the  extrication  of  carbonic 
acid  in  the  stomach  and  bowels ;  salts  with  vegetable  acids  yield  their 
acid  constituent  to  the  digestive  process,  while  their  bases  appear  to 
enter  the  circulation  as  carbonates;  acids  often  combine  with  bases  and 
form  salts ;  iodine  and  chlorine  become  acidified  and  then  neutralized ; 
and,  by  some  one  of  the  above,  or  by  other  chemical  reactions,  insoluble 
substances  are  rendered  soluble,  and  consequently  more  capable  of  ab- 
sorption. 

Some  medicines  appear  to  be  absorbed  unchanged,  as  ether,  alcohol, 
chloroform,  hydrocyanic  acid,  various  proximate  organic  principles  pre- 
viously isolated,  as  the  volatile  oils  and  vegetable  alkaloids,  and  many 
saline  bodies  in  aqueous  solution. 

It  should  be  observed  that  medicines  are  not  confined  to  the  blood- 
vessels in  their  course  through  the  system.  By  the  principle  of  diffu- 
sion, many  of  them  escape  from  the  capillaries  into  the  neighbouring 
tissues ;  and  they  may  thus  penetrate  into  the  interior  of  structures  con- 


14  OPERATION    OF    MEDICINES.  [PART  I. 

taining  no  blood-vessels,  cartilages  for  example.  Dr.  H.  Bence  Jones 
detected  traces  of  lithia  in  the  superficial  parts  of  the  crystalline  lens, 
thirty  minutes  after  the  swallowing  of  chloride  of  lithium ;  and  in  two 
hours  and  a  half  it  was  found  throughout  the  lens.* 

After  entering  the  circulation,  many  medicines  undergo  chemical 
change,  through -the  agency  either  of  principles  they  meet  with  in  the 
blood,  or  of  the  constituents  of  the  various  tissues  with  which  they  come 
in  contact.  The  character  of  these  changes  is  not  well  understood,  and 
for  the  most  part  is  merely  conjectural.  It  is  possible  that  some  soluble 
substances  may  become  insoluble,  and  by  a  mechanical  operation  modify 
the  state  of  the  capillaries.  It  would  seem  that  certain  metallic  com- 
pounds are  reduced ;  as  mercury  and  silver  are  asserted  to  have  been 
found  in  the  metallic  state  in  the  tissues.  Some  medicinal  substances, 
as  alcohol,  probably  serve  in  part  the  purpose  of  nutrition  or  respiration ; 
being,  in  the  latter  case,  oxidized  and  thrown  off  from  the  lungs,  in  the 
forms  of  water  and  carbonic  acid. 

Sooner  or  later  almost  all  the  substances  absorbed  are  eliminated  from 
the  system,  cither  unchanged,  or  variously  decomposed ;  the  change 
being  produced  either  in  the  circulation,  or  in  the  process  of  elimination. 
Examples  of  such  change  we  have  in  the  oil  of  turpentine,  which  imparts 
not  its  own,  but  a  violaceous  odour  to  the  urine,  and  in  benzoic  acid, 
which,  when  taken  into  the  stomach,  is  eliminated  by  the  kidneys  in  the 
form  of  hippuric  acid.  The  elimination  is  usually  effected,  for  solid  or 
non-volatile  matters,  by  the  great  secreting  organs,  especially  the  kid- 
neys and  the  skin ;  and  so  frequently  are  the  former  emunctories  the 
avenue  of  escape,  that,  when  evidence  is  required  of  the  absorption  of 
any  medicine,  it  is  almost  always  sought  for  in  the  urine.  Volatile  sub- 
stances escape  not  only  by  these  organs,  but  in  general  abundantly  also 
by  the  lungs. 

The  period  required  for  elimination  is  very  various  with  different  sub- 
stances. With  some  the  process  begins  almost  immediately,  and  is  com- 
pleted in  a  short  time ;  with  others,  it  is  in  various  degrees  protracted ; 
and,  with  a  few,  many  months  elapse  before  the  system  is  entirely  freed 
from  them.  Thus,  A.  F.  Orfila,  having  administered  bichloride  of  mer- 
cury, sulphate  of  copper,  acetate  of  lead,  and  nitrate  of  silver  to  dogs, 
for  a  sufficient  length  of  time  to  impregnate  their  systems  witli  those 
metallic  poisons,  found,  upon  killing  the  dogs,  and  submitting  their  bodies 
to  a  rigid  chemical  examination,  that  mercury  disappeared  from  their 

*  Dr.  Jones  experimented  upon  patients  operated  upon  for  ihe  extraction  of  cata- 
ract, giving  the  salt  of  lithium  at  various  times  before  the  operation,  and  examin- 
ing the  cataract  afterwards  by  spectrum-analysis.  Upon  exhibiting  the  carbonate 
of  lithia,  he  found  lithium  in  every  particle  of  the  cataract  in  3-5  hours,  n-.n-es  still 
remaining  in  4  days,  and  its  entire  disappearance  in  7  days.  (Med.  T.  and  Oaz., 
Sept.  1866,  p.  246.)— Note  to  the  third  edition. 


CHAP.  I.]  PRIMARY    OPERATION    OF    MEDICINES.  15 

systems  in  a  period  of  from  eight  to  eighteen  days,  silver  sometimes  so 
early  as  six  weeks,  but  in  other  instances  not  until  the  expiration  of  six 
months ;  while  lead  and  copper  were  found  in  the  liver  eight  months 
after  they  had  ceased  to  be  administered.  (Gazette  des  Hopitaux,  Jan.  24, 
1852.)  With  perhaps  the  single  exception  of  silver,  it  has  not  been 
demonstrated  that  any  substance  given  medicinally  remains  permanently 
in  the  system,  and  in  reference  to  this,  only  in  a  few  rare  instances,  in 
which  it  has  been  given  in  large  quantities,  and  for  a  long  time.  Under 
such  circumstances,  it  sometimes  leaves  a  permanent  dark  stain  of  the 
skin,  probably  from  the  deposition  of  its  oxide  in  the  substance  of  the 
cutis  vera. 

SUBSECTION  II. 
Primary  Operation  through  the  Nerves. 

About  half  a  century  ago,  it  was  a  prevalent  belief  that  medicines 
operated  on  parts  distant  from  the  seat  of  their  application  by  means  of 
sympathy ;  in  other  words,  by  the  transmission  of  their  local  impression 
through  afferent  nerves  to  the  nervous  centres  in  the  encephalon,  spinal 
marrow,  or  ganglia,  and  its  radiation  thence  to  the  part  or  parts  affected. 
In  favour  of  this  opinion,  was,  in  the  first  place,  the  want  of  proof,  in 
relation  to  the  great  majority  of  medicines,  that  they  ever  penetrated 
into  the  system  beyond  the  original  surface  of  contact;  and,  secondly, 
the  great  rapidity  with  which  some  of  them  produced  their  effects,  which 
was  supposed  entirely  to  preclude  the  possibility  of  their  actual  convey- 
ance to  the  seat  of  these  effects.  But,  since  it  has  been  discovered  that 
almost  all  medicines  are  capable  of  being  absorbed  into  the  circulation, 
and  that  perhaps  in  no  instance  are  their  effects  felt  in  a  time  shorter 
than  that  required  for  their  conveyance  with  the  blood  to  the  part  acted 
on,  the  explanation  of  their  operation  by  sympathy,  or  through  the  me- 
dium of  the  nerves,  has  become  unnecessary,  and,  in  reference  to  most 
medicines,  is,  I  think,  quite  untenable. 

It  is  true  that  many  medicines  produce  local  impressions,  which  are 
followed  by  effects  in  parts  more  or  less  distant,  that  cannot  be  explained 
upon  the  supposition  of  the  transfer  of  the  medicines  themselves,  and 
must,  therefore,  be  brought  about  through  nervous  agency.  Thus,  to- 
bacco and  ammonia,  applied  to  the  mucous  membrane  of  the  nostrils, 
occasion  sneezing,  undoubtedly  through  the  intervention  of  the  nerves 
and  the  nervous  centres ;  and  in  the  same  way  we  must  account  for  such 
effects  as  the  sweat  and  feeling  of  coldness  in  the  forehead,  sometimes 
following  the  application  of  common  salt  to  the  tongue,  and  the  flow  of 
tears  and  saliva  resulting  from  horseradish  in  the  mouth.  But  it  will  be 
observed  that  these  are  secondary  effects,  dependent  on  mere  irritation  of 
the  part  first  impressed,  and  which  might  equally  result  from  any  other 


16  OPERATION  OF  MEDICINES.  [PART  I. 

cause  capable  of  producing  an  equal  amount  of  irritation.  They  are  not 
the  primary  or  characteristic  action  of  the  medicines,  which  alone  we  are 
now  considering.  To  fulfil  the  conditions  of  the  theory  of  nervous  trans- 
mission, it  is  necessary  that  the  first  impression  on  the  surface  of  appli- 
cation should  be  conveyed  unchanged,  or  merely  modified ;  or  at  least 
that  the  remote  effect  should  be  of  a  characteristic  nature,  and  not  the 
same  as  that  which  any  irritant  might  produce. 

Yet  it  cannot  be  denied  that  there  are  facts  tending  to  show  that,  in 
some  instances,  medicines  do  propagate  their  primary  and  peculiar  influ- 
ence through  the  nerves.  Thus,  certain  fetid  substances,  which  act  effi- 
ciently as  antispasmodics  when  introduced  into  the  stomach  or  rectum, 
seem,  by  their  mere  impression  on  the  olfactory  nerves,  to  give  rise  to 
the  same  effects ;  and  tobacco  and  lobelia  occasion,  by  their  presence  in 
the  fauces,  nauseating  impressions  very  similar  to  those  produced  by 
them  when  swallowed.  I  think  every  practitioner  in  the  habit  of  ad- 
ministering opiates  by  enema,  for  the  relief  of  nephritic  and  uterine 
pains,  strangury,  etc.,  must  have  witnessed  a  greater  and  more  speedy 
effect  from  them  thus  given,  than  when  taken  into  the  stomach.  This 
can  be  accounted  for  only  by  the  transmission  of  their  anodyne  influence 
through  the  nervous  centres;  as,  if  absorbed  into  the  circulation,  they 
would  reach  the  seat  of  action  no  sooner  than  if  absorbed  from  the  stom- 
ach, and,  indeed,  less  speedily  and  efficiently;  as  medicines  administered 
by  the  rectum  are  well  known  to  affect  the  system  less  readily  than 
when  swallowed.  It  is,  therefore,  I  Jhink,  premature  to  reject  altogether 
this  mode  of  medicinal  operation;  and,  indeed,  it  is  not  impossible  that. 
some  substances  may  operate  in  both  ways,  giving  rise  to  an  impression 
through  nervous  transmission,  which  may  be  afterwards  strengthened, 
and  perhaps  modified,  by  the  immediate  action  of  the  medicine  through 
the  circulation. 

SUBSECTION  III. 
Primary  Local  Operation. 

By  the  expression,  local  action,  is  here  meant  that  exerted  on  the 
part,  or  in  the  immediate  neighbourhood  of  the  part,  to  which  the 
medicine  is  originally  applied. 

Some  medicines  are  exclusively  local  in  their  operation.  Such  an- 
those  applied  directly  to  any  surface,  with  a  view  to  some  mechanical, 
physical,  or  chemical  influence  on  that  surface.  It  is  probable  that  cer- 
tain medicines  which  act  physiologically,  that  is,  through  the  vital  prop- 
erties of  the  system,  are  also  exclusively  local.  Medicines  incapable  of 
being  absorbed,  if  there  be  any,  would  belong  to  this  category.  An 
example  of  this  kind,  I  am  inclined  to  think,  we  have  in  castor  oil. 

Many  medicines  are,  under  certain  circumstances,  local  in  their  action, 


CHAP.  I.]  PRIMARY   OPERATION    OF   MEDICINES.  17 

which,  under  others,  may  enter  the  system,  and  operate  on  distant  parts. 
Thus,  substances  capable  of  violently  irritating  or  inflaming  the  surface 
to  which  they  may  be  applied,  when  employed  so  as  to  produce  this 
effect,  are  little  apt  to  be  absorbed,  in  consequence  probably  of  the  dis- 
tension of  the  capillaries;  whereas,  if  previously  diluted  so  as  not  to 
irritate,  they  may  find  a  ready  entrance  into  the  circulation. 

Other  medicines  both  act  locally,  and,  entering  the  circulation,  pro- 
duce the  same  or  dissimilar  effects  on  distant  parts.  Thus,  opium  and 
chloroform  operate  as  anodynes  on  the  nerves  of  the  part  to  which  they 
are  applied,  and  subsequently  produce  the  same  effect  throughout  the 
system  by  acting  upon  the  nervous  centres ;  while  tartar  emetic  is  irri- 
tant in  its  local  operation,  but  sedative  when  acting  through  the  circula- 
tion upon  the  heart.  Medicines  of  this  kind  are  often  used  in  reference 
to  their  local  effects. 

In  most  cases  of  local  action,  the  influence  of  the  medicine  extends 
more  or  less  beyond  the  original  surface  of  contact.  Thus,  the  anodyne 
influence  of  chloroform,  applied  to  the  skin,  often  penetrates  through  this 
tissue  to  parts  beneath  it,  and  the  same  may  be  said  of  opium,  camphor, 
aconite,  and  other  medicines  of  the  kind.  Castor  oil,  applied  to  the  inner 
surface  of  the  alimentary  mucous  membrane,  calls  the  muscular  coat  into 
action.  An  irritant  substance  often  extends  its  effects  both  deeply  into 
the  tissues,  and  to  a  considerable  distance  superficially  beyond  the  sur- 
face of  contact.  How  is  this  result  to  be  accounted  for  ?  In  some  in- 
stances, probably,  by  the  penetration  of  the  neighbouring  tissues,  to  a 
certain  extent,  either  on  the  principle  of  the  diffusion  of  liquids,  or  on 
that  of  capillary  attraction,  or  of  both.  In  others,  the  effect  may  be  pro- 
pagated by  what  Mr.  Hunter  denominates  continuous  sympathy ;  spread- 
ing along  the  course  of  the  tissue  affected,  with  a  gradual  diminution, 
until  quite  lost.  Again,  it  is  not  impossible  that  the  influence  may  be 
extended  to  neighbouring  parts  through  common  nervous  centres ;  as 
when  the  extract  of  belladonna,  rubbed  upon  the  eyelids,  produces  dila- 
tation of  the  pupil,  or  opium  in  the  rectum  relieves  pain  in  the  ureters ; 
in  neither  of  which  instances  can  the  result  be  fairly  ascribed  to  the  cir- 
culation, as  the  effect  should  in  this  case  be,  what  it  is  known  not  to  be, 
equally  great  and  rapid  to  whatever  part  of  the  body  the  medicine  may 
be  applied,  supposing  it  to  be  equally  distant  from  the  heart,  and  to 
afford  equal  facilities  for  absorption.  Finally,  the  effect  may  be  second- 
ary, as  in  the  instance  of  castor  oil,  which  directly  irritates  the  mucous 
membrane,  and,  as  any  other  similar  irritant  would  do,  indirectly  excites 
the  peristaltic  movement,  through  the  agency  of  the  physiological  law 
which  determines  the  latter  result  as  a  necessary  consequence  of  the 
former. 

VOL.  i. — 2 


18  OPERATION    OF    MEDICINES.  [PART  I. 

SUBSECTION  IV. 
Modes  of  Primary  Operation. 

Hitherto  we  have  been  considering  rather  the  seat  of  the  operation  of 
medicines,  and  their  manner  of  reaching  it,  than  the  mode  in  which  they 
produce  their  effects.  The  latter  point  must  now  receive  attention. 

1.  Mechanical  or  Physical  Methods.  The  operation  of  medicines  may, 
in  some  instances,  be  purely  mechanical  or  physical.  Thus,  they  may 
act  by  excluding  the  atmospheric  air,  as  in  the  instance  of  collodion  ap- 
plied to  the  skin  in  cutaneous  affections ;  by  mingling  with  and  obtund- 
ing  the  acrimony  of  various  acrid  substances,  as  in  the  operation  of  de- 
mulcents ;  by  the  influence  of  gravity,  as  illustrated  by  the  laxative  effects 
of  metallic  mercury ;  or  by  their  shape  and  bulk,  as  when  bran,  mustard 
seed,  small  shot,  etc.,  operate  on  the  bowels  by  a  mechanical  irritation  of 
the  mucous  membrane. 

Endosmose  and  Exosmose.  Another  physical  mode  of  action  has  been 
suggested,  which,  though  not  satisfactorily  established,  is  not  without  a 
certain  amount  of  plausibility.  Reference  has  already  been  made  to  the 
entrance  of  medicines  into  the  blood-vessels  on  the  principle  of  endosmose. 
Poiseuille  and  others  have  demonstrated  that,  if  the  serum  of  the  blood 
be  placed  on  one  side  of  an  animal  membrane  out  of  the  body,  and  cer- 
tain strong  saline  solutions,  or  other  concentrated  liquids  on  the  other 
side,  a  current  of  the  serum  is  made  to  set  through  the  membrane  to- 
wards the  denser  liquid ;  while,  if  the  solution  be  very  weak,  the  current 
is  established  in  a  contrary  direction.  Hence,  it  has  been  suggested  thai 
strong  solutions  of  certain  salts  in  the  stomach  and  bowels  may  act  as 
cathartics,  by  producing  an  extravasation  of  the  serum  from  the  blood- 
vessels; while  weak  solutions  of  the  same  may  enter  the  vessels,  and 
thus  act  on  the  system  generally.  This  principle  has  been  extensively 
applied  to  the  explanation  of  the  action  of  medicines;  the  general  rule 
being,  that  a  liquid  denser  than  the  blood  will  produce  exosmose  of  tin- 
serum,  and  thus  operate  as  an  evacuant.*  But  the  principle  is  not  recon- 
cilable with  many  facts  which  might  be  adduced,  and  is  wholly  insuffi- 
cient to  explain  many  others.  To  mention  only  a  single  example; 
chloroform  taken  internally,  or  applied  to  the  surface  of  the  body,  pro- 
duces effects  on  the  system  which  can  scarcely  be  referred  to  any  other 
cause  than  its  presence  in  the  circulation.  It  must,  therefore,  enter  the 
blood-vessels,  though  vastly  denser  than  the  serum  of  the  blood,  and  fails 
to  produce  the  extravasation,  which  ought  to  take  place  upon  the  prin- 

*  See  experiments  of  Poiseuille  (Complex  Rcnduv,  xix.  '.(44,  A.D.  1844),  and  of  Dr. 
Cogswell  (Loud.  Med.  Times  and  Oaz.,  Jan.  3,  1852,  p.  23).  See  also  an  essay  by 
Prof.  Jos.  Carson,  on  osmosis  in  its  relation  to  medicine,  in  the  Am.  J^tirn.  of  Med. 
Set.,  July,  1865,  p.  136. 


CHAP.  I.]  PRIMARY    OPERATION    OF    MEDICINES.  19 

ciple  of  exosmose  referred  to.  Still,  this  physical  property  may  be  re- 
ceived as  one  of  the  probable  agenc'ies  through  which  medicines  operate, 
though,  in  the  present  state  of  our  knowledge,  it  cannot  be  admitted  as 
of  universal  or  even  general  application. 

The  supposed  agency  of  endosmose  and  exosmose  has  been  carried 
much  further  than  to  the  explanation  of  the  action  of  medicines  on  ex- 
posed surfaces.  Thus  it  may  be  exerted  in  the  circulation  itself,  causing 
the  character  of  the  red  corpuscles  to  vary  with  the  varying  relative 
density  of  the  serum  without,  and  the  liquid  within  the  corpuscles;  so 
that  whatever  increases  the  specific  gravity  of  the  serum,  as  certain  salts, 
for  example,  shall  cause  an  exosmose  of  the  corpuscular  contents,  and  a 
shrinking  of  those  bodies,  and  whatever  diminishes  its  density,  as  water, 
shall  occasion  an  endosmose  into  them,  and  their  consequent  distension 
or  rupture. 

Still  further,  it  is  thought  that  the  relative  density  of  the  liquor  san- 
iruinis  in  the  capillaries,  and  of  the  moisture  without  them,  may  be  one 
of  the  controlling  influences  in  the  operation  of  medicines  which  act 
through  the  circulation.  If  the  nature  of  the  medicine  be  such  as  to  in- 
crease the  density  of  the  blood,  it  would  tend  to  promote  absorption  from 
the  tissues,  if  to  lessen  it,  to  favour  extravasation  into  them;  and  the 
same  explanation  ought  to  apply  also  to  the  influence  of  medicines  within 
the  circulation  upon  the  various  secretions.  At  present,  however,  all 
this  is  merely  hypothesis  or  conjecture ;  arid  must  be  placed  upon  the 
same  basis  of  admissibility  with  that  theory  of  the  operation  of  medicines, 
which  ascribes  it  to  the  mechanical  influence  of  the  shape  of  their  ulti- 
mate particles  upon  the  tissues  with  which  they  come  into  contact. 

2.  Chemical  Methods.  Reference  is  not  had,  in  this  place,  to  the 
chemical  changes  which  medicines  undergo  in  the  alimentary  canal  pre- 
paratory to  absorption,  nor  even  to  those  which  may  take  place  in  tin- 
course  of  the  circulation  or  elimination  of  the  medicines,  so  far  as  relates 
exclusively  to  the  medicines  themselves.  But,  when  these  chemical 
changes  of  the  medicine  in  the  circulation  result  from  reactions  between 
them  and  the  constituents  of  the  blood  or  the  tissues,  it  cannot  but  hap- 
pen that  physiological  alterations  must  take  place,  which  may  possibly 
be  more  or  less  remedial ;  and  the  consideration  of  such  changes  belongs 
.-trietly  to  this  section. 

Some  medicines  have  so  strong  an  affinity  for  the  constituents  of  the 
tissues,  that,  when  in  contact  with  them  in  a  concentrated  state,  they 
overcome  their  .vital  resistance,  and  cause  the  decomposition  and  con- 
sequently the  death  of  the  part.  In  this  way  many  caustic  substance- 
act.  In  a  dilute  state,  this  affinity  is  more  than  counterbalanced  by  the 
vital  forces,  and  no  chemical  change  ensues.  As  medicines  never  extend, 
in  this  state  of  concentration,  tar  beyond  their  original  surface  of  contact, 
it  is  obvious  that  similar  decomposition  of  the  tissues  cannot  result  from 


20  OPERATION    OF    MEDICINES.  [PART  I. 

their  operation  on  the  system,  either  by  the  circulation,  or  through  the 
medium  of  the  nerves. 

It  is  highly  probable,  however,  that  many  medicines  produce  chemical 
changes  in  the  blood,  which  enter  into  their  remedial  action.  The  blood 
consists  of  certain  vitalized,  and  certain  unvitalized  constituents,  the 
latter  of  which  are  probably  merely  held  in  solution,  and  are  subject  to 
the  same  chemical  reactions  as  if  dissolved  in  a  fluid  out  of  the  body. 
Thus,  an  acid  medicine,  absorbed  into  the  blood,  may  prove  remedial  by 
neutralizing  a  morbid  excess  of  alkalinity;  and,  conversely,  an  alkaline 
medicine,  by  correcting  any  morbid  acidity  of  that  fluid.  It  is  highly 
probable  that  many  analogous  changes  may  take  place ;  and  to  some  of 
these  there  will  hereafter  be  occasion  to  allude  in  the  account  of  particu- 
lar medicines,  or  classes  of  medicines.  It  is  even  possible  that  the  normal 
condition  of  the  blood  may  be  so  far  modified  by  such  a  chemical  agency, 
exerted  for  example  upon  its  albumen,  its  fibrin,  its  salts,  etc.,  as  to  alter 
materially  the  influence  of  that  fluid  upon  the  tissues  and  functions,  and 
thus  to  give  rise  to  systemic  actions  or  conditions,  which,  though  in  fact 
only  the  secondary  effects  of  the  medicine,  are  usually  regarded  as  the 
results  of  its  direct  and  characteristic  operation.  But  these  changes  can 
be  traced  only  conjecturally ;  and  there  are  very  few,  if  any,  which  can 
be  truly  said  to  have  been  experimentally  demonstrated. 

Another  mode  in  which  a  medicine  may  act  chemically,  after  absorp- 
tion, is  at  the  time  of  elimination  by  the  secretory  functions;  when, 
coming  in  contact  with  the  products  of  secretion,  it,  or  one  of  its  con- 
stituents, or  some  compound  which  may  have  been  formed  by  chemical 
reactions  with  it  in  the  course  of  the  circulation,  may  materially  modify 
these  products.  Thus,  alkaline  medicines,  eliminated  by  the  kidnevs, 
render  soluble  the  uric  acid,  or  insoluble  urates,  which  may  have  been 
deposited  from  the  urine  after  its  secretion. 

It  is  not  impossible  that  the  peculiar  effects  of  medicines  on  the  sys- 
tem, may  sometimes  result  from  chemical  reaction  between  the  medicines 
and  the  tissues  with  which  they  are  brought  into  contact  while  in  the 
blood,  or  into  which  they  may  have  been  diffused  from  the  capillaries. 
Reactions  between  the  constituents  of  the  tissues  may  take  place  through 
the  agency  of  the  medicine,  acting  either  as  a  ferment,  or  by  what  has 
been  called  disposing  affinity,  as  when  the  presence  of  an  alkali  disposes  to 
oxidation,  so  as  to  form  an  acid  with  which  it  may  unite.  Combinations 
may  be  formed  between  the  medicine,  or  one  of  its  constituents,  and  some 
one  or  more  of  the  constituents  of  the  tissues,  at  the  moment  of  their 
physiological  disintegration;  and  these  compounds,  ret;iined  in  the 
organs,  perhaps  within  the  organic  cells,  perhaps  in  the  interstices  of 
the  tissue,  may  modify  the  functions  in  a  manner  that  may  prove  re- 
medial. These  results,  I  repeat,  are  possible;  and  the  theory  has  been 
advocated  that  medicines  generally  act  by  affecting  the  normal  oxida- 


CHAP.  I.]  PRIMARY   OPERATION    OF    MEDICINES.  21 

tion  of  the  tissues;  some  favouring  oxidation,  and  thus  producing  one 
set  of  effects,  others  retarding  or  suspending  it,  and  thus  causing  op- 
posite results;  but  it  has  not  been  proved  positively  that  medicines  do 
really  produce  their  peculiar  effects  in  this  way  in  any  one  instance ; 
and  it  is  altogether  premature  to  explain  the  whole  agency  of  medicines 
upon  the  grounds  of  their  chemical  influence.  The  only  well-ascertained 
fact  which  can  be  adduced  in  support  of  the  hypothesis  is,  that  certain 
medicines,  particularly  the  metallic,  may  be  detected  in  the  substance  of 
the  organs,  often  for  a  considerable  time  after  they  have  been  taken. 

3.  Physiological,  Vital,  or  Dynamic  Methods.  Most  medicines  prob- 
ably produce  their  peculiar  effects  by  operating  on  the  vital  properties 
of  the  system,  or  of  the  part  affected.  Of  the  nature  of  this  action  we 
are  quite  ignorant,  and  must  remain  so  until  the  nature  of  life  itself  is 
better  understood.  In  the  present  state  of  our  knowledge,  all  that  we 
can  say  is,  that  living  structure  is  endowed  with  certain  susceptibilities, 
and  medicines  with  certain  properties,  or  powers,  through  which,  when 
the  two  are  brought  together,  certain  changes  of  condition  or  action 
take  place  in  the  former.  The  medicine  is  said  to  act,  and  the  living 
structure  to  be  acted  on,  because  it  is  in  the  latter  that  the  changes  are 
most  obvious,  and  most  interesting.  This  kind  of  operation  is  called 
physiological,  or  vital,  in  reference  to  the  character  of  the  effects  pro- 
duced in  the  s}rstem,  and  dynamic,  in  reference  to  the  supposed  posses- 
sion of  an  active  power  by  the  medicine.  We  may  speculatively  ascribe 
the  results  to  physical  or  chemical  reaction;  but  this  explanation  is,  in 
the  great  majority  of  instances,  destitute  of  the  shadow  of  proof,  and 
is  indeed  altogether  insufficient,  with  our  existing  knowledge  of  physics 
and  chemistry,  to  account  for  many  of  the  phenomena.  Until,  there- 
fore, further  light  is  obtained,  it  is  safest  to  be  content  with  the  mere 
statement  of  the  fact.* 

When  medicines  are  introduced  into  the  system,  they  generally  show 
a  tendency  to  act  on  some  one  part,  or  set  of  parts,  preferably  to  others, 
and  not  unfrequently  act  on  these  parts  exclusively.  Thus,  some  medi- 
cines operate  more  especially  on  the  brain,  others  on  the  heart,  others  on 
the  stomach  and  bowels,  and  others  again  on  some  one  or  more  of  the 
secretory  organs,  though  equally  in  contact  with  the  parts  unaffected  as 


*  Much  has  been  said  of  late  of  another  mode  of  action  of  medicines,  based  on 
their  influence  upon  the  function  of  nutrition;  some  being  supposed  to  act  by  in- 
creasing that  function,  others  by  diminishing  it.  Of  course,  medicines  which 
stimulate  or  depress  the  functions  generally  must  stimulate  or  depress  nutrition, 
as  they  affect,  other  functions;  and  there  may  be  some  whose  special  tendency  is 
to  act  upon  nutrition;  but  the  resulting  changes  are  effects  of  the  medicines  and 
not  their  method  of  action.  The  question  arises,  how  do  they  increase  or  diminish 
nutrition  ?  and  we  arc  then  brought  back  to  the  chemical  or  physiological  theory. 
(Vote  to  (he  third  edition.) 


22  OPERATION    OF    MEDICINES.  [PART  I. 

with  those  upon  which  they  act.  This  tendency  is  ascribable  to  the 
peculiar  constitution  of  the  several  parts  of  the  system,  giving  them 
peculiar  susceptibilities ;  just  as  the  eye  alone  is  sensible  to  light,  and 
the  organs  of  smell  and  taste  to  odours  and  sapid  substances.  A  medicine, 
therefore,  entering  the  circulation,  and  reaching  all  parts  of  the  system, 
acts  on  such  parts  only  as  are  so  constituted  as  to  be  susceptible  to  its 
influence ;  as  light,  though  falling  on  the  whole  surface  of  the  body,  pro- 
duces its  characteristic  impression  only  upon  the  eye.  The  chemist- 
explain  this  peculiar  direction  of  medicines  by  the  supposition,  that  it  is 
only  in  the  organs  affected  that  they  find  affinities  capable  of  being 
disturbed  by  their  presence. 

It  is  not  impossible  that  some  medicines  may  act  upon  the  blood 
through  its  vital  properties,  modifying  the  condition  of  tin-  living  cor- 
puscles and  fibrin,  in  the  same  manner  as  others  act  upon  the  living 
solid  tissues.  Such  medicines  may  operate  exclusively  on  the  blood, 
producing  effects  upon  the  various  functions  simply  through  the  change 
effected  in  that  fluid;  or  they  may  operate  at  the  same  time  directly 
upon  the  organs.  The  probability,  however,  is,  that,  in  the  great  ma- 
jority of  instances,  medicines  are  merely  conveyed  by  the  blood  to  the 
part  in  which  their  effects  are  experienced ;  for  otherwise  these  et: 
would  be  more  frequently  universal,  as  any  change  in  the  blood  itself 
must  be  felt  more  or  less  in  all  the  organs  and  functions. 


SECTION  II. 
Secondary  Operation  of  Medicines. 

The  secondary  operation  of  medicines  has  been  already  defined  to  be 
that  which  follows  their  original  and  characteristic  impression,  in  conse- 
quence of  certain  physiological  laws.  Without  treating  in  this  place  of 
the  resulting  effects,  it  will  be  proper  to  explain,  in  a  general  way,  the 
several  modes  in  which  they  are  produced. 

1.  By  the  Depression  folloiving  Excitement.  It  is  a  general  phy- 
siological law,  that  excessive  exitement  of  any  function  must  be  followed 
by  a  corresponding  degree  of  depression,  upon  the  removal  of  the  cause. 
When,  therefore,  an  excitant  medicine  ceases  to  act,  its  original  and 
characteristic  operation  is  succeeded  not  only  by  a  subsidence  of  the  ex- 
citement, but  by  a  reduction  of  the  actions  of  the  part  affected  below  the 
standard  of  health.  This  depression  is  often  experienced  even  before 
the  complete  elimination  of  the  medicine  from  the  system;  for  the  ex- 
citability may  have  been  so  far  exhausted  by  the  excess,  that  the  in- 
fluence of  the  excitant  ceases  to  be  felt,  and  the  healthy  vital  stimuli 
have  no  longer  their  ordinary  influence.  The  prostration  which  fol- 


CHAP.  I.]  SECONDARY   OPERATION    OF    MEDICINES.  23 

lows  a  debauch  is  often  observable,  while  yet  the  breath  smells  of  the 
alcohol.* 

2.  By  the  Eeaction  following  Depression.     When  any  of  the  func- 
tions are  depressed  by  an  agency  which  simply  restrains  action,  without 
impairing  the  vital  forces  or  deranging  the  organization,  there  is  a  tend- 
ency, upon  the  cessation  of  the  depressing  influence,  to  an  elevation  of 
the  function  beyond  its  medium  state.   This  depends  upon  the  principle, 
that  excitability  is  recruited  by  rest.    The  resulting  elevation  of  function 
is  usually  denominated  reaction.     It  is,  however,  much  less  frequently 
noticed  as  a  consequence  of  depressing  medicines,  than  the  contrary 
condition  of  depression  after  excitants ;  probably  because  sedative  medi- 
cines usually  impair  power,  as  well  as  reduce  action.    A  fine  example  of  it 
is  afforded  in  the  reaction  which  follows  the  depressing  influence  of  cold. 

3.  Through  the  Dependence  of  Function.     Most  of  the  functions  of 
our  system  are  more  or  less  mutually  dependent,  so  that  any  considera- 
ble derangement  of  one  will  in  some  degree  affect  the  others.     A  dis- 
turbance, therefore,  of  one  of  the  more  influential  functions,  produced 
by  a  medicine  acting  primarily  upon  the  organs  of  that  function,  will  be 
followed  by  disorder  in  all  the  rest ;  and  this  disorder  will  obviously  be 
a  secondary  effect  of  the  medicine.     Thus,  alcohol,  opium,  and  quinia, 
largely  taken,  occasion  so  much  excitement  and  active  congestion  of 
the  nervous  centres  in  the  brain,  as  to  disqualify  them  from  transmitting 
their  usual  influence  to  the  various  organic  functions,  as  those  of  respira- 
tion, circulation,  and  secretion,  which  consequently  become  much  de- 
pressed ;  and  general  prostration  ensues.    The  active  cerebral  congestion 
is  a  primary,  the  general  prostration  a  secondary  effect  of  the  medicine. 
This  is  a  highly  important  principle,  and  of  very  extensive  application. 
A  due  attention  to  it  is  essential  to  the  practitioner.     Suppose  that  it 
should  be  disregarded  in  the  cases  just  stated,  and  the  prostration  con- 
sidered as  the  result  of  the  direct  and  characteristic  action  of  the  medicine. 
A  powerful  stimulant  to  the  brain  might  thus  be  mistaken  for  a  really 
sedative  medicine,  and  administered  with  the  most  serious  results  in 
cases  of  cerebral  disease. 

In  like  manner,  a  medicine,  powerfully  depressing  in  its  action  upon 
the  cerebral  centres,  would  be  followed  by  great  general  prostration  ; 
and  this  would  really  be,  as  well  as  in  the  former  instance,  a  secondary 
effect :  but  there  is  not  the  same  necessity  for  making  the  distinction ; 


*  This  law  of  depression  following  excitement  is  denied  by  some  late  writers; 
and  there  may  be  one  or  two  apparent  exceptions  to  the  universality  of  the  law,  as 
in  the  instance  of  nitrous  oxide;  but  of  its  general  truth  I  can  have  no  doubt.  The 
point  is  one  not  of  theory  but  observation;  and  every  one  must  be  determined  by 
his  own  experience.  Mine  has  been  most  assuredly  in  favour  of  the  existence  of 
Buch  a  law.  (Note  to  the  third  edition.) 


24  OPERATION    OF    MEDICINES.  [PART  I. 

because  the  secondary  is  of  the  same  character  with  the  primary  effect, 
and  no  mistake  could  occur  of  the  nature  of  that  above  referred  to. 

The  results  of  what  is  denominated  the  ahock,  are  another  example  of 
the  secondary  operation  of  medicines  belonging  to  the  same  category. 
Any  sudden  and  violent  impression,  as  from  a  fall,  a  blow,  a  surgical 
operation,  or  some  strong  emotion,  primarily  overwhelms  and  paraly/r> 
the  cerebral  centres,  and  secondarily  occasions  general  prostration.  Now 
certain  medicines  of  great  violence,  as  for  example  the  corrosive  poisons 
taken  largely  into  the  stomach,  may  produce  a  similar  shock  upon  the 
nervous  centres,  followed  by  a  similar  general  depression,  which,  with- 
out a  knowledge  of  this  principle,  might  be  mistaken  for  the  result  of 
a  directly  depressing  agency,  and  treated  as  such  with  very  serious 
consequences. 

The  operation  upon  the  system  at  large  of  medicines  which  act  by 
changing  the  character  of  the  blood,  is  another  example  of  the  same 
kind.  The  general  effects  result  from  the  state  of  the  blood,  and  not 
from  the  immediate  influence  of  the  medicine,  and  are,  therefore,  second- 
ary effects  of  the  latter. 

4.  Through  the  Principle  of  Sympathy,  or  Nervous  Transmission. 
Though  it  is  not  probable  that  special  or  peculiar  impressions  of  medi- 
cines are,  to  any  considerable  extent,  conveyed  from  the  part  impressed 
through  the  nerves  to  the  nervous  centres,  and  thence  transmitted  to 
other  parts,  yet  mere  excitative  impressions,  or  those  consisting  in  pure 
irritation  or  inflammation,  are  undoubtedly  thus  conveyed.     What  is 
special  in  the  influence  of  the  medicine  is,  therefore,  mainly  limited  to  its 
surface  of  contact;  while  it  is  only  the  pure  irritation,  such  as  may 
result  from  any  irritating  cause  whatever,  that  is  conveyed  away,  and 
propagated  through  the  nerves.    This  transmission  of  irritatjon  arises 
from  a  general  physiological  law,  and  is,  therefore,  a  secondary  effect  of 
the  medicine.    Thus,  a  rubefacient  or  epispastic  may  excite  so  much  local 
inflammation  as,  through  the  nervous  centres,  to  bring  many  of  the 
organs  into  sympathy,  and  in  this  way  to  produce  general  excitement, 
and  even  fever.    The  increased  frequency  of  pulse,  heat  of  skin,  cerebral 
disturbance,  etc.,  which  enter  into  this  excitement,  are  secondary  eflVi  t> 
of  the  rubefacient  or  epispastic,  the  primary  action  of  which  is  limited 
to  the  portion  of  skin  to  which  it  was  applied.     This  principle  is  also  of 
extensive  application  in  explaining  the  effects  of  medicines. 

5.  Through  the  Principle  of  Revulsion  or  Derivation.    There  is  in 
the  system  but  a  limited  amount  of  blood,  and  of  nervous  power.    When 
these  are  concentrated,  or  accumulated  in  undue  amount,  by  the  influence 
of  a  local  irritant  or  otherwise,  in  some  one  part  or  organ,  they  must  be 
deficient  elsewhere;    and  a  depression  must  ensue  in  those  functions 
which  are  not  irritated  by  sympathy  with   the  part  or  organ  originally 
affected.     Supposing  the  local  accumulation  of  blood  and  nervous  power 


CHAP.  I.J  SECONDARY   OPERATION    OF    MEDICINES.  25 

to  be  the  result  of  the  action  of  a  medicinal  agent,  the  depression  pro- 
duced elsewhere  is  a  secondary  effect  of  that  agent.  Now  it  may  have 
happened  that  the  parts  depressed  were  previously  in  a  state  of  morbid 
excitement,  which  has  thus  been  diminished,  and  perhaps  entirely  re- 
moved by  the  direction  given  towards  the  seat  of  the  primary  influence. 
The  name  of  revulsion  or  derivation  has  been  given  to  this  forced  trans- 
fer of  morbid  action ;  and  we  frequently  avail  ourselves  of  the  principle 
in  the  treatment  of  disease.  It  is  upon  this  principle  that  a  blister  relieves 
internal  inflammation.  It  is  upon  this,  also,  in  part,  that  a  cathartic,  by 
producing  a  moderate  irritation  along  the  whole  course  of  the  intestine, 
draws  off  morbid  excitement  from  other  organs,  and  especially  from  the 
brain.  Indeed,  whatever  remedy  occasions  a  local  irritation  may  thus 
prove  the  means  of  unseating  irritation  elsewhere.  It  is  quite  obvious 
that  the  diversion  of  disease,  thus  effected,  is  a  secondary  operation  of 
the  remedy. 

Upon  the  same  principle  exactly,  operating  reversely,  a  depression  of 
any  part  or  organ,  by  diminishing  the  blood  and  nervous  power  in  the 
part  affected,  must  cause  their  accumulation  elsewhere ;  and  thus,  de- 
pressing or  sedative  medicines,  acting  locally,  may,  through  a  secondary 
operation,  cause  irritation  in  some  other  position.  For  example,  cold 
water  applied  to  a  gouty  foot,  by  diminishing  the  inflammatory  excite- 
ment there,  may  secondarily  occasion  inflammation  of  the  stomach. 
Medicines  are  not  often  employed  in  reference  to  such  effects ;  but  this 
mode  of  secondary  action  should  be  understood,  if  on  no  other  account, 
at  least  in  order  that  its  injurious  effects  may  be  guarded  against. 

6.  Through  the  Efforts  of  Nature  to  Repair  Injuries.     It  may  be 
considered  as  a  general  law  of  the  animal  economy,  that,  when  any  in- 
jurious influence  is  exerted  upon  the  system,  actions  are  induced  with 
the  object,  and  frequently  with  the  effect,  of  obviating  the  injury,  or 
repairing  the  damage  inflicted.     It  is  probable  that  many  diseases  are 
nothing  more  than  the  struggles  of  the  system  to  free  itself  from  some 
noxious  agent,  or  to  counteract  its  influence.    The  abnormal  impressions 
made  by  medicines  are  often,  no  doubt,  upon  this  principle,  followed  by 
resisting  or  corrective  efforts  of  nature,  which  must  rank  among  the 
secondary  effects  of  the  medicine,  and  may  sometimes  be  taken  advant- 
age of  for  remedial  purposes.     Thus,  the  death  of  a  part  produced  by 
an  escharotic  is  the  primary  effect  of  the  medicine;    the  subsequent 
inflammation,  ulceration,  sloughing,  and  suppurative  discharge,  are  sec- 
ondary effects,  intended  for  the  repair  of  the  injury,  and  useful  in  reference 
to  pre-existing  disease,  upon  the  principles  of  revulsion  and  depletion. 

7.  Through  the  Removal  of  the  Cause.    Very  many  of  the  morbid 
actions  or  states  of  the  system  are  secondary,  depending  upon  the  exist- 
ence of  some  other  action  or  condition,  upon  the  removal  of  which  the 
effect  also  ceases.     It  is  obvious  that  a  medicine,  which  by  its  primary 


26  OPERATION    OF    MEDICINES.  [PART  I. 

operation  removes  the  cause,  and  thus  cures  the  disease,  acts  secondarily 
in  relation  to  the  latter  effect.  Thus,  acid  in  the  stomach  often  occasions 
severe  headache,  which  is  cured  by  an  antacid,  or  an  emetic.  The  neu- 
tralization or  evacuation  of  the  offending  agent  is  the  primary  operation 
of  the  medicine,  the  cessation  of  the  headache  a  secondary  effect.  This 
is  a  very  extensive  remedial  principle. 

It  is  very  often  difficult  to  determine  which  are  primary  and  which 
secondary  effects  of  medicines;  and  the  decision  of  the  question  will 
often  rest  on  the  view  which  may  be  entertained  of  the  mode  of  action 
of  the  remedy.  In  the  instance,  for  example,  of  a  sedative  depressing 
the  cerebral  functions,  the  question  of  its  primary  or  secondary  action 
on  the  brain  will  be  determined  by  our  opinion  upon  the  point,  whether 
it  is  merely  carried  by  the  blood  to  the  brain,  or  operates  on  that  organ 
exclusively  through  changes  first  produced  in  the  blood,  incapacitating 
that  fluid  for  the  performance  of  its  proper  functions.  In  the  latter 
case,  the  characteristic  sedative  operation  of  the  medicine  must  be  con- 
sidered as  secondary.  But  it  is  the  safest  rule  to  consider  the  obvious 
effects  of  a  remedy  as  primary,  unless  some  intermediate  stage  in  its 
operation  can  be  positively  demonstrated,  or  rendered  extremely  probable 
by  observed  facts. 


CHAP.  II.]  EFFECTS    OF    MEDICINES.  27 


CHAPTER  II. 
Effects  of  Medicines. 

SECTION  I. 
Estimation  of  their  Powers  or  Effects. 

IN  treating  of  the  effects  of  medicines,  the  first  point  which  offers  itself 
for  consideration  is  the  method  by  which  they  can  be  ascertained.  Is  it 
possible  to  determine,  before  trying  a  medicine  upon  the  human  system, 
what  will  be  its  effects?  Do  its  sensible  or  chemical  properties,  its 
botanical  relations,  or  its  action  upon  inferior  animals,  afford  us  any 
facilities  in  this  respect  ? 

1.  Through  their  Sensible  Properties.    Much  importance  has  been 
attached  by  some  to  the  sensible  properties  of  colour,  taste,  and  smell. 
In  relation  to  the  first,  it  is  probably  altogether  useless.     The  times  are 
long  past,  when  a  correspondence  between  the  colour  of  a  medicine,  and 
that  of  the  fluids  or  solids  of  the  body,  was  considered  as  indicative  of  a 
therapeutic  relation ;    when,  for  example,  dragon's  blood  was  thought 
useful  in  hemorrhage  because  it  was  red,  and  turmeric  in  jaundice  because 
it  was  yellow.     The  smell  and  taste,  however,  are  more  significative; 
substances  resembling  each  other  in  these  respects,  having  in  maey  in- 
stances a  similarity  of  medicinal  effect.     Thus,  aromatics  are  usually 
excitant,  carminative,  and  anti-emetic ;  fetid  substances,  often  antispas- 
modic ;  sweet  substances,  demulcent ;  those  having  an  astringent  taste, 
styptic ;  and  bitters,  tonic :  but,  in  such  general  statements,  allowance 
must  be  made  for  so  many  exceptions  as  to  deprive  them,  in  a  great 
measure,  of  practical  value. 

2.  Through  their  Chemical  Relations.    Analogy  in  chemical  consti- 
tution is  also  not  unfrequently  attended  with  similarity  in  medical  vir- 
tues.     The  preparations  of  any  one  of  ttie   ordinary  metals  have  a 
remarkable  correspondence  in  their  effects  upon  the  system ;  and  there 
are  several  metals  which  greatly  resemble  one  another.     The  mineral 
acids,  the  vegetable  acids,  the  inorganic  alkalies,  and  the  neutral  salts  of 
the  alkalies,  constitute  groups,  of  which  one  individual  may  often  be 
substituted  for  another  without  disadvantage.     But  in  this  respect,  as 
well  as  in  relation  to  sensible  properties,  there  is  so  much  uncertainty, 


28  EFFECTS    OF    MEDICINES.  [PART  I. 

that  no  practical  conclusion  in  reference  to  the  properties  of  any  par- 
ticular medicine  should  be  relied  on  without  careful  trial. 

3.  Through  their  Botanical  Affinities.  The  same  may  be  said  of 
botanical  affinities;  though  more  importance  has  perhaps  been  attached 
to  these  than  to  either  of  the  preceding  grounds  of  judgment,  It  might 
indeed  be  inferred,  that  the  similarity  in  internal  constitution,  which 
gives  to  plants  those  resemblances  in  obvious  structure  which  serve  as 
the  basis  of  their  arrangement  into  natural  families,  would  also  give  them 
a  certain  identity  in  other  respects,  and  among  the  rest,  in  their  opera- 
tion upon  the  system ;  and  observation  has,  to  a  considerable  extent, 
confirmed  the  truth  of  the  inference  Plants  belonging  to  the  same 
genus  yield  very  frequently  not  only  similar,  but  identical  medical  pro- 
ducts. Thus,  the  oaks  yield  tannic  acid,  the  pines  oil  of  turpentine,  the 
cinchonas  quinia  and  cinchonia,  the  different  species  of  strychnos  strych- 
nia and  brucia,  the  gentians  gentianin,  the  poppies  morphia,  and  the 
garlics  a  characteristic  volatile  oil.  This  resemblance  extends  also  very 
frequently  to  much  larger  groups ;  and  many  of  the  natural  orders  of 
plants  have  great  similarity  in  medical  virtue.  Examples  of  this  we 
have  in  the  Malvaceae,  which  are  demulcent,  the  Oentianacese  tonic,  the 
Convolvulacese  purgative,  the  Solanacese  narcotic,  the  Euphorbiacese 
emeto- cathartic  and  acrid,  the  Pinacese  stimulant,  the  Brassicacese  stim- 
ulant, pungent,  and  acrid.  Yet  in  almost  every  family  there  are  instances, 
and,  in  some,  very  striking  instances,  in  which  not  only  are  the  charac- 
teristic medical  properties  wanting,  but  others  wholly  different,  and  even 
in  some  measure  opposite  are  possessed ;  while  similar  and  even  iden- 
tical medical  virtues  belong  to  plants  having  no  botanical  affinity  what- 
ever. Thus,  in  the  Convolvulacese  above  mentioned,  there  are  some 
species  wholly  destitute  of  purgative  properties,  as  the  esculent  sweet 
potato;  and  among  the  Solanacese  is  capsicum,  which  is  simply  stimu- 
lant, without  being  in  the  least  narcotic.  Among  the  Ranunculacem  is 
Hepatica,  which  is  slightly  astringent,  tonic,  and  demulcent;  Helleborua, 
powerfully  purgative  ;  Zanthorrhiza  and  Coptis,  simply  tonic;  Aronitum. 
acrid,  sedative,  and  narcotic ;  and  Gimicifuga,  chiefly  nervine.  Of  medi- 
cines having  analogous  properties,  yet  derived  from  different  families,  we 
have  examples  in  the  volatile  oil  of  Pimpinella  anisum,  belonging  to  the 
Umbelliferse,  and  that  of  Illicium  anisatum,  belonging  to  the  Anonacese; 
in  the  oil  of  turpentine  proceeding  from  the  Pinacese,  and  from  Pistacea 
Terebinlhus  of  the  Anacardiacex;  in  the  aromatic  products  of  the  Um- 
belliferse, Mi/risticacese,  Myrtacese,  and  Zingiberacese;  in  the  astringent 
roots  and  juices  of  plants  belonging  to  the  Fabacese,  Polygonacex,  Cin- 
chonacese,  Geraniacese,  and  many  other  families;  and  in  the  simple  bit- 
ter tonics  obtained  from  the  Oentianacex,  Simarubaceee,  Ranunculacese, 
and  Menixpermacese. 

But  in  reference  to  each  of  the  analogies  above  alluded  to,  the  sensible, 


CHAP.  II.]  EFFECTS    OF    MEDICINES.  29 

the  chemical,  and  the  botanical,  though  none  should  be  relied  on  in  esti- 
mating the  virtues  of  a  medicine,  yet  each  may  be  frequently  suggestive, 
and,  in  relation  to  any  new  subject  of  inquiry,  may  be  valuable  by  giving 
a  proper  direction  to  experimental  investigation.  / 

4.  By  Experiment  or  Observation  on  Inferior  Animals.     The  effects 
produced  on  the  inferior  animals  are  more  to  be  relied  on,  and  will  gen- 
erally be  a  safe  guide  to  the  employment  of  medicine  in  man ;  but  even 
thi.s  rule  is  not  without  exceptions.     It  is  well  known,  for  example,  that 
sheep,  goats,  and  cows  eat  with  impunity  the  leaves  of  Hyoscyamus 
niger,  which  are  highly  narcotic,  and  in  large  quantities  poisonous  to  the 
human  subject. 

5.  By  Observation  of  their  Effects  on  Man.     The  only  certain  means, 
therefore,  of  judging  of  the  effects  of  medicines,  is  to  observe  carefully 
their  operation  in  man ;  and,  even  in  this  mode,  multiplied  observation 
under  diversified  circumstances,  and  a  most  cautious  comparison  of  re- 
sults, are  necessary  in  order  to  arrive  at  the  truth.     From  the  want  of 
these  precautions,  many  errors  in  relation  to  the  action  of  medicines  have 
originated,  and  been  handed  down  from  writer  to  writer  for  many  years ; 
and,  even  at  the  present  time,  there  are  medicines  which  have  been  long 
in  use,  upon  the  precise  virtues  of  which  opinion  is  yet  unsettled. 

SECTION  II. 

Whether  the  Effects  are  Organic  or  Functional. 

The  effects  of  medicines,  in  other  words,  the  changes  produced  by  them 
in  the  system,  must  be  either  organic  or  functional ;  that  is,  must  consist 
in  an  alteration,  either  of  the  organization  or  structure,  or  of  the  function 
or  actions  of  the  body,  or  of  some  one  or  more  of  its  parts.  Some  have 
denied  that  there  can  be  any  change  of  action,  or  any  action  whatever, 
in  the  system,  without  change  of  structure,  and  consequently  that  the 
effects  of  medicines  can  ever  be  exclusively  functional.  This  denial  is 
founded  upon  the  assumption  that,  in  every  operation  of  a  living  system, 
there  is  necessarily  a  chemical  action,  an  oxidation  perhaps  of  some  por- 
tion, however  minute,  of  the  part  or  tissue  acting,  by  which  it  becomes 
disintegrated  and  thrown  off;  while  its  place,  in  the  healthy  state,  is 
supplied  with  new  structure.  This  may  be  true,  but  it  has  not  been 
proved ;  and,  in  the  mean  time,  cannot  be  received  as  the  basis  of  a  gen- 
eral theory  of  the  action  of  medicines.  But,  even  admitting  its  truth,  it 
does  not  follow  that  in  all  cases  of  physiological  action  there  must  be  an 
alteration  of  structure.  Suppose  an  organ  to  be  secreting.  The  general 
opinion  now  is  that  the  function  is  performed  by  the  agency  of  cells, 
which,  abstracting  the  material  of  the  secretion  from  the  blood,  elaborate 
it  when  elaboration  is  necessary,  and  then,  breaking  up  themselves,  are 


30  EFFECTS    OF    MEDICINES.  [PART  I. 

thrown  off  with  the  secreted  matter;  their  place  being  supplied  by  new 
cells.  There  has  not  been  necessarily  in  this  case  any  change  of  structure. 
One  or  more  cells  have  disappeared,  and  their  place  has  been  supplied 
by  one  or  more  new  cells  of  the  same  character  exactly.  The  organ  is 
precisely  as  before.  There  has  been  change  of  matter,  but  no  change  of 
structure  or  organization. 

Now  it  may  be  readily  conceived  that  a  medicine,  affecting  the  secre- 
tory function  of  an  organ,  shall  act  simply  by  increasing  or  diminishing 
the  rapidity  of  the  cell-action;  that,  in  the  time  required  in  health  for 
the  throwing  off  and  replacing  of  a  certain  number  of  cells,  twice  the 
number  may  undergo  the  same  process  in  the  one  case,  or  only  half  the 
number  in  the  other;  and  yet  the  organ  shall  remain  precisely  as  in 
health,  and  in  no  degree  altered ;  the  only  appreciable  difference,  even 
in  its  condition,  being  the  greater  or  less  amount  of  blood  contained 
within  it,  or  passing  through  it  in  a  given  time,  and  the  greater  or  less 
amount  of  the  secreted  product.  Medicines  may,  therefore,  change  the 
action  of  an  organ,  as  regards  the  degree  of  rapidity,  without  altering 
its  structure;  and  the  same  may  be  said  of  the  nature  of  the  action,  as 
indicated,  for  example,  by  the  character  of  the  secretion ;  for  a  cell  may 
elaborate  different  secretory  products,  according  to  the  quality  of  the 
blood,  or  of  the  foreign  materials  brought  with  it,  without  differing  in 
the  least  in  its  characteristic  form  or  structure  from  the  normal  cell. 

But,  throwing  aside  this  refinement  of  discussion,  we  may  assume  as 
functional  effects  all  that  are  not  attended  with  appreciable  structural 
change;  and  as  organic,  all  that  are  attended  with  such  change;  and 
this  is  the  meaning  which  I  attach  to  these  terms,  as  employed  in  the 
present  work. 

In  the  sense  just  referred  to,  the  effects  of  the  great  majority  of  medi- 
cines, as  ordinarily  used,  are  exclusively  functional ;  and  it  is  chiefly 
those  employed  externally,  to  inflame,  vesicate,  or  cauterize,  that  can  be 
said  to  operate  essentially  by  a  change  of  structure. 

SECTION  III. 
Characteristic  Effects  of  Medicines. 

Medicines  either  increase,  lessen,  or  alter  the  healthy  functions;  and, 
in  reference  to  these  several  effects,  are  called  tKmulants,  sedatives,  and 
alteratives;  the  effects  themselves  being  distinguished  by  the  names  <>l 
stimulation,  sedation,  and  alteration.  It  has  been  maintained  iliat,  from 
the  very  nature  of  the  vital  functions,  medicines  can  affect  them  in  no 
other  way  than  either  by  increasing  or  diminishing  them,  and  that  they 
differ  from  each  other  only  in  the  degree  in  which  they  produce  t hex- 
effects  respectively,  or  in  the  s<-at  of  their  action.  But  this  doctrine  ir- 


CHAP.  II.]  EFFECTS    OF    MEDICINES.  31 

purely  hypothetical,  and  is  opposed,  apparently  at  least,  by  numerous 
facts.  Nothing:  is  more  common  than  to  witness  peculiar  effects  from 
different  medicines,  without  any  observable  increase  or  diminution  of  the 
vital  functions;  and  this  difference  may  often  be  observed  in  medicines 
acting  on  the  same  part.  Besides,  in  relation  to  those  which  are  essen- 
tially either  stimulant  or  sedative,  we  observe  characteristic  peculiarities 
which  cannot  be  ascribed  either  to  the  degree  or  direction  of  their  action. 
Thus,  in  relation  to  medicines  the  effects  of  which  are  visible,  we  have 
intense  redness  with  comparatively  little  tendency  to  vesication  from 
mustard,  a  less  degree  of  redness  with  large  vesication  from  cantharides, 
a  copious  vesicular  eruption  from  croton  oil,  a  peculiar  pustular  eruption 
from  tartar  emetic,  and  the  production  of  urticarious  wheals  from  the 
nettle,  all  acting  on  the  same  portion  of  the  surface,  and  all  excitant 
in  their  operation.  Now  it  is  possible  that,  in  these  and  similar  cases, 
the  result  may  be  owing  to  the  direction  of  the  action  of  the  irritants 
severally  to  some  distinct  constituent  of  the  skin ;  but  this  has  not  been 
proved;  and,  in  reference  to  a  great  number  of  the  peculiar  effects  of 
medicines,  such  a  direction  to  distinct  constituents  of  the  structure  is 
altogether  insusceptible  of  proof.  In  the  present  state  of  knowledge, 
therefore,  it  is  best  to  admit,  as  the  result  of  observation,  that  medicines 
do  materially  differ  in  the  nature  of  their  effects,  independently  of  degree 
and  position ;  and  to  leave  to  further  investigation  the  determination  of 
the  precise  nature  of  the  causes  which  occasion  such  difference. 

Another  opinion  denies  the  existence  of  directly  sedative  or  alterative 
medicines,  maintaining  that  all  substances  which  act  on  the  system  are 
essentially  stimulant,  and  that  whatever  sedative  effects  may  be  pro- 
duced are  purely  secondary.  According  to  one  view,  medicines  operate 
on  the  vital  excitability,  producing  primarily  an  elevation  of  action, 
which  is  followed  by  secondary  depression  in  consequence  of  the  exhaus- 
tion of  the  excitability;  and  whenever  a  direct  depression  takes  place,  it 
is  in  consequence  of  the  diminution  of  the  ordinary  healthy  excitants,  as 
through  the  influence  of  cold,  abstinence,  etc.  According  to  a  second 
view,  medicines  operate  as  foreign  bodies,  offensive  to  the  economy,  in 
which,  consequently,  an  excess  of  action  is  induced  in  order  to  rid  it  of 
the  offending  cause ;  in  other  words,  all  medicines  operate  by  calling 
forth  vital  reaction,  as  inflammation  is  induced  in  a  part  by  the  presence 
of  a  foreign  body,  in  order  either  to  isolate  it  by  a  coating  of  coagulable 
lymph,  or  to  throw  it  off  through  the  agency  of  suppuration  and  ulcer- 
ation.  But  in  opposition  to  all  such  purely  hypothetical  views  is  the 
simple  fact,  that  certain  medicines,  when  brought  into  contact  with  cer- 
tain parts  or  organs  of  the  body,  are  immediately  followed  by  a  depres- 
sion of  function  in  those  parts  or  organs,  without  any  other  discoverable 
intervening  derangement;  just  as,  under  similar  circumstances,  certain 
other  medicines  are  followed  by  immediate  increase  of  function  ;  and  the 


32  EFFECTS    OF    MEDICINES.  [PART  I. 

obvious  explanation  is,  that  the  susceptibilities  of  the  parts  are  such  that 
the  presence  of  a  body  constituted  in  one  mode  occasions  depression,  that 
of  another,  differently  constituted,  excess  of  excitement. 

But,  admitting  that  some  medicines  are  stimulant,  others  sedative,  and 
others  again  alterative,  we  are  not  called  on  to  believe  that  any  one 
medicine  is  essentially  one  or  the  other  under  all  circumstances.  Much 
and  very  unnecessary  discussion  has  taken  place  in  relation  to  particular 
medicines,  whether  they  were  stimulant  or  sedative.  It  might  all  have 
been  spared  by  the  admission  of  the  simple  truth,  that  the  same  medi- 
cine may  be  stimulant  or  sedative  according  to  the  part  upon  which  it 
acts,  or  the  state  of  the  system,  or  parts  of  the  system,  at  the  time  of  its 
action.  Thus,  tartar  emetic  is  stimulant  to  the  skin  or  mucous  coat  of 
the  stomach,  but  sedative  to  the  heart ;  digitalis,  which  depresses  directly 
the  circulation  and  nervous  system,  excites  the  kidneys;  and  opium,  at 
the  same  time  that  it  stimulates  the  heart  and  brain,  diminishes  secre- 
tion. These  different  primary  effects  of  the  same  medicine  are  dependent 
on  the  different  susceptibilities  of  the  parts  affected,  rendering  them  liable 
to  opposite  impressions  from  the  same  cause;  and,  as  these  susceptibili- 
ties are  often  different  in  disease  and  health,  the  same  medicine  may 
'produce  opposite  effects  in  these  two  states.  Thus,  Cayenne  pepper, 
which  produces  in  the  healthy  fauces  redness  and  burning  pain,  an 
a  sedative  in  the  sore-throat  of  scarlet  fever.  A  mere  difference  in  the 
mode  in  which  a  medicine  is  employed  may  cause  it  to  be  either  stimu- 
lant or  sedative.  A  concentrated  solution  of  acetate  of  lead  applied  to 
the  skin  denuded  of  its  epidermis,  or  to  a  mucous  membrane,  acts  as  an 
irritant;  while  the  same  solution,  very  much  diluted,  will  operate  as  a 
sedative  through  the  peculiar  powers  of  the  medicine.  This  principle  is 
of  great  importance  in  therapeutics,  as  will  be  hereafter  more  particularly 
shown. 

The  consideration  of  the  special  phenomena,  wrhether  of  stimulation, 
depression,  or  alteration,  produced  by  particular  medicines  or  classes  of 
medicines  in  the  several  functions,  belongs  to  the  department  of  special 
therapeutics.  ,  It  is  obvious  that  they  must  be  extremely  diversified, 
from  the  difference  in  the  degree  and  nature  of  the  action  of  the  medi- 
cine, from  its  direction  to  one  or  to  several  functions  at  the  same  time, 
and  from  the  great  diversity  in  the  character  of  the  functions  affected. 

SECTION   IV. 

Influences  Modifijiny  iJte  Effects  of  Medicines. 

The  circumstances  which  are  calculated  to  modify  the  ordinary  and 
characteristic  action  of  medicines  should  always  be  taken  into  account 
by  the  physician.  These  may  be  divided  into  such  as  relate  especially 


CHAP.  II.]  EFFECTS    OF    MEDICINES.  33 

to  the  medicines,  and  such  as  relate  to  the  system.  The  former  will  be 
more  conveniently  treated  of  when  the  medicines  themselves  are  con- 
sidered. A  few  general  remarks,  in  relation  to  the  latter,  will  be  appro- 
priate in  the  present  place.  To  enter  into  minute  particulars  would  be 
quite  impossible  ;  as  there  is  scarcely  a  change,  whether  consequent 
upon  the  healthy  progress  of  the  body  from  birth  to  old  age,  or  upon  the 
operation  of  morbid  causes,  which  does  not  in  some  measure  influence 
the  effects  produced  by  medicines.  Many  of  these  influences  will  be 
referred  to  in  connection  with  the  several  medicines  or  remedies  de- 
scribed; but  much,  in  practice,  must  always  be  left  to  the  observation, 
experience,  and  judgment  of  the  physician. 

The  modifying  influences  may  bfi  such  as  are  essentially  connected 
with  our  bodily  constitution  in  health,  or  such  as  are  more  or  less  acci- 
dental. The  first  may  be  ranked  under  the  heads  of  age,  sex,  temper- 
ament, and  idiosyncrasy ;  the  second  under  disease,  climate,  habit,  modes 
of  life,  and  mental  action. 

1.  Age.  It  is  a  general,  though  not  universal  law  of  nature,  that  sus- 
ceptibility to  the  influence  of  medicine  is  inversely  proportionate  to  the 
size  of  the  animal.  This  probably  results  chiefly  from  the  greater  amount 
of  a  medicine  required  to  give  a  certain  degree  of  impregnation  to  the 
blood  of  the  larger  animal  than  the  smaller.  The  medicine  acts  on  dif- 
ferent bodies,  not  in  proportion  to  its  absolute  quantity  in  the  blood,  but 
to  the  quantity  of  it  which  is  brought  to  bear  upon  each  point  acted 
on,  in  other  words,  to  the  strength  of  its  solution  in  the  blood.  Under 
the  rule  here  referred  to,  the  child  should  be  more  susceptible  to  the  in- 
fluence of  medicines  than  the  adult,  and  should  consequently  be  affected 
by  smaller  quantities.  But  there  is  another  reason,  also,  for  the  greater 
susceptibility  of  early  life.  In  the  growing  state,  greater  impressibility  and 
mobility  are  essential,  in  order  that  there  may  be  a  more  rapid  assimilation 
of  external  material,  and  a  due  arrangement  of  the  organism.  The  higher 
susceptibility  to  impression  must  extend  to  medicines,  as  well  as  to  all 
other  impressing  agents.  Still  another  cause  of  difference,  in  this  re- 
spect, between  the  young  and  the  old,  is  the  absence  or  less  degree,  in 
the  former,  of  the  influence  of  habit  in  diminishing  susceptibility.  I  do 
not  here  allude  to  the  habit  of  using  medicines;  for  the  cause  operates 
though  no  medicine  may  ever  have  been  taken.  The  general  impres- 
sibility of  the  system  diminishes  by  time  under  the  necessary  influence 
of  external  agents ;  and  this  law  holds  good  even  in  relation  to  particular 
agents  to  which  the  system  may  never  have  been  exposed,  though  it 
would  be  less  operative  in  reference  to  these  than  to  others. 

It  is  impossible  to  give  any  precise  rule  for  proportioning  the  dose  to 
the  age ;  because  different  individuals  exhibit  a  great  difference  in  this 
respect;  and  there  is  a  remarkable  diversity  in  reference  to  medicines; 
VOL.  i. — 3 


34  EFFECTS    OF    MEDICINES.  [PART  I. 

some,  as  opium,  producing  in  children  more  thnn  the  mean  proportionate 
effect;  others,  as  castor  oil  and  calomel,  much  less.  It  may  be  said,  in 
general  terms,  that  the  dose  for  an  individual  under  maturity  should  be 
proportioned  to  the  years  of  his  age.  This  holds  good  in  relation  to  all 
ages  between  12  and  24,  at  the  latter  of  which  periods  of  life,  the  full 
dose  may  be  given.  From  the  age  of  twelve  downwards  to  two  years,  the 
rule  of  Dr.  Young  is  perhaps  as  good  as  any  that  can  be  given  ;  namely, 
that  the  dose  proper  for  an  adult  should  be  diminished,  for  a  child,  in  the 
proportion  of  the  age  increased  by  twelve  to  the  age.  Thus,  the  age 
being  three  years,  and  the  dose  for  an  adult  20  grains,  the  diminution 
must  be  in  the  proportion  of  3+12  =  15  to  3;  or,  the  quantities  being 
reduced  to  their  lowest  terms,  of  5  to  1 ;  that  is,  the  dose  for  the  child 
must  be  one-fifth  of  that  for  the  adult,  or  in  the  present  instance  4  grains. 
At  one  year  the  dose  may  be  one-ninth ;  at  nine  months,  one-tenth  ;  at 
six  months,  one-twelfth;  at  three  months,  one-fifteenth;  at  one  month, 
one-twentieth  ;  but  it  must  be  admitted  that  these  numbers  are  nothing 
more  than  safe  approximations.  From  full  maturity  to  the  commence- 
ment of  declining  life,  that  is,  from  about  twenty-four  to  forty-eight,  the 
dose  may  remain  unchanged ;  but,  after  the  latter  period,  it  should  be 
somewhat  diminished  with  the  increasing  age,  not  because  the  system 
becomes  more  susceptible;  for,  as  a  general  rule,  it  is  less  so;  but  be- 
cause it  is  less  able  to  sustain,  without  injury,  a  given  impression  from 
medicines  than  in  the  full  vigour  of  life. 

2.  Sex.  It  is  necessary  to  say  but  little  under  this  head.  There  are 
certain  conditions  in  the  female  which  require  attention  in  the  prescrip- 
tion of  medicines,  which,  however,  cannot  be  said  to  exert  any  materially 
modifying  influence  over  their  effects,  and  do  not,  therefore,  require  par- 
ticular attention  in  this  place.  Such  is  pivgnancy,  which  demands 
especial  caution  in  the  use  of  all  medicines  having  a  direct  influence  on 
the  womb,  and  which,  in  its  advanced  stages,  contraindicates  the  use  of 
any  medicine  whatever  of  a  powerfully  perturbating  character.  Such, 
too,  is  the  menstrual  state,  in  which  care  is  required,  in  the  employment 
of  remedies,  to  guard  against  any  interference  with  the  uterine  function. 
Another  important  point,  of  a  similar  bearing,  is  the  caution  requisite, 
in  the  cases  of  nursing  women,  not  to  use  medicines  which  might  injure 
the  suckling ;  and  a  similar  caution  may  be  very  properly  extended  to 
pregnancy,  in  which,  while  prescribing  for  the  female,  we  should  al \vays 
bear  in  mind  that  there  is  another  being  to  be  affected  by  the  remedy 
employed. 

So  far  as  concerns  the  modifying  influence  of  sex  upon  the  effects  of 
medicines,  the  only  circumstance  of  importance  is.  that  women,  being 
smaller,  more  delicately  organized,  and  in  general  more  susceptible  than 
men.  require  a  smaller  amount  to  produce  a  given  etVeet.  The  dose  for 
females  should,  therefore,  be  somewhat  reduced.  From  one-Mxth  to 


CHAP.  II.]  EFFECTS    OF    MEDICINES.  35 

one-quarter  may  be  deducted  for  them  from  the  dose  proper  for  the  male 
at  the  same  age. 

3.  Temperament.    Temperament  should  receive  some  attention  in  the 
administration  of  medicines ;  but  the  judicious  physician  will  probably 
be  influenced  in  relation  to  it  more  by  his  general  principles  than  by  any 
special  precepts.  The  sanguine  temperament  obviously  demands  caution 
in  the  administration  of  stimulants,  and  the  nervous  in  that  of evacuants: 
while  the  phlegmatic,  being  characterized  by  a  general  deficiency  of  sus- 
ceptibility, admits  and  requires  a  freer  use  of  medicines  in  reference  to  a 
given  effect. 

4.  Idiosyncrasy.   Individual  peculiarity,  technically  denominated  idi- 
osyncrasy, is  of  much  greater  importance,  and  can  scarcely  receive  from 
the  physician  a  too  careful  attention.     In  very  many  individuals,  per- 
haps it  may  be  said  in  nearly  all,  there  is  some  peculiarity,  in  relation 
to  the  effects  of  a  particular  medicine,  or  possibly  of  more  than  one, 
which,  if  unknown  or  neglected,  may  lead  to  serious  inconvenience  or 
injury,  and  even  to  fatal  results.     This  peculiarity  sometimes  consists 
merely  in  an  excessive  susceptibility,  or  in  an  abnormal  insusceptibility 
to  the  action  of  the  medicine  or  medicines;  so  that  an  ordinary  dose 
might,  in  the  former  case,  act  with  dangerous  violence,  and  in  the  latter 
not  act  at  all.     This  is  strongly  illustrated  in  the  not  unfrequently  unex- 
pected results  from  the  use  of  the  mercurial  preparations.    In  more  than 
one  instance  that  might  be  adduced,  a  moderate  dose  of  calomel  or  other 
mercurial  has  acted  so  powerfully,  in  consequence  of  a  remarkable  con- 
stitutional susceptibility  to  its  influence,  as  to  occasion  death;  and  every 
experienced  practitioner,  who  has  used  this  medicine  habitually,  must 
have  witnessed  instances  of  unexpected  violence  in  its  action;  while,  in 
other  cases,  from  defective  susceptibility,  it  is  quite  impossible  to  bring 
about  its  peculiar  effects  on  the  system  by  any  quantity  that  can  be 
given,  with  any  regard  to  prudence.     The  instance  of  mercury  has  been 
brought  forward  simply  as  a  striking  example ;  but  there  is  scarcely  an 
efficient  article  of  the  materia  medica,  in  relation  to  which  there  does 
not  exist,  in  some  one  or  more  persons,  a  similar  excess  or  deficiency  of 
susceptibility. 

But  the  idiosyncrasy  is  not  unfrequently  also  of  such  a  nature  as  to 
vender  the  effects  of  a  medicine  altogether  different  from  those  which  it 
ordinarily  produces.  The  well-known  and  often-cited  example  of  ipe- 
cacuanha, in  causing  by  its  mere  smell  an  asthmatic  paroxysm  in  certain 
persons,  is  strikingly  illustrative  of  this  fact.  Other  examples  are  offered 
in  the  cutaneous  eruption  produced  in  some  individuals  by  copaiba  and 
the  turpentines,  the  irregular  and  very  inconvenient  effects  sometimes 
resulting  from  opium,  and  the  occasional  peculiar  and  poisonous  opera- 
tion of  mercury,  altogether  different  from  its  proper  action.  I  have 
known  so  innocent  a  medicine  as  pipsissewa  (Chimaphila  umbellata), 


3C  EFFECTS    OF    MEDICINES.  [PART  I. 

given  in  the  form  of  decoction,  in  the  dose  of  a  wineglassful,  to  cause 
a  most  violent  attack  of  erythematous  inflammation  of  the  mouth  and 
face. 

These  idiosyncrasies  are  sometimes  also  developed  by  disease,  so  as  TO 
render  individuals  susceptible  to  effects  from  medicines  quite  different 
from  those  expected,  and  sometimes  even  directly  opposite. 

Whether  original  or  acquired,  they  should  claim  the  careful  attention 
of  the  practitioner,  who  should  never  neglect  information  in  reference 
to  such  peculiarities  that  may  be  volunteered  by  the  patient,  and  should 
lay  up  in  his  memory,  for  future  use,  all  that  he  may  witness  in  his  own 
experience  or  observation.  A  physician  thoroughly  acquainted,  from 
habitual  attendance,  with  all  the  constitutional  peculiarities  of  his  patient 
in  reference  to  the  effects  of  medicines,  often  has  great  advantages  in 
treatment  over  others  without  any  experience  of  the  kind. 

5.  Disease.  Reference  has  already  been  more  than  once  made  to  the 
influence  of  disease  in  modifying  the  effects  of  medicines.  Not  only 
is  the  susceptibility  to  their  influence  greatly  increased  in  some  instances, 
and  greatly  diminished  in  others,  but  new  susceptibilities  are  occasionally 
awakened,  and  effects  wholly  abnormal,  or  at  least  apparently  so,  are  ex- 
perienced. Thus,  inflammation  of  the  stomach  so  much  increases  the 
susceptibility  to  the  influence  of  emetics,  that  a  minute  fraction  of  the 
ordinary  dose  will  often  operate;  while,  in  certain  nervous  affections,  as 
delirium  tremens  for  example,  there  is  an  almost  equal  diminution  of 
susceptibility,  and,  in  some  instances,  enormous  doses  are  required  to 
produce  vomiting.  In  certain  morbid  conditions  of  the  brain,  a  little 
opium  will  excite  to  phrensy ;  in  others,  it  is  with  the  utmost  difficulty 
that  the  medicine  can  be  brought  to  operate,  as  in  tetanus  and  certain 
forms  of  mania.  In  diarrhoea,  opium  often  cheeks  the  evacuations,  in 
colic,  on  the  contrary,  favours  the  action  of  cathartic  medicine.  Certain 
conditions  of  disease  have  a  powerful  influence  over  the  effects  of  medi- 
cines by  impeding  their  absorption.  Thus,  any  morbid  state  of  the  liver, 
which  retards  the  circulation  of  the  portal  blood  through  that  orjMii. 
must  produce  general  congestion  of  the  bowels,  and  consequently  offer  a 
strong  impediment  to  the  entrance  of  the  medicine  into  the  circulation. 
But,  in  this  place,  all  that  is  necessary  is  simply  to  notice  the  modifying 
influence  of  disease,  and  to  impress  on  the  mind  of  the  student  the  indis- 
pensable necessity  of  attending  to  it.  The  peculiarities  in  this  respect 
of  different  morbid  states,  must  be  studied  along  with  the  several  dis- 
(MH'S  iii  which,  or  the  several  medicines  in  reference  to  which,  they 
displayed. 

6.  Climate.    Climate  acts  by  altering  the  state  of  the  system.     S 
times  the  change  is  so  great  as  to  amount  to  di-casc;  and  then  the 
influence  of  this  modifying  cause  is  merged  in  that  of  the  one  last  con- 
sidered.    But  climate  also  affects  the  functions  in  a  manner  which  can 


CHAP.  II.]  EFFECTS    OF    MEDICINES.  37 

scarcely  be  considered  pathological ;  as  the  result  is  experienced  more 
or  less  by  the  whole  community;  and,  though  the  state  of  system  under 
any  particular  climatic  influence  may  be  less  vigorous,  or  less  perfectly 
balanced,  than  under  more  favourable  circumstances,  it  is  nevertheless 
the  health  of  that  region  where  the  influence  prevails.  The  following 
may  be  mentioned  as  examples  of  the  modifying  influence  of  climate 
over  the  eifects  of  medicine.  In  cold  climates  the  susceptibility  to  alco- 
holic stimulants  is  much  less  than  in  the  hot ;  probably  because,  in  the 
former,  much  of  the  stimulant  is  consumed  in  the  lungs  for  the  pro- 
duction of  heat,  and  thus  thrown  off  from  the  system;  while  in  the 
latter,  in  which  heat  is  already  in  superfluity,  none  of  the  alcohol  is  con- 
sumed  in  the  lungs,  and  more  of  it  is  consequently  retained  to  act  upon 
the  brain.  ]n  hot  climates,  calomel  acts  less  energetically  on  the  liver 
than  in  cold,  probably  from  the  diminished  general  susceptibility  of  that 
organ,  consequent  upon  its  habitual  over-excitement.  In  miasmatic 
districts,  blood-letting  and  other  evacuant  measures  are,  in  general,  not 
so  wejl  borne  as  in  regions  exempt  from  malarial  influence ;  while 
quinia  may  be  given  with  a  freedom  which  elsewhere  might  be  hazard- 
ous. But  the  modifications  produced  by  climate  in  the  operation  of 
medicines  have  not  been  investigated  with  sufficient  accuracy  and  pre- 
cision, to  justify  anything  more  than  very  general  statements  upon  the 
subject. 

7.  Habit.  This  is  a  powerful  agency.  Its  effect  is  almost  uniformly 
to  lessen  the  susceptibility  to  the  influence  of  medicines,  and  thus  to 
require  an  increase  of  their  dose  for  the  production  of  a  certain  amount 
of  impression.  In  relation  to  medicines  which  are  purely  functional  in 
their  operation,  this  augmentation  of  the  dose,  under  the  influence  of 
habit,  may  be  carried  on  almost  indefinitely.  The  quantities  of  alcohol 
and  of  opium  to  which  the  system  may  become  accustomed,  with  present 
impunity,  are  enormous.  It  is  not  exactly  the  same  with  medicines 
of  powerful  chemical  action,  corrosive  mineral  substances  for  example; 
for,  though  the  quantity  may,  through  the  agency  of  habit,  be  very  con- 
siderably increased  beyond  what  could  be  borne  without  its  aid,  yet,  at 
a  certain  point,  the  chemical  forces  necessarily  overcome  the  vital  re- 
sistance of  the  tissues,  and  decomposition  must  take  place.  The  mineral 
acids,  therefore,  the  caustic  alkalies,  and  the  corrosive  metallic  salts, 
such  as  nitrate  of  silver,  corrosive  sublimate,  and  sulphate  of  copper, 
cannot  be  indefinitely  increased  without  the  danger  of  great  organic 
mischief.  •  But  it  must  be  remembered  that,  even  with  those  acting 
functionally,  the  ultimate  eifects  are  in  the  highest  degree  injurious, 
either  through  chronic  inflammation,  induced  at  length  by  the  constant 
irritation  sustained,  or  by  the  failure  of  susceptibility  to  the  ordinary 
vital  stimuli,  and  the  consequent  loss  of  all  power  of  action. 

The  rule  in  relation  to  the  effect  of  habit  in  diminishing  susceptibility 


38  EFFECTS    OF    MEDICINE?.  [PART  I. 

is  probably  universal.  There  are,  it  is  true,  some  apparent  exception >  -. 
as  in  the  case  of  emetic  substances,  which  often  operate,  on  successiv 
occasions,  in  successively  diminishing  doses;  but  the  exception  is  only 
apparent;  for  the  result  in  this  case  is  ascribable  not  directly  to  the 
medicine,  but  to  a  diseased  state  of  irritation  produced  by  it,  which 
itself  is  sufficient  to  induce  vomiting.  If  an  emetic  substance  is  given 
at  first  in  a  small  dose,  and  afterwards  gradually  increased,  the  stomach 
becomes  accustomed  to  it,  and  very  large  quantities  may  be  given  with- 
out provoking  vomiting. 

The  practical  inferences  from  this  effect  of  habit  are,  1.  that  when  it  is 
desirable  to  maintain  for  a  long  time  a  given  medicinal  impression,  the 
dose  should  be  gradually,  but  at  the  same  time  cautiously  increased.  BO 
as  not  too  rapidly  to  wear  out  the  susceptibility;  2.  that  when  one  medi- 
cine has  been  given  so  long  as  materially  to  impair  its  powers,  another 
of  analogous  mode  of  action,  but  exerting  its  influence  on  a  differ 
tissue  or  part,  should  be  substituted,  until  the  susceptibility  to  the  firs: 
returns;  and  3.  that,  in  omitting  a  medicine  which  has  been  long-  -giver. 
in  gradually  increasing  quantities,  it  should  be  withdrawn  gradually 
its  place  should  be  supplied  for  a  time  with  another  of  similar  but  feebler 
powers,  lest  the  system  or  part  should  suffer  from  the  want  of  an  influ- 
ence to  which  it  had  become  habituated,  and  which  might  be  essential  to 
the  performance  of  its  proper  functions. 

8.  Modes  of  Living.  The  occupation  and  mode  of  life  of  an  indi- 
vidual modify  the  action  of  medicines,  in  so  far  as  they  affect  the  condi- 
tion of  his  system.  But  it  would  be  quite  impossible,  in  the  pre- 
place,  to  follow  out  this  influence  into  all  its  results.  Little  more  can  In- 
done  here  than  to  call  attention  to  its  existence.  One  consideration, 
however,  is  worthy  of  notice,  as  it  has  a  general  bearing,  and  can  }>•• 
brought  forward  nowhere  else  so  appropriately.  Firm  and  vigorous 
health  affords  the  strongest  resistance  to  all  disturbing  influences,  and 
consequently  to  the  action  of  medicines,  which  must,  therefore,  be  given 
more  freely,  to  produce  a  certain  effect,  than  in  conditions  of  the  system 
either  above  or  below  that  standard.  This  is  true  in  relation  not  only 
to  medicines  which  stimulate,  but  to  those  also  which  depress  or  alter  the 
vital  functions.  Thus,  persons  in  full  health  will  bear  both  the  stimulan: 
influence  of  alcohol,  and  the  sedative  operation  of  digitalis,  better  than 
the  plethoric  or  the  feeble.  But  it  must  be  remembered  that  full  healti 
does  not  consist  in  that  richness  and  abundance  of  blood,  and  that  high 
activity  of  the  functions,  which  are  sometimes  mistaken  for  itT  Th 
indeed  a  condition,  if  not  itself  morbid,  at  least  closely  bordering  on  dis- 
ease, and  capable  of  being  excited  into  positive  disease  by  slight  causes. 
The  system  is  most  healthy  when  all  its  parts  and  all  its  functions  are 
in  due  relation;  when  tin-  quantity  and  quality  of  the  blood  are  in  exa- •-. 
accordance  with  the  offices  it  has  to  perform  in  the  economy :  when  the 


CHAP.  II.]  EFFECTS    OF    MEDICINES.  39 

nervous  system  has  no  higher  nor  lower  activity  than  is  sufficient  to 
maintain  every  function  in  its  just  vigour  and  subordination ;  and  when 
no  one  organ  or  apparatus  is  excessively  or  deficiently  developed.  It  is 
in  this  condition  of  system  that  medicines  are  best  borne,  and  that,  upon 
the  occurrence  of  disease,  vigorous  treatment  may  be  most  safely  adopted. 
Modes  of  life,  therefore,  which  tend  to  produce  an  over-elevated  condition 
of  system  on  the  one  hand,  or  a  debilitated  condition  on  the  other,  render 
peculiar  caution  advisable  as  to  the  quantity  of  medicines  employed,  and 
the  energy  of  the  treatment  in  general. 

9.  Mental  Action.  The  influence  of  the  mind  over  the  operation  of 
medicines  is  often  very  considerable.  As  a  general  rule,  they  will  act 
with  greater  certainty  when  their  legitimate  effects  are  known  and  ex- 
pected. An  emetic  will  be  more  likely  to  vomit,  if  the  patient  anticipate 
this  effect  from  it.  The  co-operation  of  faith  with. the  medicine  will 
often  favour  its  action.  This  is  more  especially  true  when  the  nervous 
system  is  prominently  concerned.  The  full  belief  in  the  efficacy  of  quinia 
in  intermittent  diseases  aids  considerably  in  the  prevention  of  the  parox- 
ysm. But  mental  causes  sometimes  interfere  with  the  regular  operation 
of  a  medicine.  When  this  is  given  to  procure  sleep,  especially  in  divided 
doses,  at  certain  intervals,  if  the  patient  is  made  acquainted  with  the  ob- 
ject, his  anxiety  for  the  result  may  tend  to  prevent  it.  I  have  noticed, 
when  I  have  directed,  with  the  knowledge  of  the  patient,  a  certain  dose 
of  opium  to  be  given  at  bedtime,  and  repeated,  at  intervals  of  an  hour, 
until  sleep  is  produced,  or  a  certain  number  of  doses  have  been  exhibited, 
that  the  whole  quantity  prescribed  is  generally  taken.  The  nervous  dis- 
turbance occasioned  by  the  expectation  of  the  next  dose,  and  the  watch- 
fulness for  the  appointed  time,  tend  to  keep  the  patient  awake.  Hence, 
in  prescribing  an  anodyne  in  this  way,  particular  care  should  be  taken 
that  the  patient  shall  not  know  that  the  dose  is  to  be  repeated  if  requi- 
site. It  is  to  mental  influence  that  empiricism  is  partly  indebted  for  its 
seeming  triumphs,  especially  in  nervous  diseases;  and  regular  practi- 
tioners sometimes  employ  bread  pills,  with  the  happiest  effect,  in  accom- 
plishing certain  results  which  the  patient  has  been  previously  taught  to 
expect. 


40  APPLICATION    OF    MEDICINES.  [PART  I. 


CHAPTER  III. 
Application  of  Medicines. 

MEDICINES  have  hitherto  been  considered  in  relation,  not  so  much  to 
their  application  to  the  cure  of  disease,  as  to  their  modes  of  affecting  the 
system  in  health.  It  now  remains  to  consider  them  more  especially  in 
the  former  capacity;  and,  in  doing  this,  it  will  be  convenient  to  treat  first 
of  the  several  modes  in  which  they  may  operate  in  the  cure  of  disease, 
secondly  of  the  forms  in  which  they  may  be  applied,  and  thirdly  of  the 
parts  through  which,  and  the  means  by  which  they  may  be  introduced 
into  the  system.  The  remarks  which  follow  apply  not  only  to  medi< 
strictly  so  called,  but  to  all  other  remedies.  ' 

SECTION  I. 

Modes  of  Therapeutic  Action,  or  Therapeutic  Processes* 

These  may  be  arranged  under  the  heads  of  1.  depict /  >n  ;  2.  repletion  ; 
3.  dilution;  4.  elimination;  5.  stimulation;  6.  sedation;  7.  revulsion; 
8.  supersession;  9.  alteration;  10.  contra-causalion  ;  11.  chemical  ac- 
tion; and  12.  mechanical  action. 

SUBSECTION  I. 
Depletion. 

1.  Nature  of  Depletion.  By  this  term  is  here  meant  diminution  of 
the  blood,  in  relation  either  to  the  whole  mass,  or  to  some  one  or  more 
of  its  constituents.  As  it  is  these  constituents  of  the  blood  to  which, 

*  The  reader  who  may  be  familiar  with  my  Treatise  on  the  1'raetice  of  Medicine, 
in  any  of  its  editions  before  the  fifth,  will  recognize,  in  the  observations  Which  fol- 
low, many  things  which  he  has  met  with  in  that  work.  These  were  not  .introduced 
into  the  present  treatise  inadvertently.  They  essentially  belong  to  it.  and  could  not 
be  omitted  without  leaving  the  treatise  imperfect.  Their  insertion  here,  moreover. 
gave  me  the  opportunity,  in  revising  the  work  on  the  Practice  for  the  fifth  edition, 
of  dropping  in  the  revision  the  subjects  here  treated  of,  and  supplying  the  space 
thus  gained  with  new  matter  of  a  practical  nature,  which  is  ever  in  the  course  of 
discovery  and  accumulation. 


CHAP.  III.]  APPLICATION    OF   MEDICINES.  41 

both  through  the  material  they  furnish,  and  the  stimulus  they  apply,  all 
the  vital  functions  owe  their  support,  and  the  organs  their  due  nutrition, 
the  abstraction  of  them  must  necessarily  occasion,  in  the  ordinary  state 
of  the  system,  a  depression  of  action  and  reduction  of  strength.  It  is  not 
only,  however,  by  diminishing  the  quantity  of  blood  that  depletion  oper- 
ates, but  also  by  altering  its  quality.  When  a  portion  of  the  blood  is 
abstracted,  the  place  of  the  solid  constituents  withdrawn  is  rapidly  sup- 
plied by  the  process  of  absorption,  so  that  its  former  volume  is  soon 
restored  ;  but,  as  water  is  absorbed  in  much  greater  proportion  relatively 
than  the  solid  ingredients,  the  blood  becomes  diluted,  and  is,  therefore, 
less  capable  of  performing  its  due  office  in  the  economy.  Depletion  de- 
presses especially  the  force  of  the  heart,  and  of  the  whole  circulatory 
system.  It  diminishes  also  digestion,  respiration,  secretion,  nutrition, 
calorification,  and  the  functions  of  animal  life.  This  last  effect  is  ren- 
dered obvious  when  the  depletion  is  carried  far.  Languor,  impaired 
sensation,  deficient  emotional  and  intellectual  energy,  muscular  weak- 
ness, even  faintness,  and  positive  syncope,  result  from  the  failure  of  the 
due  influence  of  the  blood  upon  the  brain. 

But,  with  this  general  diminution  of  the  vital  powers  and  actions, 
there  is  one  function  which  depletion  promotes,  that,  namely,  of  absorp- 
tion. To  supply  the  loss  of  blood,  the  liquids  and  solid  tissues  of  the 
body  are  taken  up  with  more  than  the  usual  rapidity,  and  water  is  co- 
piously absorbed  from  the  contents  of  the  alimentary  canal,  and  perhaps 
also  from  the  external  air. 

Notwithstanding  what  has  just  been  stated,  depletion  is  not  always 
purely  sedative ;  and  this  is  a  very  important  therapeutical  fact.  The 
general  rule  may  be  considered  as  holding  true,  whenever  the  blood  is  in 
excess  as  regards  its  animalized  or  vital  constituents;  also,  in  the  ordi- 
nary state  of  the  blood,  so  far  as  concerns  the  immediate  effects  of  de- 
pletion, and  even  in  its  ultimate  effects  when  it  is  moderately  used  and 
properly  guarded.  Bat  excessive  depletion  may  act  as  an  excitant  in- 
stead of  a  depressing  agent  to  certain  functions,  and  especially  those  of 
the  circulatory  and  nervous  systems.  The  functions  of  the  system  gen- 
erally, feeling  the  want  of  their  ordinary  support  from  the  blood,  make 
this  want  known  to  the  nervous  centres,  which  then  transmit  a  stimulant 
influence  to  the  heart,  while,  at  the  same  time,  they  give  evidence  of  their 
own  disturbance  by  various  irregular  nervous  phenomena.  Under  no 
circumstances,  is  the  heart  thrown  into  more  violent  commotion  than, 
sometimes,  through  an  impoverished  condition  of  the  blood.  Depletion, 
therefore,  especially  the  more  direct  and  powerful  kinds  of  it,  should  be 
employed  with  reserve  in  anemic  states  of  the  circulation,  even  though 
strongly  indicated  by  other  considerations.  Another  important  rule  is 
that,  when  a  purely  sedative  effect  is  desired  from  this  remedial  measure, 
all  the  functions  should  be  kept  as  quiescent  as  possible;  so  that,  con- 


42  APPLICATION    OF    MEDICINES.  [PART  I. 

sumiug  little  blood,  they  may  not,  from  a  feeling  of  deficiency,  excite  the 
nervous  centres  and  through  them  the  heart  into  a  state  of  irritation. 
Rest  should  ho  enjoined,  the  food  diminished,  and  strong  mental  action 
or  emotion  avoided ;  so  that  the  muscles,  the  digestive  organs,  and  the 
brain  may  be  content  with  less  than  the  ordinary  supply  of  their  essen- 
tial pabulum. 

2.  Applications  of  Depletion.     The  therapeutic  applications  of  deple- 
tion are  obvious.    It  is  the  groat  rornedy  in  plethora,  and  in  an  excess  of 
local  vascular  excitement,  whether  that  excess  amount  to  irritation  merely, 
or  to  inflammation.     Sanguineous  determination  and  active  congestion, 
hemorrhage,  morbidly  increased  secretion,  and  other  derangements  of 
function,  so  far  as  these  disorders  are  the  result  of  vascular  irritation, 
are  to  be  corrected  by  it.     In  the  treatment  of  inflammation  it  is  inval- 
uable, not  only  lessening  the  force  with  which  the  blood  is  driven  into 
the  inflamed  part,  but  impairing  those  qualities  of  the  vital  fluid  which 
most  powerfully  support  that  morbid  process. 

Another  application  of  depletion,  dependent  on  its  influence  over  the 
absorbent  process,  is  to  the  treatment  of  morbid  effusions ;  the  different 
forms  of  dropsy,  for  example,  in  which  it  is  often  employed  with  great 
efficacy,  though  requiring  caution.  Upon  the  same  principle,  it  may  be 
used  in  polysarca  or  morbid  obesity. 

3.  Means  of  Depletion.     Depletion  may  be  effected  either  directly,  by 
taking  blood  or  promoting  secretion,  or  indirectly,  by  diminishing  the 
supplies  through  which  the  natural  losses  of  that  fluid  are  repaired. 

Direct  Depletion.  Beyond  all  comparison  the  most  efficient  of  the 
measures  for  direct  depletion  is  general  and  local  bleeding.  The  char- 
acter of  this  remedy,  its  peculiar  applications  in  disease,  and  the  methods 
of  employing  it,  will  be  fully  considered  in  the  second  part  of  this  work. 

Another  important  mode  of  direct  depletion,  is  increased  secretion. 
It  not  only  unloads  the  circulation  in  general,  but,  in  some  cases,  has 
the  advantage  over  bleeding,  of  directly  depleting  from  the  diseased  ves- 
sels themselves,  and  thus  imitating  a  very  frequent  process  of  nature  in 
the  relief  of  irritation  and  inflammation.  Thus,  cathartics  relieve  mucous 
enteritis,  expectorants  bronchitis,  and  diuretics  nephritis.  It  is  not 
merely  the  watery  parts  of  the  blood  that  are  thus  evacuated,  but  its 
animalized  constituents  also,  though  the  red  corpuscles  seldom  pass. 
Upon  the  whole,  this  mode  of  depletion  is  much  less  efficacious  than 
bleeding,  in  the  relief  of  plethora  and  active  congestion.  But,  for  tin- 
purpose  of  promoting  the  absorption  of  effused  fluids,  it  is  even  more 
efficacious;  as  a  much  larger  amount  of  liquid  may  be  safely  abstracted 
from  the  blood-vessels  by  increased  secretion  than  by  bleeding,  and  con- 
sequently a  greater  amount  of  absorption  produced. 

The  remedies  most  efficaciously  employed  with  reference  to  depletion, 
upon  this  principle,  are  cathartics,  diuretics,  and  diaphoretics.  But  all 


CHAP.  III.]  APPLICATION    OF    MEDICINES.  43 

that  increase  secretion  are  occasionally  useful,  including  expectorants, 
emmenagogues,  sialagogues,  errhines,  epispastics.  issues,  and  setons.  It 
is  upon  this  principle,  in  part,  that  the  warm,  hot,  and  vapour  baths  act 
usefully  in  certain  inflammatory  affections.  In  the  application  of  these 
various  remedies  there  is  much  room  for  discrimination  ;  some  being 
better  adapted  to  one  condition,  others  to  another,  and  some  being  posi- 
tively injurious  where  others  are  highly  useful.  This,  however,  is  not 
the  proper  place  to  discuss  their  properties;  and  the  reader  is  referred 
to  the  second  part  of  the  work.  It  may  be  proper  to  mention  here,  that 
such  as  are  employed  for  the  reduction  of  plethora,  or  inflammatory  ex- 
citement, should  be  destitute  of  general  stimulating  properties,  and  that 
the  most  efficient  are  those  which  unjte  a  sedative  influence  over  the  cir- 
culation with  the  power  of  increasing  secretion.  Such  especially  are  the 
saline  cathartics,  and  the  antimonial  diaphoretics  and  expectorants.  A 
general  rule  applicable  to  all  these  medicines  is,  that,  in  cases  of  high 
vascular  excitement,  when  the  pulse  is  full  and  strong,  and  bleeding  is 
otherwise  indicated,  they  should  be  preceded  by  that  remedy.  Secretion 
is  often  checked  by  excess  of  excitement  in  the  secreting  organ,  and 
favoured  by  a  reduction  of  the  excitement.  Besides,  medicines  are  not 
easily  absorbed  when  the  blood-vessels  are  full  to  distension.  If  the 
object  be  to  reduce  active  congestion  or  inflammation  by  promoting 
secretion  from  the  part  or  organ  affected,  preference  should  always  be 
given,  at  least  in  the  earlier  stage,  to  those  stimulants  of  the  secretory 
function  which  are  least  irritant  in  their  action.  Thus,  sulphate  of  mag- 
nesia should  be  preferred  to  gamboge,  scammony,  or  elaterium,  in  the 
treatment  of  dysentery ;  tartar  emetic  or  ipecacuanha  to  squill  or  seneka, 
in  the  earlier  stage  of  bronchitis ;  and  cream  of  tartar  to  oil  of  turpentine, 
in  acute  nephritis. 

Indirect  Depletion.  This  is  effected  by  whatever  prevents  the  usual 
amount  of  solid  organic  material  from  entering  the  circulation.  Emetics 
and  cathartics  act  in  this  way,  by  discharging  the  partially  digested  food 
from  the  alimentary  canal  before  it  has  been  absorbed.  Still  more  effi- 
cacious is  a  temporary  abstinence  from  food,  or  a  reduction  of  its  quan- 
tity and  quality.  But  the  subject  of  diet  as  a  means  of  indirect  depletion 
belongs  to  special  therapeutics,  and  will  be  considered  hereafter. 

SUBSECTION  II. 
Repletion. 

This  term  is  here  employed,  rather  in  reference  to  its  origin  than  in 
accordance  with  its  accepted  meaning,  to  signify  an  increase  in  the 
quantity  of  the  blood  in  general,  or  of  its  solid  animalized  ingredients. 
The  circumstances  of  disease  under  which  this  remedial  process  is  de- 
sirable are  the  opposite  of  those  requiring  depletion ;  namely,  general 


44  APPLICATION    OF    MEDICINES.  [PART  I. 

debility,  a  too  scanty  blood,  and  a  condition  of  that  fluid  in  which, 
though  its  bulk  may  be  sufficient,  there  is  an  undue  proportion  of  the 
watery  ingredient.  The  means  by  which  it  may  be  accomplished  are 
the  free  employment  of  a  highly  nutritious  diet,  and  the  use  of  remedies 
calculated  to  invigorate  digestion  and  sanguification,  such  as  moderate 
exercise,  tonic  and  stimulant  medicines,  frictions,  and  the  cold  bath. 

SUBSECTION  III. 
Dilution. 

By  this  is  meant  the  copious  internal  use  of  water,  whereby  the  liquids 
of  the  body  are  diluted,  and  rendered  less  excitant.  The  contents  of  the 
stomach  are  first  diluted,  then  the  blood  through  absorption  of  the  water, 
and  lastly,  the  secretions,  especially  those  of  the  skin  and  kidneys,  in 
consequence  of  its  passing  out  through  these  emunctories.  The  thera- 
peutic effect  is  to  relieve  irritation  or  inflammation  of  the  surface  with 
which  the  diluted  fluid  may  be  in  contact,  as  the  mucous  membrane  of 
the  stomach,  and  that  of  the  urinary  passages,  and  to  moderate  general 
excitement  by  attenuating  the  blood. 

SUBSECTION  IV. 
Elimination, 

It  is  well  known  that,  in  the  course  of  various  diseases,  matters  accu- 
mulate in  the  blood,  either  altogether  foreign  to  that  fluid,  or  existing  in 
it  during  health  only  in  almost  inappreciable  quantities,  and  in  the  course 
of  spontaneous  elimination  from  the  system.  Thus,  urea  and  uric  acid, 
which  are  the  results  of  the  disintegration  of  the  tissues,  or  the  super- 
fluous residue  of  the  food  in  its  conversion  into  blood,  are,  in  the  healthy 
state,  present  in  the  circulation  only  until  they  can  be  thrown  off  by  the 
kidneys ;  and  the  same  may  be  said  of  the  colouring  matter  of  the  bile, 
which  is  separated  and  excreted  by  the  liver.  These  accumulate  ab- 
normally in  the  blood,  when  their  respective  emunctories  fail  in  their 
office  of  excretion,  and  become  sources  of  inconvenience  and  danger.  It 
is  highly  probable  that  other  noxious  principles,  not  well  understood,  in 
like  manner  vitiate  the  blood,  either  forming  special  diseases,  or  com- 
plicating those  resulting  from  other  causes.  In  febrile  complaints,  a 
sour  odour  is  often  observable  in  the  breath  and  perspiration,  arising 
from  the  escape  of  acid  matters  from  the  blood.  In  typhus  fever,  small- 
pox, and  many  cases  of  disordered  digestion  and  obstinate  constipation, 
the  breath  and  other  secretions  have  an  offensive  odour,  indicating,  no 
doubt,  an  impure  condition  of  the  circulating  fluid.  Now  the  existence 
of  such  morbid  matters  in  the  blood  affords  a  well-grounded  indication 


CHAP.  III.]  APPLICATION    OF    MEDICINES.  45 

for  the  use  of  remedies  calculated  to  effect  their  elimination ;  and  there 
can  be  no  doubt  that  this  is  not  unfrequcntly  a  very  useful  therapeutic 
process.  The  remedies  alluded  to  are  such  as  stimulate  the  several 
emunctories;  and  cathartics,  diuretics,  diaphoretics,  and  cholagogues. 
add  this  mode  of  action  to  their  other  beneficial  influences  in  disease. 

There  is  another  mode  of  elimination  which  has  recently  begun  to 
attract  attention,  and  which  may  possibly  hereafter  prove  a  highly  im- 
portant method  of  cure.  It  has  been  shown  that  certain  substances, 
having  a  noxious  influence  upon  the  health,  are  sometimes  incorporated 
with  the  tissue  of  the  organs,  and  probably  thus  impair  their  efficiency 
by  a  constant  unhealthful  influence.  Such  are  various  metallic  poisons, 
as  the  preparations  of  arsenic,  lead,  copper,  and  mercury.  To  separate 
these  from  their  seat  in  the  tissues  is  an  important'indication ;  and  there 
is  reason  to  believe  that  this  may  sometimes  be  fulfilled,  not  only  by 
medicines  calculated  to  promote  absorption  and  secretion,  or  to  alter  the 
nutrition  of  the  organ,  but  also  by  others  which  modify  the  condition  of 
the  foreign  matter,  so  as  to  render  it  soluble  in  the  blood,  and  thus  ca- 
pable of  being  eliminated  from  the  system.  It  is  believed,  for  example, 
that  lead  is  thus  displaced,  when  producing  colica  pictonum  or  paralysis, 
by  the  exhibition  of  iodide  of  potassium.  More  will  be  said  on  this 
subject  under  the  head  of  the  several  remedies  employed  on  the  principle 
referred  to. 

SUBSECTION  V. 

Stimulation. 

Stimulation,  as  here  understood,  is  the  exaltation  of  any  or  of  all  the 
vital  functions  above  the  state  in  which  they  may  happen  to  exist,  at  the 
time  when  the  stimulating  measure  is  resorted  to.  There  is  a  vast  diver- 
sity in  this  process.  It  differs  in  direction,  degree,  duration,  and  char- 
acter. Perhaps  the  most  convenient  primary  division  of  it  is  into  general 
and  local;  the  former  being  felt,  to  a  greater  or  less  extent,  throughout 
the  body,  the  latter  confined  originally  to  a  particular  part  or  organ. 

A  property  common  to  all  stimulation  is,  that  it  is  followed,  in  the 
ordinary  state  of  the  system,  by  a  degree  of  depression  bearing  some 
proportion  to  the  previous  excitement.  There  are  conditions  of  tem- 
porary prostration,  in  which  stimulation  may  put  the  system  in  the 
power  of  resuming  its  ordinary  grade  of  action  without  subsequent  de- 
pression ;  but  these  do  not  come  within  the  general  rule.  The  depression 
is  dependent  upon  the  temporary  diminution  of  excitability,  resulting 
from  excessive  action.  If  the  stimulant  influence;  be  continued,  it  follows, 
as  a  consequence  of  the  diminished  excitability,  that  a  greater  amount 
of  the  stimulant  agent  must  be  employed  to  produce  the  same  effect,  and 
the  excitability  is  thus  still  further  diminished ;  until,  in  the  end,  the 


46  APPLICATION    OF    MEDICINES.  [PART  I. 

<-m  refuses  entirely  to  respond  to  the  ordinary  healthy  excitants,  and 
morbid  and  often  fatal  debility  results.  This  is  an  evil  against  which  it 
is  necessary  to  be  constantly  on  our  guard,  in  the  use  of  stimulant  meas- 
ures. Another,  scarcely  less  important,  is  the  production  of  inflammation 
by  the  excessive  or  repeated  excitement  to  which  the  stimulated  organ  or 
sy-tem  is  exposed. 

1.  General  Stimulation.  It  is  barely  possible  that  stimulation  should 
b».-  absolutely  universal.  In  whatever  degree  the  functions  generally  may 
be  excited,  there  is  almost  always  some  one  or  more  that  become  de- 
-sed,  or  remain  quiescent.  Stimulation  may  be  considered  general, 
when  any  one  of  the  vital  properties  or  functions  which  belong  to  all 
parts  of  the  frame  is  exalted,  as  contractility  or  nutrition;  or  when  one 
of  the  anatomical  systems  which  pervade  the  whole  body  is  excited  into 
increased  action,  as  the  circulatory  or  nervous.  In  such  cases,  the  ex- 
citement is  felt  throughout  the  frame,  though  not  in  every  function. 

The  lowest  grade  of  general  stimulation  is  that  produced  by  astringents, 
which  operate  on  the  organic  contractility,  and  produce  a  general  con- 
densation or  shrinking  of  the  tissues.  Tubes  and  orifices  are  thus  con- 
tracted, the  flesh  becomes  firmer,  and  the  pulse  somewhat  more  tense. 
The  therapeutic  applications  of  this  power  of  astringency,  with  the 
requisite  cautions,  will  be  hereafter  fully  considered. 

Somewhat  higher  in  the  scale  of  general  stimulation  is  the  action 
usually  denominated  tonic.  This  is  a  moderate  increase  of  the  vital 
functions  generally,  produced  rather  slowly,  and  lasting  for  a  consider- 
able time.  It  is  of  vast  importance  in  the  treatment  of  moderate  or 
chronic  debility.  For  an  account  of  its  special  applications,  the  reader 
i^  referred  to  the  second  part  of  the  work.  Among  the  agents  by  which 
it  is  effected  is  a  class  of  medicines  denominated  tonics,  which  may  act 
directly  on  the  whole  system,  or  especially  on  the  digestive  function, 
thereby  enriching  the  blood,  and  making  that  fluid  the  immediate  ex- 
citant. Some  medicines  probably  also  give  tonic  power  to  the  blood  by 
a  direct  action  on  that  fluid.  Such  are  the  chalybeates.  But  there  are 
other  very  important  tonic  agents  besides  medicines.  Cold  operates  in 
this  way  secondarily,  through  the  reaction  which  follows  its  direct  de- 
pressing influence.  A  wholesome,  and  nourishing  diet,  succeeding  an 
impoverished  one,  and  pure  fresh  air  with  those  who  have  been  con- 
fined to  a  close  and  vitiated  atmosphere,  have  a  powerful  tonic  operation. 
So  also  has  moderate  physical  exercise,  under  similar  circumstances  of 
ious  deprivation.  Gentle  electrical  excitation  may  be  placed  in  the 
>;nue  category.  Mental  influences,  moreover,  have  great  «  ff>'<-\.  No 
tonic  is,  under  many  circum-tunn  s.  more  efficient  than  the  cheering  in- 
fluence of  social  pleasure.-,  domestic  enjoyment,  and  a  gentle  exercise  of 
iitellectual  faculties,  and  all  the  kindlier  emotions. 

A  quicker  and  more  rapid  stimulation  is  sometimes  distinguished  by 


CHAP.  III.]  APPLICATION    OF    MEDICINES.  47 

the  name  of  diffusible.  It  usually  affects  more  or  less,  at  the  same  time, 
the  functions  both  of  organic  and  animal  life;  though,  as  proceeding 
from  one  cause  it  may  be  more  especially  felt  in  the  circulation  and  its 
dependent  functions,  from  another,  in  the  nervous  system.  This  special 
direction  is  sometimes  so  far  exclusive  as  to  justify  the  division  of  diffu- 
sible stimulants  into  those  operating  more  particularly  on  the  circulation, 
and  those  upon  the  cerebro-spinal  functions.  It  will  be  found,  hereafter, 
that  this  distinction  serves  as  the  basis  of  an  arrangement  in  the  plan  of 
classification  which  I  have  adopted.  For  want  of  a  better  name,  the 
medicines  acting  on  the  circulation  especially,  with  little  tendency  to  the 
nervous  system,  may  be  denominated  arterial  stimulants. 

Stimulants  which  act  chiefly  on  the  nervous  system  may  diffuse  an  ap- 
parently equable  action  over  the  whole  of  that  system,  or  may  concen- 
trate their  influence  especially  on  the  brain.  The  former  may  be  called 
nervous  stimulants,  though  more  commonly  designated  as  antispas- 
modics;  the  latter  I  propose  to  call  cerebral  stimulants,  preferring  this 
title  to  that  of  narcotics,  which  has  reference  to  the  property  of  stupefy- 
ing, that  belongs  also  to  medicines  of  wholly  different  powers.  It  will 
be  perceived  hereafter  that  the  above  arrangement  of  stimulant  medi- 
cines is  not  only  natural,  in  relation  to  their  physiological  effects,  but  has 
also  an  important  practical  bearing. 

Other  influences  besides  those  properly  medicinal  are  susceptible  of 
very  useful  employment  in  reference  to  general  stimulation.  Heat  and 
electro-magnetism  are  agencies  of  this  kind ;  and  stimulating  food  is 
yet  more  important.  These  will  be  fully  treated  of  under  Special  Ther- 
apeutics. 

2.  Local  Stimulation.  Local  stimulation  may  have  the  effect  of 
merely  irritating  or  inflaming  a  part;  or  of  exciting  it  to  an  increased 
performance  of  its  peculiar  function. 

In  the  former  case,  the  object  is  usually  to  act  revulsively,  or  to  pro- 
duce general  stimulation  through  the  sympathy  of  the  system  with  the 
part  affected.  The  agents  employed  for  either  purpose,  so  far  as  the  ex- 
ternal surface  is  concerned,  are  the  rubefacients,  epispastics,  and  escharo- 
ties.  Occasionally,  however,  the  object  is  entirely  local.  The  vessels  of 
a  part  may  become  relaxed  and  congested  with  blood,  and,  in  conse- 
quence, an  imperfect  sort  of  inflammation  may  be  sustained;  or  there 
may  be  ulceration,  and  the  surface  too  feeble  to  take  on  the  action 
necessary  for  the  healing  process.  In  either  case,  local  stimulation 
sometimes  answers  an  excellent  purpose  in  removing  the  evil. 

But  still  more  frequently  this  remedial  process  is  employed  for  the 
increase  of  function.  The  surface  may  be  pale,  dry,  and  inactive;  the 
muscles  may  be  enfeebled  to  paralysis ;  the  senses  of  smell,  taste,  and 
touch  maybe  imperfect  from  weakness;  digestion  may  be  feeble,  and 
tin-  bowels  costive  fr.in  deficient  secretion,  or  want  of  due  peristaltic 


48  APPLICATION    OF    MEDICINES.  [PART  I. 

movement;  the  liver,  kidneys,  or  other  secretory  glands  may  be  inert. 
The  means  used  to  restore  the  weakened  functions  are  medicines  and 
other  remedies,  having  a  special  influence  over  the  functions  severally. 
Hence  the  use  of  friction  to  the  surface ;  the  hot  bath ;  the  cold  bath 
used  with  a  view  to  reaction;  diaphoretics;  errhines:  masticator' 
gastric  stimulants,  such  as  bitters,  aromatics.  and  the  mineral  acids : 
emetics;  cathartics;  diuretics;  expectorants;  emmenagogues;  and  chola- 
gogues  to  excite  the  liver,  as  mercury  and  nitromuriatic  acid.  Hence  the 
employment  of  ergot  to  stimulate  the  uterus  to  contraction. 

Sometimes  a  local  stimulant  is  employed  to  produce  general  di 
sion ;  as  in  the  case  of  the  hydragogue  cathartics,  which,  though  they 
stimulate  the  secretory  function  of  the  bowels  and  promote  the  peristal- 
tic movement,  depress  the  system  in  consequence  of  the  depletion  they 
produce. 

SUBSECTION  VI. 
Sedation  or  Depression. 

This  implies  a  diminution  of  action.  Like  stimulation  it  may  In- 
general  or  local.  General  sedation  may  affect  especially  either  the  cir- 
culation and  its  dependent  functions,  or  the  nervous  system.  The  agents 
which  produce  the  former  effect  I  denominate  arterial  sedatives.  They 
are  the  refrigerants  of  other  writers ;  as  they  reduce  temperature  along 
with  vascular  action.  Those  operating  upon  the  nervous  system 
produce  their  depressing  effect  in  two  ways;  in  one,  by  directly  allecting 
the  functions  of  the  nervous  tissue  wherever  they  encounter  it :  in  the 
other,  by  acting  primarily  on  the  brain,  and  through  the  cerebral  centres 
depressing  the  dependent  nervous  functions.  The  former  may  he  called 
simply  nervous  sedatives,  the  latter  may  be  distinguished  by  the  title  of 
cerebral  sedatives.  It  is  important  to  understand  that  general  nen 
sedation  may  result  even  from  the  cerebral  stimulants,  through  this  de- 
pendence of  function.  In  this  case,  the  nervous  centres  are  overwhelmed 
by  an  active  congestion,  which  cripples  their  power  both  of  receiving  im- 
pressions and  transmitting  influence ;  and  sensibility,  muscular  motion, 
and  in  fact  all  the  functions  which  derive  a  necessary  support  from  the 
brain  are  more  or  less  impaired.  This  distinction  is  of  great  practical 
value.  Thus,  hydrocyanic  acid,  tobacco,  and  acetate  of  lead  might  In- 
used  as  sedatives,  when  it  might  not  be  altogether  safe  to  employ  alcohol 
or  opium. 

The  agents  of  sedation  will  be  enumerated"  and  described  hereafter. 
It  is  here  sufficient  to  say  that,  besides  sedative  medicines,  we  are  in 
possession  of  two  powerful  remedies  of  this  kind ;  viz.  cold,  in  relation 
to  its  primary  effects,  and  water. 

Local  sedation  may  affect  all  the  constituent  tissues  of  a  part,  or 


CHAP.  III.]  APPLICATION    OF   MEDICINES.  49 

more  especially  the  nervous.  In  the  former  relation,  it  is  employed  to 
repress  inflammation,  or  vascular  irritation  as  shown  in  morbid  secre- 
tion, hemorrhage,  or  simply  congestion ;  in  the  latter,  to  relieve  neuralgic- 
pain,  and  allay  spasm. 

Many  of  the  general  sedatives  may  be  employed  locally  for  these 
purposes. 

SUBSECTION  VII. 
Revulsion.     Derivation.     Counter-irritation. 

Revulsion  consists  in  the  diversion  of  disease  from  one  part  of  the 
system,  by  the  production  of  inflammation  or  irritation  in  another  part. 
The  term  derivation  is  applied  to  the  same  process,  but  may  be  ex- 
tended also  to  cases  in  which  the  diversion  is  effected  by  a  degree  of 
excitement,  which  may  still  be  within  the  limits  of  health.  Counter- 
irritation,  strictly  defined,  applies  to  the  revulsive  impression  rather 
than  to  the  revulsion  itself.  The  system  has  only  a  certain  capacity  of 
nervous  action,  and  a  certain  amount  of  blood.  When  either  the  former 
or  the  latter  is  strongly  directed  to  a  particular  part  of  the  body,  there  is 
a  tendency  to  its  diminution  elsewhere.  This  is  absolutely  necessary  of 
the  blood :  and  it  is  true,  to  a  great  extent,  in  relation  to  nervous  action. 
Such  a  direction  is  given  by  the  application  of  irritants  of  any  kind. 
Hence,  in  order  to  relieve  inflammation,  any  of  the  forms  of  vascular 
irritation,  or  mere  nervous  disorder  as  indicated  by  pain  or  spasm,  in 
any  particular  part  of  the  body,  we  apply  irritants,  which  under  these 
circumstances  are  called  revulsives,  to  some  other  part.  This  principle 
is  of  very  extensive  applicability  to  the  cure  of  disease.  It  often  comes 
into  play  as  an  auxiliary  force,  in  cases  in  which  the  remedy  is  used  for 
other  purposes.  Thus,  while  emetics  are  employed  to  relieve  spasmodic 
affections  of  the  air-passages,  in  consequence  of  the  relaxation  they  pro- 
duce, they  are  probably  also  useful  by  a  revulsive  influence  towards  the 
stomach.  Cathartics  act  very  powerfully,  upon  this  principle,  in  the 
relief  of  inflammations  and  active  congestions,  though  they  may  be  em- 
ployed chiefly  in  reference  to  their  depleting  power.  There  is  no  remedy 
whatever,  allowing  it  to  have  the  power*  of  producing  excitement  in  any 
part  of  the  body,  which  may  not  act  as  a  revulsive.  But  the  remedies 
usually  employed,  in  special  reference  to  this  principle  of  action,  are 
external  irritants,  such  as  hot  water,  rubefacients,  epispastics,  and  caus- 
tics. Derivation  may  often  be  advantageously  effected  by  exercise, 
calling  off  undue  excitement  from  internal  organs  to  the  exterior,  or 
from  one  part  of  the  body  to  another,  and  thus  producing  an  equilibrium 
of  the  vital  actions. 

The  application  of  the  principle  of  revulsion  requires  discrimination. 
VOL.  i. — 4 


50  APPLICATION    OF    MEDICINES.  [PART  I. 

When  the  local  affection  consists  rather  in  a  determination  of  blood 
to  the  part  affected  than  in  inflammation,  as  in  cases  of  vertigo  threaten- 
ing apoplexy,,  and  of  frequently  recurring  epistaxis  or  haemoptysis,  the 
indication  is  to  divert  the  general  current  of  excitement,  and  of  the 
blood,  towards  the  most  distant  parts  of  the  body.  Hence  the  use  of 
strongly  stimulating  pediluvia,  and  of  sinapisms  to  the  legs,  in  cases 
of  cerebral  affection  of  the  character  just  alluded  to.  But,  when  the 
disease  is  fixed  in  a  part  in  the  form  of  inflammation,  it  is  necessary 
to  bring  the  revulsive  impression  into  nearer  contiguity  with  the  dis- 
eased part,  though  it  may  be  proper  also  to  employ  remote  revulsion  as 
an  adjuvant.  Hence,  in  inflammation  of  the  lining  membrane,  or  of  the 
contents  of  the  great  cavities,  the  revulsive  remedy  is  most  advantage- 
ously  applied  over  the  outer  surface  of  the  walls  of  those  cavities,  as 
over  the  abdomen  in  cases  of  peritonitis  or  enteritis,  the  chest  in  cases 
of  pleurisy  or  pneumonia,  and  the  scalp  in  those  of  encephalic  inflam- 
mation. 

The  revulsive  influence  of  remedies  is  peculiarly  indicated  in  cases  of 
metastasis,  or  of  diseases  which  are  especially  liable  to  assume  the  metas- 
tatic  form.  In  these  cases,  the  agent  should  be  applied  to  a  portion  of 
the  body  towards  which  there  is  a  natural  tendency  of  the  morbid  action 
to  flow,  and  in  which  it  would  be  safe;  as,  in  gouty  cases,  to  the  feet, 
and  in  retrocedent  eruptions,  to  the  part  of  the  surface  from  which  the 
retrocession  has  taken  place. 

Another  important  principle  is  not  to  employ  a  highly  irritative  revul- 
sive agent,  in  inflammatory  cases,  during  the  greatest  violence  of  the 
disease.  A  strong  impression  upon  the  surface  may  sometimes  prove 
useful  in  a  commencing  inflammation,  before  any  febrile  action  has  been 
excited,  and  in  the  declining  stages,  when  the  fever  has  in  some  measure 
yielded  to  depletion,  or  subsided  spontaneously.  But,  during  the  ex- 
istence of  high  constitutional  excitement,  the  revulsive  agent  is  not  suffi- 
cient to  unseat  the  inflammation,  and,  if  itself  very  irritant,  as  in  the 
instances  of  the  more  powerful  rubefacients  and  of  blisters,  may  add  t<> 
the  existing  excitement  by  the  sympathy  of  the  system  with  the  super- 
ficial inflammation  it  produces.  But,  when  the  revulsive  impression  is 
conjoined  with  copious  depletion,  as  in  the  case  of  the  saline  hydragogue 
cathartics,  which  produce  a  revulsion  towards  the  whole  lining  mem- 
brane of  the  bowels,  while  they  evacuate  the  contents  of  the  blood- 
vessels, it  may  be  resorted  to  in  the  greatest  height  of  the  inflammation. 
The  copious  secretion  prevents  the  production  of  an  intestinal  irritation 
sufficient  to  bring  the  constitution  into  sympathy. 

When  the  local  affection  to  be  remedied  is  a  mere  nervous  irritation, 
such  as  spasm  or  neuralgic  pain,  it  is  generally  best  to  produce  a  quick, 
powerful,  and  transient  revulsion;  when  inflammatory,  especially  when  the 
inflammation  is  severe,  to  sustain  a  more  moderate  impression  for  a  longer 


CHAP.  III.]  APPLICATION    OF    MEDICINES.  51 

time.     Hence,  the  more  active  rubefacients,  such  as  mustard  and  am- 
monia, are  applicable  in  the  former  case,  and  epispastics  in  the  latter. 


SUBSECTION  VIII. 
Supersession  or  Substitution. 

By  this  process  is  meant  the  displacing  or  prevention  of  one  affection 
by  the  establishment  of  another  in  the  seat  of  it.  It  is  a  general,  though 
by  no  means  universal  pathological  law,  that  two  powerful  diseases,  or 
forms  of  abnormal  action,  cannot  exist  in  the  whole  system,  or  in  any 
one  part  of  it  at  the  same  time.  If,  therefore,  we  can  produce  a  new 
disease,  or  new  mode  of  abnormal  action,  in  the  exact  position  of  one 
that  may  be  existing  or  expected,  we  may  possibly  supersede  the  latter; 
and,  if  the  new  disorder  subside  spontaneously  without  injury,  we  cure 
our  patient.  The  operation  of  numerous  remedial  agents  may  be  ex- 
plained in  this  way.  It  is  thus,  for  instance,  that  mercury  has  been  sup- 
posed to  cure  syphilis.  But  we  have  better  examples  in  the  powerful 
influence  of  certain  antiperiodic  remedies,  such  as  quinia  and  arsenic,  in 
tin-  cure  of  intermittent  diseases.  They  establish  their  own  morbid  im- 
pression in  the  absence  of  the  paroxysm ;  and  the  system,  being  thus 
occupied  at  the  moment  when  the  disease  was  to  return,  is  incapable  of 
admitting  it.  In  the  same  way  may  be  explained  the  effects  of  blisters, 
opiates,  emetics,  or  indeed  any  violent  impression  from  any  source,  in 
the  cure  of  paroxysmal  diseases,  if  caused  to  be  in  full  action  at  the  time 
of  the  expected  recurrence  of  the  paroxysm. 

Mental  influences  are  sometimes  very  powerful  in  the  superseding  not 
only  of  intermittent  diseases,  but  of  continued  disease  also,  when  of  a 
merely  functional  character.  The  excitement  of  any  strong  emotion 
may  have  this  effect ;  and  the  pre-occupation  of  the  nervous  system 
resulting  from  a  strong  faith  has  often  exhibited  a  wonderful  influence. 

The  same  law  holds  in  cases  of  purely  local  diseases.     It  is  probable 

that  many  cutaneous  eruptions,  and  diseases  of  the  mucous  membrane 

of  the  alimentary  canal  and  urinary  passages,  yield,  upon  this  principle 

-'ipersession,  to  certain  applications  made  to  them  directly,  or,  in  the 

'('urinary  diseases,  through  the  route  of  the  circulation. 

si  15SECTION  IX. 
Alteration. 

This  name  may  be  given  to  that  operation  of  medicines  by  which  they 
change  existing  morbid  actions  or  states,  without  any  observable  effect 
on  the  system  to  which  the  result  could  be  ascribed.  The  medicines  are 
usually  called  alteratives.  They  may  produce  their  effects  by  changing 


52  APPLICATION    OF    MEDICINES.  [PART  I. 

the  character  of  the  blood,  or  the  condition  of  the  solids.  Their  precise 
mode  of  action  is  unknown,  or  at  best  conjectural.  It  will  be  perceived 
that  the  employment  of  the  term  is  merely  a  convenient  mode  of  classi- 
fying certain  unintelligible  results,  which  depend  altogether  for  their 
acceptance  upon  the  evidence  of  observation.  In  certain  states  of  dis- 
ease we  administer  certain  remedies,  without  other  observable  effect  than 
a  cure.  It  is  often  very  difficult,  in  such  cases,  to  decide  whether  the 
result  has  proceeded  from  the  remedy,  or  has  happened  in  the  ordinary 
course  of  the  disease.  It  is  at  least  highly  probable  that  a  great  many 
medicines  have  acquired  a  credit  as  alteratives,  which  was  due  exclu- 
sively to  nature. 

Among  the  most  striking  illustrations  of  this  operation  of  medicines 
is  that  of  mercury  in  the  cure  of  inflammation.  After  due  depletion,  or 
when  depletion  is  not  indicated,  no  remedy  has  so  powerful  an  antiphlo- 
gistic influence  as  mercury,  urged  to  the  point  of  affecting  the  system. 
Other  examples  are  offered  by  iodine  in  scrofula,  sarsaparilla  in  venereal 
disease,  colchicum  in  gout,  etc. 

It  is  apparent  that  supersession  and  alteration  may  often  lay  claim  to 
the  same  results.  Thus,  does  mercury  cure  syphilis  and  inflammation 
by  the  substitution  of  its  own  transitory  morbid  effects  for  the  existing 
disease,  or  does  it  merely  alter  the  morbid  into  healthy  action  ?  Upon 
the  solution  of  this  question  it  depends,  whether  the  remedy  is  to  be 
looked  upon  as  a  supersedent  or  an  alterative. 


SUBSECTION  X. 
Contra-causation. 

I  use  this  term  to  express  that  operation  of  a  remedy  which  consists 
in  the  cure  of  a  disease  by  the  removal  of  its  cause.  It  very  often  hap- 
pens that  one  morbid  state  depends  upon  another;  and  the  cure  of  the 
latter,  by  any  process  whatever,  results  in  the  cure  of  the  former.  This 
is  not,  however,  the  influence  to  which  allusion  is  here  made.  To  bring 
any  case  under  the  present  head,  the  cause  must  not  itself  be  a  disease, 
ami  the  remedy  removing  it  must  do  so  by  a  special  agency.  Thus, 
antacids  cure  headache  by  neutralizing  acid  in  the  stomach,  which 
produces  the  headache.  An  emetic  will  cure  spasm  of  the  stomach 
caused  by  indigestible  food  by  evacuating  the  offending  matter,  and 
cathartics  often  relieve  colic  on  a  similar  principle.  An  alkaline  car- 
bonate will  relieve  irritation  of  the  urinary  passages  dependent  on  the 
precipitation  of  uric  acid,  and  certain  acids  the  same  condition  pro- 
duced by  the  presence  of  undissolved  phosphates ;  each  operating  on  the 
offending  cause  by  neutralizing  it,  or  rendering  it  soluble.  Anthelmin- 
tics  cure  various  disorders,  dependent  on  worms  in  the  bowels,  by  destroy- 


CHAP.  III.]  APPLICATION    OF    MEDICINES.  53 

ing  or  expelling  the  worms.  In  like  manner,  the  class  of  parasiticides 
act  by  destroying  the  microscopic  parasites,  whether  animal  or  vegetable, 
which  infest  the  skin  and  various  internal  structures ;  and  under  the  same 
head  may  be  classed  the  remedies  which  render  inert  or  destroy  those 
poisonous  agents,  now  generally  believed  to  be  organized  beings,  which, 
entering  the  circulation,  and  there  acting  as  ferments,  give  rise  to  the 
various  zymotic  diseases. 

SUBSECTION  XI. 
Chemical  Influence. 

This  might,  perhaps,  be  included  in  some  one  or  more  of  the  processes 
already  referred  to.  Substances  may  be  employed  therapeutically,  in 
reference  to  their  chemical  influence,  for  three  purposes ;  first,  for  the 
destruction  of  the  tissues,  as  in  the  formation  of  issues,  the  removal  of 
morbid  ulcerated  surfaces,  etc.;  secondly,  for  the  neutralization,  or  other 
chemical  change  of  substances  contained  within  the  body,  but  not  form- 
ing an  essential  part  of  it,  as  when  excess  of  acid  in  the  prima?  viaB,  the 
blood,  or  the  urine,  is  obviated  by  alkalies,  or  an  insoluble  metallic  com- 
bination in  the  tissues  is  rendered  soluble  by  the  chemical  agent  admin- 
istered; and,  thirdly,  through  their  reaction  with  the  constituents  of  the 
blood  or  of  the  tissues,  to  produce  changes  in  them  favourable  to  the 
removal  of  disease.  But  their  influence  in  all  these  methods  of  action 
may  be  resolved  either  into  contra-causation,  elimination,  or  alteration ; 
except  in  the  formation  of  issues,  in  which  instance  the  chemical  action 
is  not  in  itself  curative,  but  simply  operates  by  setting  on  foot  certain 
physiological  processes  which  constitute  the  real  remedy  in  the  case.  In 
relation  to  the  process  of  alteration,  it  is  highly  probable  that,  in  many 
instances,  it  is  purely  the  result  of  chemical  reactions  set  on  foot  by  the 
remedy  in  the  interior  of  the  system ;  but  we  have  little  positive  knowl- 
edge upon  the  subject,  and  theoretical  speculations  can  lead  to  little 
practical  good,  except  in  so  far  as  they  may  serve  as  a  guide  to  inquiry 
and  experiment.  They  should  not  be  allowed  to  serve  as  the  basis  of 
curative  methods,  until  the  chemical  reactions  have  been  experimentally 
traced  out,  and  demonstrated  beyond  reasonable  doubt. 

SUBSECTION  XII. 
Mechanical  Influence. 

This  is  often  very  important  in  the  treatment  of  disease.  Upon  care- 
ful examination,  however,  of  its  effects,  it  will  be  found  in  general  to  act 
upon  some  one  or  more  of  the  principles  already  considered.  The  fol- 
lowing are  the  different  modes  in  which  this  kind  of  influence  may  be 
remedially  employed. 


54  APPLICATION    OF    MEDICINES.  [PART  1. 

Position  may  be  made  to  favour  or  counteract,  through  the  agency  <>f 
gravitation,  the  entrance  of  blood  into  a  part.  Thus,  when  fainting  is 
threatened  from  a  want  of  the  due  pressure  of  the  blood  upon  the  brain, 
by  placing  the  patient  in  a  horizontal  posture,  the  pressure  is  favoured, 
and  the  apprehended  result  prevented.  Much  more  frequently,  how- 
ever, the  object  is  to  diminish  congestion  or  inflammation  in  a  part,  by 
diminishing  the  access  of  blood ;  and  this  is  accomplished  by  elevating 
the  part  affected  above  its  usual  position.  Thus,  in  an  inflamed  limb, 
the  extremity  should  be  raised,  instead  of  being  allowed  to  retain  its 
ordinary  dependent  position  of  health.  It  is  clear  that  the  remedy  oper- 
ates, in  the  latter  of  these  cases,  upon  the  principle  of  local  depletion, 
and  in  the  former,  upon  that  of  local  repletion.  Position  is  occasionally 
useful  in  other  modes,  as  in  obviating  intussusception  of  the  bowels,  hi 
favouring  the  passage  of  calculi,  in  relieving  painful  pressure  or  ten- 
sion, etc. 

Compression  is  another  useful  mechanical  process,  which  may  he- 
made  to  diminish  or  increase  the  quantity  of  blood  in  a  particular  part 
of  the  body,  and  thus  to  accomplish  in  some  degree  the  same  object  as 
the  former  remedy.  Thus,  the  access  of  blood  to  a  part  may  be  lessened 
or  cut  off  by  pressure  upon  the  arterial  trunks  which  supply  it;  or  the 
capillaries  themselves  may  be  emptied  by  direct  and  equable  pressure 
made  upon  them.  In  the  latter  mode  especially,  much  good  is  often  done 
in  obstinate  inflammation  and  passive  congestion.  An  accumulation  of 
blood  may  be  produced  by  pressure  upon  the  veins,  and  not  upon  the 
arteries,  as  when  the  tourniquet  is  applied  not  very  tightly.  This  pro- 
cess may  sometimes  be  useful  by  abstracting  temporarily  a  quantity  of 
blood  from  the  general  circulation,  without  its  ultimate  loss.  It  is  a 
mode  of  general  depletion.  Compression  upon  nervous  trunks  has  been 
used  as  an  anaesthetic  agent  in  surgical  operations.  Other  advantageous 
effects  of  this  agency  are  to  promote  absorption,  and  to  afford  mechanical 
support  to  relaxed  parts,  as  in  varicose  veins  of  the  legs,  and  to  the 
abdomen  after  the  operation  of  tapping. 

Distension  sometimes  also  operates  usefully  by  stimulating  a  part  to 
increased  action  ;  as  when  large  fluid  injections  are  thrown  up  the  bowels. 
It  may,  however,  be  carried  so  far  as  to  produce  paralysis  of  the  muscu- 
lar fibres,  arid  thus  to  prevent  all  contraction.  This  is  an  important 
therapeutical  fact.  Distension  is  used  to  enlarge  passages,  strictured  or 
otherwise,  as  by  means  of  bougies  ;  and  substances  are  also  used  for  this 
purpose  which  swell  \\lien  they  become  moist,  as  compressed  sponge, 
.^lippery-elm  bark,  and  gentian  root. 

Friction  may  be  considered  as  a  mechanical  remedy.    It  acts  partly  by 

compression,  partly  by  stimulation.     Employed  for  the  latter  effect,  it  is 

often  a  powerful  agent  in  rousing  and  supporting  the  system  in  low  dis- 

,  and  in  exciting  the  part  itself  when  enfeebled;  but  it  is  more  f're- 


CHAP.  III.]  APPLICATION    OF    MEDICINES.  55 

quently  and  usefully  employed  for  its  effect  in  producing  revulsion  from 
within  outwardly. 

The  covering  of  surfaces,  so  as  to  protect  them  against  irritating  sub- 
stances, and  the  contact  of  the  air,  is  another  useful  mechanical  process. 
Thus,  demulcents  protect  inflamed  mucous  surfaces ;  and  collodion,  cata- 
plasms, plasters,  cerates,  and  thin  layers  of  gutta-percha  and  caoutchouc, 
are  applied  for  the  same  purpose  to  the  skin.  It  is  not  improbable  that 
the  effect  of  nitrate  of  silver  and  iodine,  in  subverting  superficial  inflam- 
mation, may  be  partly  owing  to  a  chemical  change  in  the  epidermis, 
rendering  it  less  pervious  to  the  air.  How  the  exclusion  of  the  air 
proves  useful  it  is  not  easy  to  determine.  Perhaps  it  may  be  partly  by 
maintaining  the  moisture  which  would  otherwise  be  evaporated ;  per- 
haps, as  suggested  by  Dr.  Latour,  by  diminishing  calorification  to  which 
the  presence  of  the  air  may  contribute,  if  it  be  not  essential  (Archives 
Oenerales,  4e  ser.,  xxvii.  237)  ;  or,  possibly  by  preventing  any  direct  in- 
fluence which  the  atmospheric  oxygen  may  have  in  supporting  the  inflam- 
matory process. 

SECTION  II. 
Forms  in  'which  Medicines  are  Applied. 

Medicines  are  used  in  the  solid,  liquid,  and  aeriform  states.  In  the  solid 
state,  they  arc  employed,  internally,  in  the  several  shapes  of  powder, 
electuary,  con  serve.,,  pill  or  bolus,  and  lozenge;  and  externally,  of  cata- 
plasm, ointment,  cerate,  and  plaster.  In  the  liquid  state  they  are  either 
originally  liquid,  or  rendered  so  by  mixture  or  solution.  In  the  aeriform 
state  they  have  the  form  either  of  gas  or  of  vapour.  For  ample  details 
upon  each  of  the  Solid  and  liquid  forms  mentioned,  the  reader  is  referred 
to  the  U.  S.  Dispensatory.  It  will  be  sufficient,  in  this  place,  to  make  a 
few  general  observations,  calculated  to  facilitate  to  the  learner  the  study 
of  the  practical  application  of  medicines  which  is  to  follow. 

SUBSECTION  I. 
Solid  Forms. 

1.  POWDERS  (pulveres)  are  medicines  finely  comminuted  by  the  pro- 
cesses of  pounding,  grinding,  levigation,  elutriation,  precipitation,  etc. 
This  is  a  convenient  form  for  the  administration  of  insoluble  substances, 
not  very  disagreeable  to  the  taste.  It  is  unsuitable  for  deliquescent  sub- 
stances, as  carbonate  of  potassa,  and  for  combinations  consisting  of  in- 
gredients which  become  liquid  or  semiliquid  by  chemical  reaction,  as  is 
the  case  when  acetate  of  lead  is  mixed  with  sulphate  of  zinc.  Light 
powders,  readily  miscible  with  water,  may  be  given  diffused  in  that  liquid, 


56  APPLICATION    OF    MEDICINES.  [PART  I. 

either  pure,  or  rendered  more  agreeable  to  the  taste  by  sugar  and  aroma- 
tics.  Resinous  powders,  in  order  to  be  diffused,  require  that  the  water 
should  be  rendered  somewhat  viscid  by  saccharine  or  gummy  additions. 
Heavy  powders,  as  the  metallic,  are  more  conveniently  exhibited  in  the 
form  of  electuary. 

2.  ELECTUARIES  (electuaria)  are  preparations  in  which  the  medicine 
is  brought  into  the  condition  of  a  soft  solid,  and  may  be  conveniently 
made  by  mixing  powders,  extracts,  etc.,  with  syrup,  molasses,  or  honey. 
They  are  included  among  the  confections  in  the  U.  S.  Pharmacopoeia. 
Liquids  may  be  brought  into  the  same  condition  by  admixture  with 
sugar  and  gum.     Any  medicine  may  be  exhibited  in  this  form  which  is 
not  too  bulky,  or  too  offensive  to  the  taste.     In  forming  powders  into 
electuaries,  the  proportion  of  the  semiliquid  vehicle  must  vary  with  the 
nature  of  the  article  used.    Thus,  dry  vegetable  powders  usually  require 
twice  their  weight  of  syrup,  gummy  and  resinous  powders  an  equal 
weight,  and  the  metallic  a  still  smaller  proportion.     In  the  last  case,  it 
is  well  to  add  a  small  quantity  of  some  conserve ;  as  the  tenacity  of  syrup 
or  honey  alone  is  scarcely  sufficient  to  prevent  a  separation,  by  the  subsi- 
dence of  the  heavier  ingredients. 

3.  CONSERVES  (conserves)  are  preparations  in  which  fresh  vegetable 
substances  are  beat  up  with  sugar,  as  well  for  the  sake  of  preservation, 
as  for  convenience  of  Administration.     They  are  included,  along  with 
electuaries,  under  the  confections  of  the  U.  S.  Pharmacopoeia.     Yen- 
few  medicines  are  exhibited  in  this  way. 

4.  PILLS  (pilulse)  are  small,  spherical,  solid  bodies,  of  a  convenient 
size  for  swallowing.    Medicines  of  which  the  dose  is  small,  and  the  taste 
(ii-agreeable,  may  be  appropriately  given  in  this  form  ;  but  it  is  not  suit- 
able for  deliquescent  substances,  nor,  indeed,  for  those  which  are  copi- 
ously efflorescent,  unless  previously  deprived  of  their  water  of  crystalli- 
zation.    Hence,  when  carbonate  of  soda  or  sulphate  of  iron  is  given  in 
pill,  the  dried  salt,  from  which  the  water  of  crystallization  has  been  driven 
off  by  heat,  should  be  preferred.     Care  should  be  taken,  in  prescribing  a 
substance  in  this  form,  that  the  adjuncts  should  be  such  as  not  to  render 
it  too  hard,  and  of  difficult  solubility  in  the  liquors  of  the  stomach.    As 
a  general  rule,  pills  recently  made  are  preferable  to  the  old,  as  being 
><>t'ter  and  more  soluble;  but  occasionally,  when  the  object  is  that  the 
medicine  should  act  very  slowly,  and  consequently  that  it  should  be 
^lowly  dissolved,  old  and  hard  pills  may  be  advantageously  administered. 
The  weight  of  the  pill,  it'  Composed  of  vegetable  substances,  should  not 
generally  exceed  three  or  four  grains ;  if  of  metallic  ingredients,  it  may 
be  from  four  to  eight  grains.     It  will  sometimes  be  useful,  when  the  in- 
gredients of  the  pill  are  very  offensive  to  the  smell  or  taste,  to  give  it  a 
coating  of  some  material,  either  tasteless  or  not  disagreeable,  which  may 
lie  ivailily  dissolved  in  the  stomach.    Gelatin  and  sugar  answer  this  pur- 


CHAP.  III.]  APPLICATION    OF    MEDICINES.  57 

pose  very  well,  and  are  easily  applied.    Gold  leaf,  formerly  employed,  is 
objectionable  from  its  insolubility. 

Boluses  are  preparations  similar  to  pills,  but  larger,  and  may  be  pre- 
ferably used  where  the  dose  is  large,  and  the  patient  can  swallow  them 
without  difficulty.  Their  size  is  limited  only  by  the  patient's  capacity  of 
deglutition. 

5.  LOZENGES,  or  TROCHES  (trochisci),  are  solid  masses  of  various  shape 
and  size,  which  may  be  conveniently  held  in  the  mouth,  and  there  allowed 
slowly  to  dissolve.    They  are  adapted  for  the  administration  of  medicines 
of  agreeable  taste,  or  of  which  the  taste,  if  disagreeable,  can  be  qualified 
or  covered  by  pleasant  additions.     They  should  be  made  with  materials 
which,  without  being  wholly  insoluble,  are  dissolved  slowly  by  the  saliva. 
Demulcent  medicines  are  often  administered  in  this  form ;  and  it  is  con- 
venient in  all  cases,  in  which  the  object  is  to  sustain  a  slight  impression 
steadily  on  the  interior  of  the  mouth  and  fauces.     Sir  J.  Y.  Simpson, 
of  Edinburgh,  informed  me  that  he  was  much  in  the  habit  of  administer- 
ing certain  medicines,  especially  to  children,  in  the  form  of  biscuit,  the 
powder  being  incorporated  with  the  dough,  and  then  baked  with  it.     Of 
course,  this  method  of  administration  is  applicable  only  to  substances  not 
injured  by  heat. 

6.  CATAPLASMS,  or  POULTICES  (cataplasmata),  are  intended  only  for 
external  use.     They  should  be  soft  and  moist,  somewhat  tenacious,  and 
of  such  a  consistence  as  to  accommodate  themselves  accurately  to  the 
part  to  which  they  are  applied,  without  being  disposed  to  spread,  or  to 
adhere  firmly  to  the  skin.     They  may  be  employed  solely  in  reference 
to  the  sedative  influence  of  the  water  they  contain,  or  to  protect  the  dis- 
eased surface  from  the  air,  or  to  produce  the  peculiar  impression  of  a 
medicine  either  on  the  surface,  or,  through  the  medium  of  absorption, 
upon  the  system. 

7.  OINTMENTS  (unguenta),  CERATES  (cerate),  and   PLASTERS  (em- 
plastra)  are  preparations  also  intended  exclusively  for  external  use.    As 
the  terms  will  be  frequently  used,  the  student  should  have  a  precise  idea 
of  their  meaning  at  the  outset.     Ointments  are  soft  solids,  always  con- 
taining fatty  or  oily  matter,  and  capable  of  being  applied  by  gentle  rub- 
bing, or,  to  use  an  appropriate  phrase,  by  inunction.      Cerates  are  of  a 
tinner  consistence,  generally  contain  wax  (cera),  from  which  they  derive 
their  name,  and  are  capable  of  being  spread  by  means  of  a  spatula,  at 
common  temperatures,  upon  suitable  dressings,  in  which  state  they  are 
usually  applied.     Plasters  differ  from  cerates  in  possessing  a  still  firmer 
consistence,  requiring  heat  in  order  that  they  may  be  spread,  and,  though 
quite  firm  and  brittle  at  common  temperatures,  becoming  softish,  tena- 
cious, and  adhesive  at  the  temperature  of  the  skin.    Either  of  these  prep- 
arations may  be  employed  exclusively  for  local  effect,  or  with  a  view  to 
act  upon  the  system.    For  the  latter  purpose,  the  ointments  are  preferable 


58  APPLICATION    OF   MEDICINES.  [PART  I. 

when  the  cuticle  remains;  as,  by  the  friction  with  which  their  applica- 
tion is  often  accompanied,  they  may  be  forced  between  the  epidermic 
scales,  and  thus  brought  more  completely  within  reach  of  absorption. 

8.  EXTRACTS  (extracta)  are  rather  modes  of  pharmaceutical  prepara- 
tion, than  forms  for  administration.  They  consist  of  the  active  ingre- 
dients  of  complex  medicinal  substances,  extracted  by  water,  alcohol,  or 
acetic  acid,  or  by  expressing  the  juice  of  plants,  and  then  evaporating  to 
the  solid  consistence.  Some  of  them  are  so  dry  that  they  may  be  readilv 
reduced  to  powder,  and  given  in  this  state.  All  of  them  may  be  admin- 
istered in  the  form  of  officinal  mixture.  But  the  most  common  method 
of  exhibition  is  in  the  shape  of  pill,  to  which  they  are  often  very  readily 
brought,  in  consequence  of  their  soft,  somewhat  cohesive  consistence. 

SUBSECTION  II. 

•) 

Liquid  Forms. 

In  the  liquid  form  medicines  may  be  given  internally,  or  applied  to 
the  surface.  In  the  former  case,  if  taken  in  any  considerable  quantity,  they 
receive  the  name  of  POTION  (polio),  or  DRAUGHT  (haustus);  the  former 
being  sometimes  applied  to  a  quantity  of  liquid  which  may  be  taken  in 
divided  doses,  the  latter  exclusively  to  a  single  dose.  Applied  to  the  sur- 
face, they  receive  the  name  of  LOTION  (lotio)  when  thin  and  watery,  and 
of  LINIMENT  (linimentum)  when  of  a  soft  oleaginous  consistence,  fitted 
for  application  by  gentle  friction  with  the  hand.  One  of  our  late  officinal 
liniments  (Linimentum  Saponis  Camphoratum,  U.  S.  1850)  was  of  the 
consistence  of  a  soft  solid  when  cold,  but  became  quite  liquid  at  the  tem- 
perature of  the  body.  Some  medicines  are  essentially  liquid,  as  castor 
oil,  glycerin,  etc.;  others  are  brought  to  the  liquid  form  by  admixture  and 
suspension,  or  by  solution.  The  following  are  forms  of  officinal  liquid 
preparations. 

1.  MIXTURES  (miaturse),  in  the  sense  of  the  term  as  employed  in  the 
U.  S.  Pharmacopoeia,  are  preparations  in  which  a  medicine,  insoluble  in 
water,  is  suspended  in  that  fluid,  pure  or  variously  medicated,  by  means 
of  viscid  soluble  substances,  as  gum  arabic,  sugar,  and  the  yolk  of  eggs.* 
The  term  julep  embraces  both  these  preparations  and  others  in  which 
the  mixed  substances  may  be  dissolved.  The  form  of  mixture  is  one  of 
the  most  common  and  convenient  for  the  administration  of  insoluble 
medicines.  As  a  general  rule,  the  medicine  is  so  proportioned  in  the 
mixture  as  to  render  the  dose  a  tablespoonful  (fgss)  for  an  adult. 

*  In  the  U.  S.  Pharmacopoeia  of  I860,  one  preparation  was  admitted,  in  deroga- 
tion of  this  rule,  among  the  Misiur-x.  that,  namely,  of  Mixiuni  I'otasxte  Citratix,  which 
Is  strictly,  as  it  was  called  in  the  Pharmacopoeia  of  1850,  a  solution  of  citrate  of 
potassa.  (Note  to  the  third  edition.) 


CHAP.  III.]  APPLICATION   OF    MEDICINES.  59 

2.  SOLUTIONS  (liquores)  are  preparations  in  which  the  medicine,  or  its 
active  principle,  is  dissolved  in  water  or  other  menstruum.    The  officinal 
Solutions  (LIQUORES,  IT.  S.),  now  first  adopted  as  a  pharmaceutical  class 
in  the  U.  S.  Pharmacopeia,  are  exclusively  aqueous  solutions,  with  one 
single  exception,  that  of  Liquor  Gutla-perchse,  in  which  chloroform  is 
the  menstruum.     In  relation  to  medicines  which  are  wholly  soluble,  the 
process  is  extremely  simple ;  and  the  only  rule  requiring  attention  is  not 
to  mix,  in  the  same  solution,  substances  which   will  undergo  mutual 
decomposition,  so  as  to  form  an  insoluble  precipitate.     In  administering 
in  solution  substances,  the  absorption  of  which  is  desirable,  it  is  import- 
ant that,  if  irritant  in  their  character,  they  should  be  so  far  diluted  as 
to  produce  as  little  irritation  as  may -be  of  the  alimentary  canal.     Medi- 
cines generally  find  a  readier  entrance  into  the  system  when  largely 
diluted  than  when  concentrated.     Under  the  head  of  solutions  may  be 
considered  various  officinal  preparations,  in  which  the  soluble  and  active 
principles  of  a  medicine  are  extracted,  leaving  behind  the  insoluble  and 
inert.     Such   are   the  waters,  infusions,  decoctions,  tinctures,  spirits, 
wines,  vinegars,  syrups,  honeys,  oxymels,  fluid  extracts,  and  oleoresin* 
of  the  pharmacopoeias. 

3.  WATERS  (aquse)  are  forms  of  solution  which  have  been  long  in  use, 
and  which,  with  a  somewhat  peculiar  signification,  constitute  a  class  of 
preparations  in  our  Pharmacopoeia.     Formerly,  the  name  was  somewhat 
indefinitely  applied,  embracing  certain  solutions  of  solid  bodies,  as  lead- 
water,  lime-water,  tar-water,  etc.,  and  was  occasionally  extended  in  com- 
mon language  to  spirituous  preparations,  as  cologne-water,  lavender- 
water,  etc.;  but,  so  far  as  it  had  a  distinctive  meaning,  it  was  used  to  de- 
signate watery  solutions  of  volatile  substances,  obtained  by  distillation; 
as  mint-water,  rose-water,  etc.     In  the  present  Pharmacopoeia,  the  title 
WATERS  or  Aquae  is  restricted  to  preparations  in  which  volatile  or  gas- 
eous substances  arc  held  in  solution  by  water,  no  matter  how  the  solution 
may  be  effected,  whether  by  distillation  with  water,  by  simple  trituration, 
or  other  method  of  impregnation  ;  the  condition  being  essential  that  the 
preparation  might  be  made  by  distillation,  as  it  often  was  originally. 
The  medicines  most  frequently  thus  treated  are  the  volatile  oils  of  aro- 
matics,  as  of  mint,  cinnamon,  fennel,  etc.;   but  the  category  also  em- 
braces other  medicines,  as  the  waters  of  ammonia,  carbonic  acid,  and 
chlorine;  while  solutions  of  non-volatile  substances  formerly  called  wa- 
ters, as  lime-water  (aqua  calcis)  and  potassa-water  (aqua  potassse),  are 
now  designated  as  solutions  (liquores). 

4.  INFUSIONS  (infusa)  are  aqueous  solutions  made  by  treating  with 
water,  without  boiling,  medicines  containing  principles  soluble  in  water, 
with  others  insoluble.     They  air  either  cold  or  hot,  the  former  being 
prepared  with  water  at  ordinary  temperatures,  the  latter  with  the  same 
liquid  previously  heated  to  the  boiling  point.      Hot  water  acts  more 


60  APPLICATION    OF    MEDICINES.  [PART  I. 

rapidly  than  cold  under  circumstances  otherwise  the  same,  and  may, 
therefore,  be  preferred  when  speedy  action  is  desirable.  But  it  is  some- 
times objectionable  in  consequence  of  dissolving  starchy  matters,  which 
are  insoluble  in  cold  water,  and  the  presence  of  which  may  render  the 
infusion  more  liable  to  speedy  change.  On  the  contrary,  cold  water 
is  liable  to  the  same  objection  in  reference  to  vegetable  albumen,  which 
it  dissolves,  while  hot  water  coagulates  instead  of  dissolving  it.  Heat 
injuriously  affects  the  virtues  of  certain  medicines,  and  should  not,  there- 
fore, be  employed  in  preparing  them.  These  considerations  should  be 
allowed  some  weight  in  the  choice  between  cold  and  hot  infusion.  Many 
of  the  infusions  are  most  elegantly  and  efficiently  prepared  by  the  pro- 
cess of  percolation  or  displacement.  The  U.  S.  Pharmacopeia  uses 
both  the  method  of  percolation  and  that  of  simple  maceration,  preferring 
one  or  the  other  according  to  the  nature  of  the  substance  used ;  and 
sometimes  it  presents  the  alternative  of  either  method  in  reference  to 
the  same  substance.  Where  percolation  is  used,  the  plan  pursued  is  to 
moisten  the  medicine,  in  powder,  with  a  little  of  the  menstruum,  then 
to  pack  it  in  a  percolator,  and  pour  on  water  till  the  infusion  passed 
measures  a  given  quantity,  which  is  generally  a  pint.  (See  U.  S.  Dis- 
pensatory.) In  domestic  practice  the  method  of  maceration  should 
generally  be  preferred ;  as  that  of  percolation  requires  a  degree  of  skill 
possessed  only  by  the  practical  pharmaceutist. 

5.  DECOCTIONS  (decocta)  differ  from  infusions  simply  in  the  circum- 
stance that  boiling  is  used  in  preparing  them.     They  arc  liable  to  the 
same  objections  as  the  hot  infusions  in  a  still  greater  degree,  but  are 
convenient  when  haste  is  requisite,  and  the  active  principles  of  the  medi- 
cine are  not  likely  to  be  materially  injured  by  the  heat.    As  atmospheric 
air,  at  a  high  temperature,  is  liable  to  act  injuriously  on  various  vegeta- 
ble principles,  the  process  should  be  performed  in  a  covered  vessel,  and 
should  not  be  continued  longer  than  is  necessary  to  the  end  in  view. 
Hard,  tough,  fibrous  substances  are  often  most  conveniently  treated  in 
this  way;  but  the  process  is  altogether  inapplicable  to  those  medicines 
whose  activity  depends  upon  a  volatile  principle,  as,  for  example,  upon 
a  volatile  oil.     In  the  present  Pharmacopeia,  a  somewhat  modified  plan 
of  preparing  the  decoctions  has  been  adopted.     The  substance  treated  is 
boiled  with  water  generally  for  fifteen  minutes  ;  after  which  the  whole  is 
placed  upon  a  strainer,  and  sufficient  water  added,  through  the  strainer, 
to  make  the  decoction  measure  a  certain  quantity,  which  is  generally  a 
pint.     More  precision  in  the  result  is  thus  obtained  than  by  the  old 
method  of  merely  boiling  and  straining. 

6.  TINCTURES  (tinclurse)  are  alcoholic  solutions  of  medicinal  principles. 
As,  in  consequence  of  the  preservative  inllneiice  of  the  alcohol,  they  may 
generally  be  kept,  in  well-closed  bottles,  an  indefinite  length  of  time,  they 
are  almost  always  prepared  by  the  pharmaceutist,  and  very  seldom  extern- 


CHAP.  III.]  APPLICATION   OF    MEDICINES.  61 

poraneously.  In  much  the  larger  proportion  of  them,  the  process  of 
percolation  is  employed,  somewhat  varied  according  to  the  nature  of  the 
medicine  used.  It  should  be  remembered  that  some  of  them  are  prepared 
with  officinal  alcohol  (sp.  gr.  -835),  and  others  with  diluted  alcohol,  made 
by  mixing  equal  measures  of  the  officinal  alcohol  and  water.  The  former 
are  of  course  more  stimulating  than  the  latter,  so  far  as  concerns  the 
menstruum ;  and  this  circumstance  may  be  occasionally  of  practical  im- 
portance. The  officinal  tinctures  (U.  S.  Pharmacopoeia)  of  the  pure 
resins,  gum-resins,  balsams,  aconite  root,  hemp,  nux  vomica,  American 
hellebore,  ginger,  castor,  and  iodine  are  made  with  the  stronger  alcohol; 
almost  all  others,  including  those  of  the  roots,  barks,  leaves,  and  fruits  of 
plants,  with  the  diluted.  This  set' of  preparations  is  applicable  only 
when  some  degree  of  stimulation  is  admissible,  or  when  the  active  prin- 
ciple dissolved  in  the  alcohol  is  so  powerful  as  to  render  the  amount  of 
the  menstruum  employed  in  each  dose  insignificant,  as  in  the  instances 
of  tinctures  of  aconite  root  and  opium.  They  are  especially  useful  as 
adjuvants  to  other  forms  of  preparation,  when  it  is  desirable  to  render 
these  somewhat  more  stimulating.  Thus,  tincture  of  Peruvian  bark 
may,  in  low  forms  of  disease,  be  very  appropriately  added  to  the  infusion 
or  decoction,  or  to  the  solution  of  sulphate  of  quinia.  In  relation  to  the 
long-continued  employment  of  tinctures,  the  practitioner  should  be  aware 
of  the  danger  of  establishing  a  habit  of  intemperance,  and  should  be  on 
his  guard  accordingly.  The  resinous  and  camphorous  tinctures  become 
turbid  on  the  addition  of  water,  in  consequence  of  the  precipitation  of 
the  resin  or  camphor,  and  should  therefore  be  given  with  a  viscid  liquid, 
as  mucilage,  syrup,  or  sometimes  milk,  or,  if  diluted  with  water  alone, 
should  be  taken  immediately  after  admixture. 

7.  SPIRITS  (spiritus)  are  closely  analogous  to  tinctures,  being,  like 
them,  solutions  of  medicinal  principles  in  alcohol,  but  diifering,  as  for- 
merly understood,  in  being  prepared  by  distillation.     As  many  of  the 
spirit*  are  now  prepared  by  simply  dissolving  in  alcohol  the  principles 
originally  separated  from  the  substances  containing  them  by  distillation, 
and  as  this  mode  of  preparation  is  recognized  in  the  present  U.  S.  Phar- 
macopoeia, the  meaning  of  the  term  must  be  considered  as  having  been 
officinally  extended  so  as  to  include  all  alcoholic  solutions  of  volatile 
principles,  whether  made  by  means  of  distillation  or  otherwise.     Thus. 
the  term  spirit  of  peppermint,  originally  applied  to  the  liquid  obtained  by 
distilling  peppermint  with  alcohol,  is  now  used  to  designate  the  simple 
alcoholic  solution  of  the  volatile  oil,  which  in  the  previous  Pharmaco- 
poeia was  denominated  tincture  of  oil  of  peppermint. 

8.  WINES  (vina)  differ  from  the  tinctures  simply  in  being  prepared  with 
wine  as  the  menstruum,  instead  of  alcohol  or  diluted  alcohol.    These  are 
also  usually  the  subjects  of  officinal  preparation.     The  advantages  of 
wine,  in  the  cases  to  which  it  is  applicable,  are  that  it  is  less  stimulant 


62  APPLICATION    OF    MEDICINES.  [PART  I. 

than  alcohol,  while  it  is  more  effectual  than  water  in  counteracting  the 
tendency  of  the  organic  medicinal  principles  to  decomposition,  and,  in 
consequence  of  the  alcohol  it  contains,  is  sometimes  more  effective  as  a 
solvent.  For  the  purposes  of  a  medicinal  solvent,  the  stronger  wines 
are  preferred  to  the  weaker;  as  the  latter  are  apt  to  contain  principles 
incompatible  with  the  substance  dissolved.  Thus,  Madeira,  sherry,  or 
Teneriffe  should  be  preferred  to  claret  or  the  Rhine  wines.  Port  wine  is 
seldom  proper,  on  account  of  the  tendency  of  the  tannic  acid  it  contains 
to  form  insoluble  compounds  with  other  bodies. 

9.  VINEGARS  (aceta)  are  simply  infusions  made  with  cold  distilled 
vinegar,  or  diluted  acetic  acid.     Very  few  of  them  are  used;  and  these 
more  in  the  preparation  of  other  forms  of  medicine,  than  for  direct  ad- 
ministration.    Thus,  vinegar  of  squill  is  much  used  as  an  ingredient  in 
the  syrup  of  squill,  seldom  alone.    This  class  of  preparations  is  based  on 
the  fact,  that  in  certain  cases  acetic  acid  favours  the  solvent  property  of 
water,  while  it  also  has  a  preservative  effect,  though  in  this  respect 
much  less  efficient  than  alcohol. 

10.  SYRUPS  (syrupi)  are  aqueous  solutions  of  sugar  impregnated  with 
medicinal  principles.     When  the  term  SYRUP  (syrupus)  is  used  singly,  it 
implies,  officiually,  a  simple  solution  of  sugar  in  water,  of  a  certain  recog- 
nized strength,  which,  according  to  the  U.  S.  Pharmacopeia,  is  about 
t\vo  and  a  half  pounds  of  sugar  to  a  pint  of  water.     The  medicated  syrups 
are  designated  by  the  name  of  their  chief  medicinal  ingredient,  as  syrup 
or  rhubarb,  syrup  of  ginger,  etc.     The  mode  in  which  the  medicinal  im- 
pregnation is  effected  varies  much  with  the  character  of  the  medicine. 
The  syrups  are  generally  subjects  of  officinal  direction,  and  are  kept 
ready  made  in  the  shops.     Their  advantages  are  that  the  sugar  serves 
to  cover  the  disagreeable  taste  of  the  medicine,  and  at  the  same  time 
prevents  its  spontaneous  decomposition.     They  are  favourite  prepara- 
tions in  infantile  cases;  but,  in  their  use,  the  physic-inn  should  bear  in 
mind  the  frequently  injurious  effect  of  much  sugar  in  a  feeble  stomach. 

11.  HONEYS  (melUta)  differ  from  the  syrups  only  in  the  substitution  of 
honey  for  sugar.    They  are  at  present  little  used;  honey,  in  consequence 
of  its  impurities,  being  inferior  to  sugar  as  a  preservative. 

1-2.  OXYMELS  are  preparations  in  which  the  menstruum  cons' 
honey  and  vinegar  combined.    They  are  now  almost  out  of  use;  oxymel 
of  squill,  which  for  some  time  was  the  only  one  officinal,  having  been 
rereiitly  d:.-carded  by  the  Pharmacop- 

13.  FLUID  EXTRACTS  (extracta  fluida)  are  highly  concentrated  solu- 
tions of  the  active  constituents  of  medicines,  or  the  active  constiti: 
themselves  extracted  in  the  liquid  state;  and  are  often  very  convenient 
and  efficient  preparations.  They  have  been  introduced  into  use  at  a 
comparatively  recent  date,  and  an-  at  present  much  employed.  There 
are  two  kinds  of  them.  In  one,  the  active  principles  of  the  medicine  arc 


OH  A  P.  III.]  APPLICATION    OF    MEDICINES.  63 

extracted  by  alcohol  or  diluted  alcohol,  sugar  is  often  added  as  a  preser- 
vative, and  to  improve  the  flavour,  and  the  alcohol  is  afterwards  to  a 
greater  or  less  extent  evaporated.  These  are  concentrated  alcoholic 
solutions,  or  aqueous  solutions  with  a  little  alcohol  remaining;.  The 
other  kind  consist  mainly  of  volatile  oil  and  resinous  matter,  extracted 
by  ether  from  the  medicine,  and  subsequently  freed  from  the  solvent  by 
evaporation.  To  the  latter  division  the  name  of  OLEORESINS  (oleore- 
sinse),  expressive  of  their  composition,  has  been  applied  in  the  latest 
edition  of  our  Pharmacopeia. 

14.  GLYCERATES  (Glycerolex)  are  preparations,  recently  introduced, 
in  which  glycerin  serves  as  the  menstruum.     Advantages  of  these  prep- 
arations are  that  glycerin  dissolves , substances  which  water  will  not, 
that  it  does  not  evaporate  spontaneously  like  water  and  alcohol,  and  that 
it  contributes  to  the  preservation  of  the  substance  dissolved,  without 
being  stimulating  or  irritating  like  spirit.     Several  of  the  glycerates  are 
more  or  less  used,  as  those  of  iodine,  aloes,  and  tar ;  but  they  do  not 
as  yet  form  a  class  in  our  officinal  code. 

1 5.  Spray.    As  it  is  desirable,  in  certain  diseases  of  the  air-passages, 
to  bring  various  substances  into  contact  with  the  diseased  surface  in 
the  liquid  form;  but,  from  the  great  sensitiveness  of  the  respiratory  or- 
gans, it  has  been  found  extremely  inconvenient  to  introduce  liquids  in  an 
aggregate  condition  beyond  the  glottis;  the  expedient  has  been  adopted 
of  bringing  the  liquid  into  a  state  of  extremely  minute  division,  and 
then   causing  it  to  be  inhaled  admixed  in  this  condition  with  the  at- 
mospheric air.     The  names  of  atomization,  pulverization,  and  nebuliza- 
lion  have  been  given  to  the  different  processes  by  which  this  minute 
division  is  effected;  and  instruments  adapted  to  the  purpose  are  called 
atomizers,  pulverizers,  etc.     In  treating  of  the  forms  in  which  liquids  are 
used,  it  was  necessary  to  call  attention  to  this  method  of  applying  them; 
but  it  will  be  found  more  convenient  to  consider  the  subject  fully  in  con- 
neetion  with  the  lungs,  as  one  of  the  parts  to  which  medicines  are  applied ; 
and  the  reader  is  accordingly  referred  to  the  subsection  in  which  inha- 
hition  is  treated  of. 

SUBSECTION  III. 

Aeriform.  State. 

This  may  be  a  state  either  of  gas  or  vapour.  GASES  are  aeriform 
fluids  which  retain  their  condition  at  common  temperatures.  VAPOVRS 
arc  likewise  aeriform  fluids,  but  require  an  elevated  temperature,  under 
the  ordinary  degree  of  atmospheric  pressure,  to  enable  them  to  retain 
that  state,  and,  upon  the  diminution  of  their  temperature,  become  liquid 
or  solid.  Both  gases  and  vapours  are  employed  as  medicinal  agents, 
the  former  seldom,  the  latter  very  frequently.  Gases  are  used  chiefly 
by  inhalation;  vapours  both  in  this  manner,  and  by  application  to  the 
surface  of  the  body. 


64  APPLICATION    OF    MEDICINES.  [PART  I. 


SECTION  III. 

Parts  to  which  Medicines  are  Applied,  and  Modes  of 
Application. 

The  parts  to  which  medicines  are  applied,  in  order  to  affect  the  sys- 
tem, are  chiefly  1.  the  alimentary  canal,  2.  the  skin,  3.  the  bronchial 
tubes  and  pulmonary  air-cells,  and  4.  the  subcutaneous  areolar  tissue. 
When  applied  to  other  surfaces,  it  is  generally  with  a  view  to  local  effect. 

SUBSECTION  I. 
Alimentary  Canal. 

Medicines  are  applied  to  the  two  opposite  extremities  of  the  alimentary 
canal ;  to  the  stomach,  namely,  and  to  the  rectum. 

1.  The  Stomach.  This  is  the  most  convenient,  generally  the  most 
effective,  and  by  far  the  most  frequently  employed  avenue  for  medicines 
into  the  system.  To  this,  as  to  any  other  part,  they  may  be  applied 
with  the  view  exclusively  to  a  local  effect;  but  much  more  frequently 
the  object  is  to  act  on  the  system  at  large,  or  on  some  distant  part,  for 
which  the  stomach  affords  great  facilities,  both  by  the  readiness  with 
which  absorption  takes  place  from  its  inner  surface,  and  the  sympathies 
which  connect  it,  beyond  any  .other  accessible  organ,  with  all  parts  of 
the  body.  The  forms  in  which  medicines  are  introduced  into  the  stomach 
have  been  already  referred  to.  The  modes  of  administering  them  are  in 
general  too  obvious  to  require  notice.  Two  or  three  remarks,  however. 
upon  this  point  will  not  be  irrelevant.  1.  Sometimes  patients  are  coma- 
tose, and  cannot  voluntarily  swallow  medicines.  In  these  cases,  there 
is  sometimes  danger  of  the  medicine  passing  into  the  glottis,  and  pro- 
ducing embarrassment  of  respiration.  Substances,  however,  which  act 
in  small  doses,  as  croton  oil,  may  be  placed  upon  the  tongue  towards  its 
further  extremity,  where  thev  excite  the  reflex  action  of  deglutition,  and 
are  often  swallowed.  2.  Children  not  (infrequently  refuse  to  take  medi- 
cine into  their  mouth,  and  cannot  be  prevailed  on  by  any  persuasion. 
They  can  generally  be  made  to  swallow,  without  great  difficulty,  by 
taking  them  in  the  lap,  closing  the  nostrils  so  as  to  compel  them  to  open 
the  mouth,  and  then  introducing  the  medicine  by  a  teaspoon.  3.  In  the 
cases  of  adults  who,  from  insanity  or  the  purpose  of  suicide,  will  not,  or 
from  paralysis  or  insensibility,  cannot  take  medicine,  the  physician  may 
sometimes  be  justified,  in  order  to  save  life,  in  forcibly  injecting  it  into 
the  stomach  by  means  of  the  stomach-tube  and  a  syringe. 


CHAP.  III.]  APPLICATION    OF    MEDICINES.  65 

Attempts  have  been  made,  in  cases  of  impervious  and  incurable  stric- 
ture of  the  oesophagus,  to  prevent  starvation  by  making  a  fistulous 
opening  from  without  into  the  stomach,  through  which  food  might  be 
introduced ;  but  the  experiment,  though  not  without  some  encouraging 
circumstances,  has  not  hitherto  proved  successful.  Considering  that,  in 
several  instances,  such  openings  have  resulted  from  accidental  wounds, 
and  the  patient  afterwards  recovered,  with  a  permanent  fistulous  orifice, 
or  even  an  aperture  of  considerable  size,  the  operation  of  gastrotomy 
would  seem  to  be  justifiable  in  otherwise  necessarily  fatal  cases.  (See 
Guy's  Hospital  Reports,  iv.  1.) 

2.  The  Rectum.  Medicines  are  employed  by  the  rectum  with  two 
distinct  objects;  one  to  evacuate  the  bowels  by  simply  irritating  the 
part,  the  other  to  produce  their  peculiar  and  characteristic  impression 
either  on  the  rectum  itself,  or,  through  absorption  or  sympathy,  upon 
other  parts,  or  the  whole  system.  These  two  objects  are  often  incom- 
patible ;  and  it  is  necessary,  therefore,  when  the  latter  effect  is  desired, 
to  administer  the  medicine  in  such  a  manner  as  not  to  produce  the 
former.  But,  in  either  case,  the  patient  should  be  directed  to  resist  the 
immediate  impulse  to  evacuate  the  bowels ;  as,  even  when  the  cathartic 
effect  is  aimed  at,  time  should  be  allowed  for  the  influence  of  the  medi- 
cine to  be  extended  to  the  higher  portions  of  the  large  intestines,  which 
might  otherwise  not  be  affected,  and  only  the  rectum  emptied.  Medi- 
cines may  be  administered  by  the  rectum  either  in  the  liquid  or  solid 
form.  In  the  former  case,  they  are  called  enemata,  injections,  or  clysters ; 
in  the  latter,  suppositories. 

In  either  of  the  forms  mentioned,  the  dose  of  the  medicine,  when  given 
in  reference  to  its  peculiar  effects,  may  be  about  three  times  that  given 
by  the  mouth.  But,  as  the  relative  susceptibility  of  the  stomach  and  rec- 
tum varies,  it  would  be  a  safer  course,  when  the  medicine  is  very  active, 
as  in  the  instances  of  the  poisonous  alkaloids,  to  administer  at  first  about 
the  same  dose  as  by  the  stomach,  and  increase  afterwards  if  necessary. 
There  is  another  important  consideration  in  regard  to  the  relative  dose 
by  the  stomach  and  rectum.  When  an  individual  has  become  habituated 
to  very  large  quantities  of  the  more  active  medicines  by  the  mouth,  as 
opium,  for  example,  it  might  be  very  dangerous  to  triple  the  quantity, 
xvlu'ii  administering  it  per  anum.  Though,  undoubtedly,  the  loss  of 
susceptibility  is  mainly  in  the  nervous  centres,  it  is  very  probable  that 
the  stomach  experiences  the  loss  in  a  greater  degree  than  other  organs, 
and  that,  applied  to  another  part,  the  medicine  might  be  found  to  exor- 
cise a  much  greater  proportionate  influence.  It  would  be  best,  therefore, 
in  such  cases,  not  only  not  to  triple  the  dose,  but  not  to  increase  it  at  all, 
and  at  first  even  to  administer  the  medicine  in  much  smaller  quantity  by 
the  rectum  than  the  stomach,  until  the  relative  susceptibility  of  the  two 
VOL.  i. — 5 


66  APPLICATION    OF    MEDICINKS.  [PART  I. 

parts,  or  the  relative  facility  of  absorption  from  them,  shall  have  been 
tested  by  trial.* 

The  circumstances  under  which  medicines  may  be  administered  by  the 
rectum,  in  reference  to  their  peculiar  effects,  are  the  following :  1.  when 
the  stomach  is  unable  to  retain  them,  or  from  any  cause  they  may  be 
thought  injurious  to  that  organ ;  2.  when  it  is  desirable  to  produce  a  very 
rapid  or  powerful  impression  on  the  system,  and  thus  to  seek  an  entrance 
into  it  by  every  avenue;  3.  when,  from  the  long  continuance  of  the  in- 
dication for  the  use  of  any  medicine,  it  is  advisable  to  vary  the  surface 
of  application,  in  order  to  avoid  wearing  out  the  susceptibility  of  the 
stomach,  and  thus  to  prolong  the  period  during  which  the  effects  of  the 
medicine  may  be  sustained;  4.  when  the  seat  of  disease  is  in  pans 
neighbouring  to  the  rectum,  and  the  disease  itself  is  of  such  a  character 
as  to  be  relieved  by  impressions  made  in  its  vicinity  more  speedily  and 
effectually  than  through  the  system  at  large,  as  in  painful  affections  of 
the  urinary  and  genital  organs;  and  5.  when  the  indication  is  to  produce 
the  effects  of  the  medicine  upon  the  rectum  itself,  as  in  neuralgia  or  spasm 
of  that  bowel,  and  chronic  inflammation  and  ulceration  of  its  lining  mem- 
brane. Medicines  are  also  exhibited  in  this  way,  in  order  to  weaken  or 
destroy  the  thread-worm  which  infests  the  rectum. 

Enemata.  When  intended  to  evacuate  the  bowels,  the  enema  should 
measure  for  an  adult  a  pint  or  somewhat  less,  for  a  youth  of  twelve  years 
about  half  the  quantity,  for  a  child  one  or  two  years  old  two  fluidounces, 
and  for  an  infant  at  birth  one  fluidounce.  Too  great  a  quantity,  if  used 
habitually,  may  injuriously  distend  the  rectum,  and  diminish  its  power 
of  contraction.  Upon  the  subject  of  cathartic  enemata  more  will  be  said 
under  the  head  of  cathartics. 

When  the  object  is  to  obtain  any  characteristic  effect  from  medicines, 
other  than  purgation,  the  bulk  should  be  small,  say  from  one  to  four 
iluidounccs,  and  the  vehicle  very  bland,  consisting  of  pure  water,  or  of 
some  mucilaginous  or  starchy  fluid;  and.  when  there  is  danger  of  its 
being  rejected,  from  twenty  to  forty  drops  of  laudanum,  or  an  equivalent 

*  Experiments  performed  by  Mr.  W.  S.  Savory  on  the  lower  animals,  especially 
the  rabbit,  guinea  pig,  and  rat,  show  that  certain  medicines  injected  into  the 
rectum  act  much  more  vigorously,  in  these  animals,  than  when  introduced  in  the 
same  dose  into  the  stomach.  This  was  true  especially  of  strychnia;  but  the  same 
results,  though  in  less  degree,  were  obtained  with  other  medicines,  as  cyanide  of 
|.(>t:i-siiim  and  hydrocyanic  acid.  (Lancet,  May  9,  1863,  p.  510:  also  Ibid.  p.  548.) 
Mr.  Savory,  however,  states  that,  in  order  to  obtain  these  results,  the  ni<-<lioine 
must  be  exhibited  in  the  liquid  form;  as  in  the  solid  state  the  substance  often  re- 
mains long  in  the  rectum  without  effect.  ( Med.  T.  and  Gaz.,  June,  1865,  p.  586. )  These 
results  of  Mr.  Savory  confirm  the  propriety  of  the  caution  given  in  the  text.  In 
relation  to  powerful  medicines,  administered  in  the  liquid  form,  it  would  be  prudent 
never  to  commence  with  them  by  the  rectum  in  larger  dose  than  by  the  stomach. 
(Xote  to  the  third  edition.) 


CHAP.  III.]  APPLICATION   OF    MEDICINES.  67 

quantity  of  some  other  liquid  preparation  of  opium,  should  be  added,  in 
order  to  control  the  irritability  of  the  rectum. 

The  most  convenient  instrument  for  the  administration  of  enemata  is 
on  the  whole  a  good  metallic  syringe,  which  may  vary  in  capacity,  ac- 
cording to  the  bulk  to  be  thrown  up,  from  a  pint  to  two  fluidounces. 
The  old-fashioned  pipe  and  bladder  may  be  resorted  to,  in  the  absence 
of  this  instrument.  The  gum-elastic  bottle  with  a  tube  is  still  more  con- 
venient. Another  instrument,  sometimes  used  in  France,  is  a  slender, 
water-proof,  tube-like  bag,  three  or  four  feet  long,  two  or  three  inches 
in  diameter  at  the  larger  end,  and  gradually  diminishing  to  the  smaller, 
to  which  an  ivory  pipe  is  attached  for  insertion  into  the  rectum.  When 
employed,  the  pipe  is  introduced,  the  larger  extremity  of  the  bag  held  up 
as  high  as  it  will  extend,  and  the  liquid  poured  in.  This  either  enters 
the  rectum  by  its  own  specific  gravity,  or  may  be  gently  forced  in  by 
running  the  fingers,  pressing  the  bag  between  them,  from  the  upper 
gradually  down  towards  the  lower  end.  The  self-injecting  apparatus, 
which  is  a  kind  of  forcing-pump,  is  very  useful  when  an  individual 
wishes  to  administer  an  enema  to  himself,  and  also  when  the  object  is  to 
throw  an  indefinite  quantity  of  liquid  into  the  bowels,  with  the  view  of 
overcoming  obstruction.*  Whatever  instrument  is  employed,  the  liquid 
injected,  as  well  as  the  instrument  itself,  should  be  at  about  the  tempera- 
ture of  the  interior  of  the  body;  and,  after  the  injection,  the  operator,  in 
'•uses  where  there  is  any  disposition  to  a  premature  discharge  of  the 
liquid,  should  aid  the  efforts  of  the  patient  to  retain  it  by  pressing  a 
warm  folded  towel  against  the  fundament,  until  the  first  irritant  effect 
shall  have  passed  away.  Great  care  should  be  taken  not  to  wound  the 
mucous  membrane  by  entangling  the  end  of  the  pipe  in  its  folds,  or 
pressing  it  against  the  membrane  too  strongly.  Severe  pain  is  some- 
times produced  by  a  neglect  of  this  caution.  In  relation  to  the  medicine 


*  The  apparatus  of  Dr.  Mattson  is  very  convenient,  for  the  same  purpose,  being 
exceedingly  simple,  and  easy  of  application.  It  consists  of  a  gum-elastic  bag, 
communicating  near  its  orifice  with  a  rectum  tube,  and  having  a  short  tube 
with  a  valve  opening  inward  inserted  into  its  orifice,  through  which  the  liquid 
to  be  injected  enters  the  instrument.  The  open  end  of  this  tube  is  introduced 
into  the  liquid,  which  is  drawn  into  the  instrument,  and  then  forced  into  the  rectum, 
l>y  the  alternate  expansion  and  compression  of  the  bag.  (See  Boston  Mcd.  and  Surg. 
Jmirn.,  liii.  274.) 

A  still  more  convenient  instrument,  which  is  a  modification  of  Dr.  Mattson's,  is 
•  Ic-cril.cd  in  the  London  Lancet  (March  31,  186G,  p.  349).  It  consists  of  a  stout 
oval  gum-elastic  bag,  communicating  at  one  end  with  a  rectum  tube,  and  at  the 
other  with  a  water-proof  bag  containing  the  liquid  to  be  injected,  a  valve  opening 
inwurd  being  placed  at  the  orifice  connected  with  the  receiver.  By  alternate 
]>iv«suro  with  the  hand,  it  is  obvious  that  the  gum-elastic  bag  will  be  alternately 
emptied  into  the  rectum  and  filled  from  the  receiver  until  any  desirable  quantity 
<>t  liquid  is  made  to  enter  the  bowel.  (Note  to  the  third  edition.) 


68  APPLICATION    OF    MEDICINES.  [PART  I. 

injected,  if  a  soluble  substance,  it  should  be  dissolved ;  if  a  solid,  or  liquid 
not  soluble  in  water,  it  should  be  thoroughly  and  equably  incorporated 
with  the  liquid  vehicle  by  means  of  some  suspending  substance.  When 
an  irritating  substance,  such  as  oil  of  turpentine,  is  injected,  the  yolk  of 
eggs  is  an  excellent  intermedium. 

Advantage  might  sometimes  ensue,  in  cases  in  which  a  speedy  opera- 
tion of  the  medicine  is  essential,  and  the  stomach  will  not  retain  it,  from 
introducing  it  by  means  of  a  long  flexible  tube  far  up  into  the  colon. 
Being  thus  diffused  over  a  greater  extent  of  surface,  it  might  possibly 
be  absorbed  more  rapidly,  and  in  greater  amount,  and  consequently  pro- 
duce a  more  speedy  and  powerful  effect. 

Suppositories.  Like  enemata,  these  may  be  used  simply  to  evacuate 
the  bowels  by  irritating  the  rectum,  or  to  produce  the  peculiar  effect 
of  the  medicine  employed.  For  the  former  purpose,  they  may  be  of 
a  cylindrical,  oval  or  conical  form,  an  inch  or  two  in  length  by  about 
half  an  inch  in  diameter,  and  made  of  some  softish  material,  like  soap  or 
cacao  butter.  For  the  latter,  they  should  be  as  small  as  is  consistent 
with  due  effect,  and  preferably  of  the  pilular  form;  the  object  being  that 
they  should  irritate  as  little  as  possible.  Opium  is  not  unfrequently  em- 
ployed in  this  way.  Suppositories,  with  a  view  to  systemic  effect,  have 
recently  come  into  more  extended  use.  They  have  even  been  adopted 
as  officinal  in  the  British  Pharmacopoeia.  For  a  fuller  account  of  this  set 
of  preparations,  see  the  U.  S.  Dispensatory  (12th  ed.,  p.  1361). 

Gaseous  Injection.  Aeriform  substances  have  sometimes  been  injected 
into  the  rectum,  though  this  method  of  medication  is  rare.  Atmospheric 
air  thrown  up  largely  has  been  found  useful  in  overcoming  obstruction  of 
the  bowels;  tobacco  smoke  has  been  employed  to  produce  relaxation: 
and  carbonic  acid  gas  has  been  recommended  in  certain  morbid  states  of 
the  rectum. 

Electric  action  may  also  be  developed  in  the  rectum,  either  by  intro- 
ducing a  complete  metallic  galvanic  arrangement  in  a  compact  form,  or 
by  passing  a  wire  connected  with  one  pole  into  the  bowel,  and  applying 
the  other  at  some  point  on  the  back  or  abdomen. 


SUBSECTION  II. 
The  Skin. 

Next  to  the  alimentary  canal,  the  skin  is  most  frequently  resorted  to 
for  the  application  of  medicines.  The  object  may  be  either  to  affect  the 
system  or  some  unconnected  part  through  absorption,  sympathy,  deple- 
tion, revulsion,  etc.,  or  to  act  exclusively  on  the  skin  itself.  The  modes 
of  application  are  various,  both  in  relation  to  the  state  of  the  skin  and 
the  substance  employed.  Thus,  the  skin  may  remain  undisturbed,  the 


CHAP.  III.]  APPLICATION    OF    MEDICINES.  69 

medicine  being  merely  brought  into  contact  with  it;  or  the  epidermic 
scales  may  be  disturbed  by  friction  at  the  time  of  application ;  or  the 
epidermis  may  be  removed,  and  the  medicine  placed  upon  the  denuded 
cutis.  The  substance  employed  may  be  solid,  semiliquid,  liquid,  or  aeri- 
form, and,  if  solid,  may  be  of  different  degrees  of  consistence. 

1.  Simple  Application  to  the  Sound  Skin.  Of  such  application  we  have 
examples,  with  reference  to  solids,  in  cataplasms,  cerates,  and  plasters; 
with  reference  to  liquids,  in  lotions,  fomentations,  general  baths,  local 
baths,  the  douche,  affusion,  and  sponging;  and,  with  reference  to  aeri- 
form substances,  in  the  hot  air  bath,  the  general  and  local  vapour  bath, 
and  the  vapour  douche.  Of  the  different  solid  forms  mentioned,  as  well 
as  of  lotions,  enough  has  been  already  said.  Fomentations  or  sto^s  are 
heated  liquids,  applied  by  means  of  flannels  or  other  cloths  saturated 
with,  or  wrung  out  of  them.  They  are  usually  employed  to  obtain  the 
effects  of  water  and  heat,  but  sometimes  also  for  the  specific  effects  of 
medicines,  as  when  the  decoction  of  poppy-heads,  or  infusion  of  tobacco 
is  applied. 

Raths  consist  in  the  direct  application  of  water,  either  pure  or  medi- 
cinally impregnated,  more  or  less  extensively  to  the  surface ;  the  general 
bath  being  applied  to  the  whole  surface,  the  head  perhaps  excepted;  the 
vmicupium  or  half-bath,  to  the  lower  half  of  the  body ;  the  coxseluvium 
or  hip-bath,  to  the  pelvis  and  upper  part  of  the  thighs;  the  pediluvium 
or  foot-bath,  to  the  feet  and  legs;  and  the  maniluvium  or  hand-bath,  to 
the  hands  and  forearms.*  When  the  water  is  made  to  fall  upon  the 
body  generally  from  above,  in  minute  currents  or  streams,  as  through  a 
colander,  the  application  is  called  a  shower  bath  ;  when  a  single  stream 
of  greater  or  less  size  is  directed  upon  one  part  with  more  or  less  force,  it 
is  named,  from  the  French,  the  douche.  In  all  these,  the  water  may  be 
cold,  warm,  or  hot;  and  we  thus  have  the  cold  bath,  the  warm  bath,  and 
the  hot  bath,  which  are  very  different  in  their  effects,  and  employed  for  a 
great  diversity  of  purposes.  Of  the  principles  of  operation,  and  of  the 
applications  of  the  different  forms  of  baths,  I  shall  have  occasion  to  treat, 
at  some  length,  under  the  different  classes  of  remedies  to  which  they  re- 
spectively belong.  It  is  sufficient  here  to  state  that  the  bath,  when  below 
75°,  may  be  called  a  cold  bath  ;  when  between  85°  and  98°,  a  warm  bath  : 
and  from  98°  to  112°,  a  hot  bath.  Some  make  a  distinction  between  the 
tepid  and  warm  baths,  the  former  being  of  a  somewhat  lower  temperature 
than  the  latter. 

*  The  means  of  employing  the  varieties  of  local  bathing  mentioned  in  the  text 
are  well  known;  but  the  application  of  water  to  other  limited  parts  than  those 
referred  to  may  be  indicated,  and  some  ingenuity  would  be  requisite  to  fashion 
apparatus  suitable  for  the  purpose.  The  reader  may  find  it  useful  to  consult,  upon 
this  subject,  a  paper  on  the  "Localization  of  Baths ,"  by  Dr.  Conrad  Mayor,  con- 
tained in  the  New  York  Journal  of  Medicine  (3d  ser.,  ii.  182). — Note  to  the  second 
edition. 


70  APPLICATION    OF    MEDICINES.  [PART  I. 

Water  may  also  be  applied  to  the  surface  more  or  less  extensively  by 
means  of  wet  sheets,  or  cloths,  which  may  be  wrapped  around  the  whole 
body,  so  as  to  obtain  .in  some  degree  the  effect  of  the  general  bath,  or 
folded  and  applied  around  the  waist  like  a  belt,  with  a  view  to  local 
effect. 

The  douche  acts  not  only  by  the  temperature  of  the  water,  but  also 
by  the  shock  and  pressure,  consequent  upon  the  force  with  which  the 
liquid  falls.  When  continued  long,  or  from  a  considerable  height,  say 
ten  or  twelve  feet,  it  becomes  after  a  time  extremely  painful,  so  as  to  be 
quite  intolerable ;  and,  on  this  account,  has  been  employed  as  an  instru- 
ment of  fear  or  punishment  to  criminals  and  maniacs.  So  far  as  it  acts 
mechanically,  it  is  primarily  excitant,  and  secondarily  depressing. 

Liquid  in  the  form  of  spray,  or  pulverized  by  minute  division  in  a 
current  of  air,  has  been  of  late  used  in  the  mode  of  a  douche,  and  pro- 
duces analogous,  but  milder  effects.  Independently  of  the  mechanical 
results  of  percussion,  and  the  peculiar  local  effects  of  the  medicine,  it  is 
asserted  that  substances  applied  to  the  surface  in  this  way  are  some- 
times absorbed,  and  act  characteristically  on  the  system.  Directed  to 
the  conjunctiva,  they  are  said  to  enter  the  lachrymal  passages  and  even 
to  reach  the  nostrils.  (Archives  Gen.,  Juin,  186(5,  p.  725.)  When  the 
liquid  employed  is  very  volatile,  an  intense  degree  of  cold  may  be  pro- 
duced by  its  rapid  volatilization,  which  has  recently  been  applied  to 
important  practical  purposes,  as  will  be  more  fully  stated  hereafter. 

Affusion  consists  in  the  pouring  of  water,  at  various  temperatures, 
from  pitchers,  buckets,  etc.,  more  or  less  extensively  over  the  body.  It 
differs  from  the  douche  in  being  more  diffused,  and  in  falling  with  less 
force  upon  the  surface.  It  has  been  highly  recommended  in  certain 
febrile  and  inflammatory  diseases,  but  requires  caution  in  its  use,  of 
which  more  will  be  said  hereafter. 

Sponging  is  a  term  sufficiently  expressive  without  definition.  It  may 
be  employed  locally  or  generally,  with  water,  spirit,  or  other  liquid,  at 
different  temperatures.  It  is  often  extremely  useful. 

Healed  atmospheric  air  has  been  employed  as  a  remedial  ugent,  in 
the  form  of  a  warm  or  hot  air  bath.  When  the  object  is.  that  the  patient 
shall  breathe  the  heated  air,  as  well  as  experience  its  effects  externally, 
it  may  be  most  conveniently  accomplished  by  simply  placing  him  naked 
in  a  confined  apartment,  raised  by  the  introduction  of  hot  air  to  the  re- 
quired temperature,  which  may  vary  from  90°  to  150°.  More  frequently 
the  application  is  made  to  the  external  surface  alone,  while  the  patient 
is  allowed  to  breathe  air  at  ordinary  temperatures.  This  may  be  done 
by  inclosing  the  body  in  a  cell,  box,  or  closet  of  suitable  dimension.-. 
arranged  that  the  head  shall  project  through  an  open  ing,  which  is  accu- 
rately closed  around  the  neck,  while  the  confined  air  is  heated  by  any 
convenient  plan.  An  extemporaneous  bath  of  this  kind  may  be  prr- 


CHAP.  III.]  APPLICATION    OF    MEDICINES.  71 

pared,  by  supporting  the  bed-coverings,  over  the  patient  in  bed,  upon 
two  or  three  pairs  of  crossed  half-hoops,  so  as  to  form  a  vacant  space 
around  him  ;  and  then  either  introducing  heated  air,  by  means  of  a  tube, 
from  some  exterior  source,  or  heating  that  around  the  patient  by  hot 
bricks,  bottles  filled  with  hot  water,  or  bags  filled  with  heated  salt,  oats, 
or  other  suitable  material. 

Medicated  hot  air  baths  may  be  applied,  in  the  same  way,  by  impreg- 
nating the  air  with  gaseous  bodies,  as  chlorine  and  sulphurous  acid,  or 
with  the  vapours  of  volatile  solids,  as  cinnabar,  iodine,  etc. 

The  vapour  bath,  like  the  hot  air  bath,  may  be  so  employed  that  the 
patient  shall  or  shall  not  breathe  the  vapour.  In  the  former  case,  the 
heating  effect  upon  the  body  is  greater  from  a  certain  temperature  of 
the  bath  than  in  the  latter;  for  the  natural  refrigerating  effect  of  the  pul- 
monary exhalation  is  prevented.  The  bath  is  much  more  frequently 
employed  in  reference  to  the  external  surface  alone.  Various  modes  of 
obtaining  the  effects  of  the  vapour  bath  have  been  practised.  One  of 
the  most  simple  is  to  make  a  space  around  the  patient  in  bed,  by  ele- 
vating the  coverings  by  means  of  crossed  half-hoops,  in  the  manner 
above  mentioned,  and  tucking  them  well  in  at  the  sides  of  the  bed  or 
mattress,  and  then  to  introduce  into  this  space  bricks  previously  heated, 
immersed  in  water,  and  covered  with  flannel,  taking  care  that  they  do 
not  touch  the  body  of  the  patient.  The  vapour  from*  the  heated  bricks 
soon  fills  the  empty  space.  Another  mode  of  introducing  vapour  is  by 
means  of  Jennings'  apparatus,  which  consists  of  a  tin  tube,  much  broader 
at  one  extremity  than  the  other,  curved  so  that  the  smaller  end  may  be 
inserted  into  the  space  around  the  patient,  while  the  larger  end  may  be 
supported  on  a  stool  without  the  bed.  A  lighted  spirit  lamp  is  placed 
within  the  broad  end  of  the  tube,  in  the  side  of  which  an  opening  is  left 
for  the  entrance  of  air.  As  the  spirit  burns,  a  current  of  heated  air, 
with  the  aqueous  vapour  and  carbonic  acid  resulting  from  the  combus- 
tion, passes  through  the  tube,  and  envelopes  the  body.  A  different  mode 
of  accomplishing  the  same  end,  is  to  seat  the  patient  on  a  stool  or  in  a 
chair,  placed  either  over  or  in  a  tub  or  bucket  containing  hot  water,  and 
then,  by  blankets  descending  from  his  shoulders  to  the  floor,  to  enclose 
together  his  body  and  the  whole  apparatus.  The  heat  of  the  water  may 
be  increased  by  introducing  into  the  tub  or  bucket  heated  bricks,  as  they 
may  be  required.  Caution,  however,  is  requisite  not  to  scald  the  patient. 
A  case  occurred  in  Philadelphia,  under  the  care  of  an  empiric,  in  which 
a  child,  subjected  to  a  vapour  bath  of  this  kind,  was  scalded  to  death. 

Where  convenience  permits,  a  better  vapour  bath  may  be  arranged, 
by  making  a  frame  of  wood-work,  and  covering  this  with  cloth  imper- 
vious to  vapour,  so  as  to  enclose  a  space  within  which  the  patient  may 
conveniently  sit  upon  a  stool  or  chair,  while  the  vapour  is  introduced 
into  the  lower  part  of  the  enclosure,  by  means  of  a  tube  proceeding  from 


72  APPLICATION    OF    MEDICINES.  [PART  I. 

a  kettle  of  boiling  water.  The  heat  of  the  vapour  mar  vary  from  100° 
to  150°,  and  has  been  increased  with  impunity  beyond  the  latter  tem- 
perature; but  it  is  better,  in  this  respect,  to  err  on  the  side  of  caution. 

Medicated  vapour  baths  may  be  formed  by  introducing  volatile  sub- 
stances into  the  water  evaporated,  so  that  their  vapour  may  rise  with 
that  of  the  water. 

The  vapour  douche  is  a  stream  of  vapour  directed  with  some  force 
upon  a  particular  part  of  the  body. 

2.  Application  with  Friction.     The  friction  here  alluded  to  is  em- 
ployed not  to  excite  the  surface,  but,  by  deranging  the  epidermic  scales, 
to  force  an  entrance  for  medicinal  substances  to  the  absorbent  tissues 
beneath.     It  is  made  by  the  hand  protected  by  a  leather  glove,  or  by 
means  of  a  piece  of  flannel,  or  of  coarse  linen.     Substances  applied  in 
this  way  are  most  frequently  in  the  unctuous  form,  as  in  the  case  of  the 
mercurial  and  iodine  ointments ;  but  oleaginous,  aqueous,  and  spirituous 
medicines  and  solutions  are  also  not  unfrequently  used.     The  medicine 
employed,  if  insoluble,  should  be  brought  to  the  finest  possible  state  of 
division.     The  parts  usually  selected  for  the  application  are  those  in 
which  the  cuticle  is  most  delicate,  as  the  inside  of  the  upper  and  lower 
limbs,  especially  the  inner  surface  of  the  thighs ;  but  reference  should  be 
had  to  the  special  object  in  view;  and,  when  a  particular  org'an  or  part 
is  to  be  acted  on,  or  a  tumour  to  be  dispersed,  it  is  usually  deemed  best 
to  apply  the  medicine  as  nearly  as  may  be  over  the  seat  of  disease.     In 
affections  of  the  absorbent  glands,  the  portion  of  surface  from  which  lym- 
phatics run  through  the  diseased  glands  should  be  preferred. 

This  mode  of  using  medicines  is  uncertain  in  its  results,  and,  in  con- 
sequence of  the  irritation  produced  in  the  skin,  is  often  inconvenient. 
But  it  may  be  resorted  to  in  aid  of  internal  medication,  or  when  from 
circumstances  this  cannot  be  employed ;  and  it  is  often  very  efficient  in 
the  cure  of  local  affections,  as  of  neuralgic  pains,  for  example,  and  tume- 
factions of  various  kinds. 

3.  The  Endermic  Method  of  Application.    In  this  mode  of  employing 
medicines,  the  epidermis  is  first  removed,  and  the  medicine  then  applied 
to  the  denuded  surface.     It  is  by  far  the  most  efficient  external  method. 
Medicines  are  rapidly  absorbed ;  and  produce  their  effects  in  some  in- 
stances  as  quickly  as  when  taken  by  the  mouth,  or  even  more  so.     In 
cases  of  great  irritability  or  phlogosis  of  the  stomach,  and  when  t Im- 
patient cannot  or  will  not  take  medicines  by  the  mouth,  it  is  an  invalua- 
ble resource.    Other  indications  for  its  use  are  afforded  by  insusceptibility 
of  the  stomach,  arising  from  a  long-continued  or  excessive  employment 
of  the  medicine,  by  the  necessity  in  urgent  cases  of  introducing  medicines 
by  every  practicable  avenue,  and  by  the  existence  of  serious  local  affee- 
tions,  which  have  refused  to  yield  to  remedies  addressed  to  the  constitu- 
tion.    The  last  indication  is  often  very  agreeably  fulfilled  by  endermic 


CHAP.  III.]  APPLICATION    OF    MEDICINES.  73 

medication.  I  have  known,  for  example,  vomiting  which  had  resisted 
all  other  means,  yield  to  a  salt  of  morphia  sprinkled  upon  a  blistered 
surface  in  the  epigastrium.  This  method  of  medication  had  long  been 
partially  employed,  as  exemplified  in  the  frequent  application  of  mer- 
curial ointment  to  blistered  surfaces ;  but  it  was  first  systematized  by 
Dr.  A.  Lembert,  of  France,  whose  experiments  were  repeated  and  ex- 
tended by  Dr.  Gerhard,  of  Philadelphia,  by  whose  essay  on  the  subject 
the  attention  of  the  profession  in  this  country  was  first  extensively  called 
to  it,  as  a  useful  mode  of  employing  a  great  number  of  medicines.  (N.  Am. 
.1A'</.  and  Surg.  Journ.,  ix.  392,  A.D.  1830.)  Almost  all  medicines,  the 
dose  of  which  is  not  very  large,  or  which  do  not  irritate  severely,  or 
corrode  the  surface  to  which  they  are-  applied,  may  be  employed  in  this 
way ;  but  it  is  especially  appropriate  to  the  organic  alkalies,  and  to  the 
other  more  active  proximate  vegetable  principles.  Perhaps  no  medicine 
acts  more  efficiently  by  the  endermic  plan  than  the  salts  of  morphia. 

The  dose  of  medicines  administered  in  this  way  may  be  twice  or  thrice 
that  given  by  the  mouth.  There  is  less  danger  here  from  an  over-dose ; 
as  what  remains  of  the  offending  material  may  be  readily  removed, 
should  serious  consequences  be  threatened.  Sometimes  the  medicine 
will  be  found  to  act  as  efficiently  as  by  the  stomach  in  the  same  dose. 

The  part  best  adapted  for  the  application  of  the  medicine,  when  some 
local  affection  does  not  call  for  a  special  direction,  is  the  epigastrium ; 
hut  any  portion  of  the  anterior  surface  of  the  body,  or  the  inner  surface 
of  the  thighs  and  arms  will  answer  well.  A  denuded  surface  for  the 
purpose  is  most  conveniently  obtained  by  means  of  a  blister  of  canthar- 
uk's:  though,  in  cases  of  great  urgency,  the  more  rapid  action  of  the 
stronger  solution  of  ammonia  may  be  resorted  to.  Upon  the  average, 
the  blistered  surface  may  be  about  three  or  four  inches  square.  It  is 
not  necessary  to  detach  the  cuticle  immediately.  The  medicine  may  be 
first  applied  over  the  raised  epidermis,  which,  if  cut  freely,  will  come  off 
with  the  first  dressing. 

The  medicine  should  be  reduced  to  the  state  of  a  very  fine  powder, 
and,  if  irritant,  should  be  diluted  with  pulverized  gum  arabic,  or  other 
bland  substance,  and  then  sprinkled  equably  over  the  surface,  or  applied 
upon  dressings  of  simple  cerate.  If  so  soft  that  it  cannot  be  powdered, 
it  may  be  rubbed  up  with  solution  of  gelatin,  glycerin,  mucilage,  lard,  or 
cerate,  and  applied  upon  pledgets  of  lint;  and  substances  originally  liquid 
may  be  applied  in  the  same  way. 

Care  should  be  taken  to  avoid  irritation  as  far  as  possible.  Active 
congestion  and  inflammation,  independently  of  the  pain  and  inconveni- 
ence, interfere  with  the  operation  of  the  medicine  by  offering  an  impedi- 
ment to  absorption.  Sometimes  sloughing  results  from  the  incautious 
use  of  an  irritant  medicine,  and  a  permanent  scar  is  left.  I  have  known 
this  to  follow  the  application  of  sulphate  of  quinia  undiluted. 


74  APPLICATION    OF    MEDICINES.  [PART  I. 

In  cases  of  excessive  constitutional  action  from  the  medicine,  it  may 
sometimes  be  advantageously  followed,  after  removal,  by  a  counter- 
agent.  Thus,  unpleasant  symptoms  from  strychnia  or  digitalis,  might 
possibly  bo  relieved  by  morphia  applied  to  the  blistered  surface  ;  and  the 
effects  of  morphia  are  said  to  have  been  neutralized  by  musk. 


SUBSECTION  III. 
The  Lungs. 

The  bronchial  mucous  membrane,  and  the  surface  of  the  pulmonary 
air-cells,  afford  not  unfrequently  a  ready  entrance  of  medicines  into  tin- 
system,  in  consequence  of  the  great  facility  of  absorption  through  their 
delicate  tissue.  Indeed,  some  volatile  medicines  act  much  more  rapidly 
and  powerfullv  in  this  way  than  when  taken  into  the  stomach.  The 
effects,  for  example,  of  ether  and  chloroform  are  familiar  to  every  one. 
But  the  practical  use  of  this  avenue  into  the  system  is  very  much  limited 
by  the  inconvenience,  and  even  danger,  of  administering  most  medicines 
in  that  way.  Some,  it  is  true,  have  proposed  to  throw  fine  medicinal 
powders  into  the  lungs  by  loading  with  them  the  respired  air;  but  when 
the  hazard  is  considered  of  exciting  inflammation  by  such  means  in  this 
delicate  tissue,  it  must,  I  think,  be  admitted  to  outweigh  any  probable 
advantages.  The  substances  to  which  this  method  is  especially  appli- 
cable are  gases  and  vapours.  Of  these,  some  have  been  employed  to  act 
locally  on  the  bronchial  passages,  as  chlorine  gas.  the  vapour  of  tar  and 
iodine,  and  the  fumes  of  burning  rosin  in  chronic  bronchitis,  and  ethereal 
vapour,  the  smoke  of  stramonium  and  tobacco,  and  the  gases  evolved  by 
the  burning  of  paper  impregnated  with  nitre,  in  the  asthmatic  paroxysm. 
At  present,  however,  attention  is  much  more  than  formerly  directed  to 
constitutional  impression;  and  various  volatile  substances  have  been  em- 
ployed for  their  exhilarating  and  anaesthetic  effect.  Aqueous  vapour  has 
been  long  and  much  employed  by  inhalation. 

Inhalation  may  be  effected  in  various  ways.  One  of  the  simplest  is 
to  impregnate  the  air  of  the  apartment  in  which  the  patient  is  confined 
with  i lie  gas  or  vapour.  In  this  way  a  sti-ady  effect  may  be  sustained. 
for  a  great  length  of  time,  by  proper  attention  to  the  degree  of  impreg- 
nation, so  as  not  to  oppress  the  breathing.  Kveii  v.  hen  the  patient  is 
not  confined  to  the  house  during  the  day,  much  advantage  will  often 
accrue  from  medicating  the  air  of  his  sleeping  chamber.  Chlorine  and 
the  vapour  of  tar  may  be  thus  administered;  and  I  have  witnessed  the 
happiest  effects  from  the  latter  remedy,  continued  for  months,  in  very 
threatening  chronic  pulmonary  disease.  A  convenient  method,  in  tin- 
case  of  tar  and  other  liquids  but  moderately  volatilixable,  is  to  employ  ;r 
commou  tin  apparatus  called  the  nurse-lamp,  in  which  a  cup,  containing 


CHAP.  III.]  APPLICATION    OF    MEDICINES.  l-r> 

the  material  to  be  evaporated,  is  placed  in  a  small  water-bath  over  a 
spirit  lamp. 

Another  mode,  applicable  to  very  volatile  liquids,  such  as  ether  and 
chloroform,  intended  for  temporary  use,  is  to  place  them  upon  a  large 
sponge,  or  piece  of  linen  cloth,  a  handkerchief  or  towel  for  example,  and 
apply  this,  fully  charged,  over  the  mouth  and  nostrils,  so  that  the  patient 
may  inhale  their  vapour  along  with  the  atmospheric  air  Sometimes 
the  saturated  sponge  is  enclosed  in  an  apparatus,  so  arranged  that  all  the 
vapour  which  escapes  from  the  liquid  shall  be  inhaled,  and  thus  unneces- 
sary loss  be  prevented,  while  a  due  supply  of  atmospheric  air  is  insured. 
In  the  exhibition  of  the  narcotic  vapours,  it  is  of  the  utmost  importance, 
in  order  to  avoid  the  most  serious  consequences,  to  attend  strictly  to  this 
latter  caution.  The  patient,  rendered  more  or  less  unconscious  by  the 
medicine,  is  not  sensible  of  the  want  of  air,  and  does  not,  therefore,  give 
warning  of  his  danger  to  the  operators,  as  he  would  do  under  other  cir- 
cumstances. There  can  be  little  doubt,  that  death  has  sometimes  re- 
sulted from  an  insufficient  supply  of  atmospheric  air,  in  this  method  of 
using  anaesthetic  agents. 

The  pure  gases,  and  the  vapours  of  very  volatile  substances,  such  as 
Hher,  may  also  be  inhaled  by  means  of  an  air-tight  bag,  supplied  with 
a  mouth-piece  and  stop-cock,  so  as  to  regulate  the  escape  of  the  confined 
gas  or  vapour.  The  patient  is  made  to  breathe  into  and  out  of  the  bag ; 
but  it  is  obvious  that,  unless  there  be  a  large  admixture  of  atmospheric 
air  or  oxygen,  life  could  be  sustained  but  a  very  short  time  during  such 
a  process,  which,  therefore,  should  be  of  short  continuance,  and  always 
carefully  watched. 

The  vapour  of  water,  pure  or  impregnated  with  various  volatile 
matters,  may  be  inhaled  by  means  of  an  instrument  called  the  inhaler. 
Madge's  inhaler,  which  has  been  much  used  for  this  purpose,  consists 
of  a  pewter  quart  mug,  with  a  metallic  removable  lid,  in  which  is  a 
small  opening  to  admit  the  air,  and  another  larger  one  to  which  a  flex- 
ible tube  with  a  mouth-piece  is  affixed.  Water,  alone  or  variously  im- 
pregnated, is  introduced  into  the  instrument,  which  may  then  be  placed 
in  a  vessel  containing  water,  heated  to  whatever  point  may  be  necessary 
sufficiently  to  volatilize  the  confined  liquid,  the  vapours  of  which  are  in- 
haled by  the  patient,  along  with  the  air  admitted  through  the  small 
opening.  A  better  apparatus  for  the  same  purpose  may  be  made  from 
a  Wolfe's  bottle,  with  three  tubulures  at  top,  into  one  of  which  is  fitted 
a  flexible  tube  with  a  mouth- piece,  into  a  second  a  glass  tube  extending 
from  the  air  without  to  a  point  beneath  the  surface  of  the  liquid  in  the 
bottle,  and  into  the  third  a  glass  stopper,  to  be  removed  when  there  is 
occasion  to  pour  liquid  into  the  bottle.  It  is  obvious  that,  when  t In- 
patient  inspires,  the  air  from  without  must  pass  through  the  liquid,  and 
thus  become  more  thoroughly  loaded  with  the  vapour  than  it  would  be 


76  APPLICATION    OF    MEDICINES.  [PART  I. 

likely  to  be  in  Mudge's  inhaler.  An  extemporaneous  inhaler  may  be 
made,  as  formerly  suggested  by  Dr.  Physick,  by  fitting  a  cork  into  any 
broad-mouthed  common  bottle,  making  three  openings  through  the  cork, 
and  supplying  these  with  tubes  in  the  manner  mentioned  in  reference  to 
the  Wolfe's  bottle,  only  that  the  breathing  tube  may  be  straight,  and,  if 
glass  is  not  at  hand,  common  pipe-stems,  or  pieces  of  goose's  quill, 
lengthened  sufficiently  by  insertion  into  one  another,  maybe  substituted. 
As  in,  the  Mudge's  inhaler,  a  proper  temperature  of  the  contained  liquid 
may  be  maintained,  if  necessary,  by  setting  the  bottle  in  a  water-bath. 
Besides  those  mentioned,  several  other  inhalers  have  been  invented, 
and  more  or  less  employed,  all,  however,  acting  on  the  principles  re- 
ferred to  * 

Finally,  certain  fumes  and  vapours  may  be  inhaled  through  a  com- 
mon smoking  pipe,  as  those  of  stramonium  and  camphor  for  example, 
the  former  being  set  on  fire  in  the  bulb,  the  latter  volatilized  in  the  same 
position  by  the  current  of  air  passing  through  it.  Another  mode  of 
effecting  the  same  object  is  by  the  smoking  of  cigarettes,  made  by  rolling 
into  the  form  of  small  cigars  narrow  strips  of  paper,  previously  impreg- 
nated with  a  solution  of  the  substance  the  fumes  of  which  are  to  be  in- 
haled, and  then  drying  them. 

Use  of  liquids  in  the  form  of  spray.  Reference  has  already  been 
made  to  a  new  process  by  which  liquids  are  brought  into  contact  with 
the  air-passages,  mixed,  in  a  state  of  extremely  minute  division,  with 
atmospheric  air,  or  aqueous  vapour,  but  still  retaining  the  liquid  form. 
Liquids  in  this  condition  are  said  to  be  pulverized,  atomized,  or  nebu- 
lized; and  the  instruments  by  which  the  effect  is  produced  are  variously 
named  atomizers,  pulverizers,  or  nebulizers;  the  first  of  these  terms 
being  preferred  by  English  writers,  the  second  by  the  French,  and  the 
third  by  the  Germans.  As  this  subject  has  been  pretty  fully  considered 
in  the  recently  published  edition  of  my  Treatise  on  the  Practice  of  Medi- 
cine (6th  ed.,  vol.  i.  p.  949),  it  is  unnecessary  to  do  more  here  than  to 
make  a  few  observations,  calculated  to  give  the  reader  a  general  knowl- 
edge of  the  subject.  It  is  well  known  that  various  substances  in  solu- 
tion, or  othen\yse  in  the  liquid  state,  often  have  a  curative  effect  when 
brought  into  contact  with  local  diseases,  whether  of  the  skin,  or  of  acces- 
sible mucous  surfaces.  It  has,  therefore,  been  a  desideratum  to  find  a 
method  by  which  these  substances  might  be  applied  to  the  air-passages 
within  or  beneath  the  larynx.  Attempts  have  been  made  to  accomplish 
this  object,  to  a  certain  extent,  by  the  injection  of  liquids  into  the  trachea 


*  Among  these  may  be  mentioned  Chixholni's  inhaler  (N.  Y.  Medical  Record,  Jan.  1, 
18C7,  p.  509);  Nelson's  inhaler  (Lancet,  Feb.  11,  1865);  Curtis'*  inhaler  (Med.  T.  and 
Gaz.,  Dec.  1861,  p.  624);  and  Thompson's  hydro-pneumatic  inhaler  (Lancet,  Jan."  28, 
18(10),  which,  howerer,  acts  on  a  different  principle.  (Note  to  the  third  edition.) 


CHAP.  III.]  APPLICATION    OF   MEDICINES.  77 

and  bronchia,  or  by  penetrating  the  rim  a  glottidis  with  moistened  sponge 
at  the  end  of  a  long  handle;  but  the  inconvenience  if  not  danger  of 
these  methods  is  very  great,  and  their  success  very  problematical.  But 
when  the  idea  suggested  itself  that  the  end  might  be  safely  attained  by 
imitating  certain  processes  of  nature,  by  which  liquids  in  a  state  of  ex- 
tremely minute  division,  still  holding  soluble  substances  in  solution, 
might  be  intimately  mixed  with  air,  and  in  this  state  safely  introduced 
into  the  air-passages  in  ordinary  respiration,  a.s  when  we  inhale  the  spray 
from  breakers  on  the  sea-shore;  it  was  an  obvious  conception,  that  this 
process  might  be  artificially  imitated,  and  medicinal  liquids  in  this  way 
be  brought  into  direct  contact  with  the  interior  of  the  lungs.  Two 
methods  of  accomplishing  this  object  suggested  themselves  to  experi- 
menters ;  one  by  causing  a  small  stream  of  the  liquid  to  be  forcibly  im- 
pelled against  a  solid  body,  and  thus  to  be  broken  into  minute  particles 
and  diffused  in  the  surrounding  air  ;  and  another,  by  which  a  strong  cur- 
rent of  air  should,  at  the  point  of  issue  from  a  tube,  be  made  to  bear  upon 
a  slender  column  of  liquid,  and  to  carry  this  along  with  it  in  the  form  of 
spray,  expanding  into  a  cone  with  a  constantly  increasing  base  till  lost  in 
the  atmosphere.  Instruments  were  contrived  on  both  of  these  principles, 
and  have  come  into  extensive  use ;  those,  however,  based  upon  the 
second  plan  being  generally  preferred.  For  an  account  of  the  instru- 
ments and  their  mode  of  use,  I  must  content  myself  with  referring  to 
my  Treatise  on  the  Practice,  and  to  the  various  published  monographs 
on  the  subject.*  There  is  reason  to  believe  that  good  may  be  effected 
by  this  method  of  inhalation,  not  only  by  the  curative  influence  exerted 
in  the  diseased  membrane  by  the  contact  of  the  medicine,  but  also 
through  its  absorption  into  the  circulation,  and  the  exercise  on  the 
system  at  large  of  its  peculiar  powers.  It  has  been  objected  to  this 
mode  of  medication,  so  far  as  concerns  its  action  on  the  pulmonary 
air-tubes,  that  the  pulverized  liquid  never  really  passes  below  the 
glottis ;  being  deposited  before  it  reaches  the  respiratory  passages. 
This,  howrever,  is  not  exactly  true.  Abundant  proof  has  been  offered 
that  some  substances  do  in  fact  reach  the  bronchia,  and  beneficial 
therapeutical  effects  have  been  obtained;  but  it  is  true,  nevertheless, 
that  much  of  the  liquid  separates  before  reaching  the  interior  of  the 
larynx,  and  very  little  of  it  is  carried  to  the  ultimate  ramifications 

*  I  would  especially  call  attention  to  two  essays;  one  by  Dr.  J.  M.  Da  Costa,  of 
Philadelphia,  in  the  X.  Y.  Med.  Journ.  (Sept.  and  Oct.  1866,  pp.  401  and  29):  the 
other  by  Dr.  Ephraitn  Cutter,  of  Boston,  in  the  Med.  and  Surg.  Reporter  (July  14  and 
•21,  1866,  pp.  38  and  60).  In  the  Boston  Med.  and  Surg.  Journal  (Dec.  27,  1866. 
p.  434)  a  variety  of  the  apparatus  has  been  described,  denominated  the  "hydros- 
tatic atomizer,"  in  which  the  pressure  of  a  column  of  water  is  employed  in  order 
to  give  requisite  force  to  the  current  of  air,  instead  of  pressure  by  the  hand,  by  a 
forcing  pump,  or  by  steam,  which  is  employed  in  other  instruments. 


78  APPLICATION    OF    MEDICINES.  [PART  I. 

of  the  bronchia ;  so  that  wo  must  bo  satisfied  with  less  practical  result, 
as  regards  pulmonary  diseases,  than  may  have  been  anticipated  by  some 
in  the  beginning.  By  certain  modifications  of  the  apparatus,  the  pul- 
verization may  be  effected  in  the  cavity  of  the  mouth,  and  even  in  the 
fauces;  so  that  the  spray  may  be  brought  to  bear  with  its  entire  inten- 
sity, upon  the  pharynx,  the  posterior  nares.  the  entrance  of  the  Eustachian 
tube,  and  the  exterior  glottis;  and  will  probably  also  pass  more  deeply 
into  the  air-passages  than  when  inhaled,  as  it  ordinarily  is,  from  with- 
out. The  particular  medicines  adapted  to  this  mode  of  exhibition,  and 
the  strength  of  the  solutions  to  be  atomized,  will  be  more  appropriately 
considered  under  the  heads  of  the  several  medicines  employed. 

Besides  the  remedial  advantages  above  mentioned  as  resulting  from 
this  method  of  applying  medicines,  other  useful  results  have  been  ob- 
tained. For  disinfecting  purposes  the  atomizer  has  been  found  very  effi- 
cient, diffusing  as  it  does  the  disinfecting  material  equably  through  the 
air  of  the  apartment,  and  thus  causing  it  to  act  on  every  particle  of  the 
offensive  or  noxious  agent.  Another  effect  is  the  production  of  extreme 
cold  by  the  rapid  evaporation  of  volatile  liquids,  brought  into  this  suite 
of  minute  division ;  and  the  anaesthetic  influence  of  the  cold,  thus  generated 
upon  the  surface  of  the  body,  has  been  taken  advantage  of  to  a  considerable 
extent  by  surgeons.  More  will  be  said  of  both  of  these  effects  hereafter 
in  this  work. 

SUBSECTION  IV. 
The  Subcutaneous  Areolar  Tissue. 

Subcutaneous  Injection.  Hypodermic  Method.  These  names  have 
been  given  to  a  plan  of  medication,  first  announced,  in  1855,  by  Dr. 
Alexander  Wood,  of  Edinburgh,  consisting  of  the  injection  of  remedial 
substances  into  the  subcutaneous  areolar  or  cellular  tissue.  Though  ap- 
paivntly  aware  that  medicines  might  be  employed  in  this  way  with 
a  view  to  their  effects  on  the  system  at  large,  Dr.  Wood  confined  his 
views  practically  to  their  local  influence,  and  especially  to  the  relief  of 
neuralgic  pains  by  anodynes  injected  into  the  areolar  tissue,  as  near  :is 
possible  to  the  seat  of  the  affection.  He  no  doubt  believed  that  the  relief 
obtained  depended  on  the  local  action  of  the  medicine.  To  Mr.  Charles 
Hunter  is  due  the  credit  of  having  generalized  this  plan  of  medication. 
He  soon  satisfied  himself  that  the  anodyne  effect  was  obtained  by  in- 
jecting the  medicine  at  a  distance  from  the  seat  of  pain,  as  well  as  in  its 
immediate  vicinity;  and  hence  concluded  that  the  medicine  operated,  not 
immediately  on  the  painful  nerve,  but  through  the  medium  of  the  circu- 
lation, being  absorbed  into  the  blood,  and  carried  with  it  to  all  parts 
of  the  system.  He  ascertained,  moreover,  that  substances,  employed 
in  this  way,  exercised  their  ordinary  remedial  influence  over  systemic 


CHAP.  III.]  APPLICATION    OF    MEDICINES.  79 

diseases;  and  the  important  fact  was  thus  established,  that  the  areolar 
tissue  might  be  resorted  to  as  an  avenue  for  the  introduction  of  medicines 
into  the  system,  in  all  cases  in  which  their  relations  with  this  tissue 
allowed  them  to  be  applied  to  it  in  a  condition  permitting  their  absorp- 
tion in  sufficient  quantity,  without  injurious  local  effects.  It  must,  never- 
theless, be  admitted  that  certain  medicines,  especially  anodynes,  such  as 
morphia  and  aconitia,  while  they  operate  on  the  system  generally  through 
absorption,  do  exercise  a  peculiar  influence  in  the  neighbourhood  of  their 
application.  This  was  proved  by  experiments  of  Dr.  Eulenberg,  who 
found  that  the  sensibility  of  the  parts  into  which  morphia  was  injected, 
on  one  side  of  the  body,  was  much  more  diminished  than  that  of  the  cor- 
responding parts  on  the  other  side.  (Am.  Journ.  of  Med.  Sci.,  April, 
186B,  p.  432.)  It  would  probably  be  a  good  practical  rule,  to  inject  the 
areolar  tissue  as  near  as  possible  to  the  seat  of  the  disease,  whenever 
there  is  good  reason  to  believe  that  this  is  exclusively  local,  and  in  the 
arm  ^or  any  other  convenient  spot,  without  reference  to  the  precise 
locality  of  the  pain,  when  this  depends  on  disorder  of  the  nerve-centres, 
;i  morbid  state  of  the  blood,  or  some  other  systemic  derangement. 

Alter  the  discovery  of  the  method  of  subcutaneous  injection  by  Dr. 
Wood,  it  came  rapidly  into  use,  and  is  now  almost  universally  re- 
soiled  to  under  favouring  circumstances.  From  the  abundance  of  the 
capillaries  distributed  in  the  areolar  tissue,  it  affords  extraordinary  facili- 
ties for  absorption;  and  suitable  remedies,  applied  in  this  way,  act 
much  more  rapidly,  and  consequently  with  greater  energy  in  equal 
quantities,  than  the  same  remedies  introduced  into  the  stomach  or  rec- 
tum, or  employed  endermically.  One  cause,  no  doubt,  of  the  greater 
rapidity  of  the  action  hypodermically,  is  that  substances  taken  up  from 
the  alimentary  canal  are  for  the  most  part  conveyed  through  the  portal 
vc-ns  into  the  liver,  and  are  distributed  through  that  organ  before  reach- 
ing the  general  circulation,  while  from  the  areolar  tissue  they  probably 
enter  immediately  into  the  veins.  Another  advantage  possessed  by  this 
method  is  that  the  medicine  enters  the  circulation  unchanged,  and  there 
exercises  purely  its  legitimate  effects  on  the  system;  while,  when  given 
by  the  stomach,  it  is  liable  to  be  modified  by  the  action  of  the  various 
and  often  powerful  agents  it  finds  in  the  alimentary  passages;  and, 
besides,  the  effects  it  produces  directly  on  the  stomach  and  bowels,  which 
are  often  much  disordered  by  it,  complicate  its  proper  systemic  influ- 
enoes.  Mr.  Hunter  states  that  the  remedial  effects  of  medicines,  hypo- 
dermically administered,  are  often  more  permanent  than  those  from  the 
ordinary  methods  of  exhibition.  Thus,  he  has  repeatedly  effectually 
cured  cases  of  disease,  by  injecting  certain  medicines  into  the  areolar 
tissue,  which  had  long  resisted  the  same  medicines  given  by  the  stomach  ; 
being  relieved,  indeed,  for  a  time  by  the  latter  method,  but  returning 
constantly  with  uniuipr.'.ed  force.  It  has  been  asserted  that  narcotics. 


80  APPLICATION    OF    MEDICINES.  [PART  I. 

especially  opiates,  are  less  apt  to  disturb  the  brain,  than  when  given  by 
the  mouth. 

Notwithstanding  these  various  advantages  of  the  hypodermic  method, 
the  number  of  remedies  to  which  it  is  applicable  is  limited.  Many  art- 
altogether  unsuited  to  it  on  account  of  the  large  quantity  required  to 
operate;  others  from  their  insolubility;  and  others,  again,  from  their 
irritant  properties,  which  at  the  same  time  occasion  local  inflammation, 
and  interfere  with  absorption.  It  is  now  well  known  that  crystalline 
bodies  in  solution  are  diffused  through  animal  membrane  much  more 
readily  than  gelatinous  or  glue-like  substances  (the  colloids  of  Graham). 
which  pass  with  great  difficulty  if  at  all.  Hence  it  may  be  inferred  that 
active  principles  of  medicines,  capable  of  assuming  crystalline  forms,  are 
much  better  adapted  than  others  not  crystallizable,  to  this  mode  of  ad- 
ministration, as  likely  to  find  easier  admission  into  the  capillaries;  and 
the  fact  is,  that  the  vegetable  alkaloids,  as  morphia,  atropia,  quinia,  etc.. 
are  peculiarly  fitted  for  subcutaneous  injection. 

The  following  circumstances  are  peculiarly  favourable  to  this  method 
of  medication.  It  is  called  for  in  cases  of  great  severity,  where  tin- 
prompt  relief  of  pain  is  required,  or  immediate  interference  may  be  neces- 
sary to  save  life;  and,  under  these  circumstances,  it  may  either  be  de- 
pended on  as  the  chief  agency,  or  may  be  used  as  auxiliary  to  the  ordi- 
nary measures.  As  examples,  may  be  adduced  the  excruciating  pain 
attendant  on  the  passage  of  a  urinary  calculus,-  and  a  case  of  pernicious 
fever  in  which  life  may  depend  on  the  prompt  and  efficient  action  of 
quinia.  When  the  stomach  rejects  all  suitable  remedies,  or  the  patient 
obstinately  refuses  or  is  unable  to  swallow  them,  subcutaneous  injection 
is  a  most  valuable  resource.  When,  moreover,  remedies  by  the  mouth 
and  rectum  have  been  used  without  satisfactory  results,  there  is  a  strong 
indication  for  this  method.  Indeed,  it  may  be  resorted  to  in  almost 
all  instances,  otherwise  not  unsuitable,  in  which  it  may  be  preferred  by 
the  patient. 

There  are,  however,  circumstances  which  considerably  limit  its  ap- 
plicability. The  danger  of  producing  great  local  irritation,  inflammation, 
or  gangrene,  is  extremely  slight,  when  due  attention  is  paid  to  the  choice 
of  medicines,  the  proper  introduction  of  them,  and  the  state  of  the  system. 
Non-irritant  remedies,  in  a  liquid  form,  may  almost  always  be  injected 
without  the  least  inconvenience ;  or,  if  a  slight  irritation  be  produced,  it 
subsides  rapidly,  without  leaving  any  unpleasant  effect.  But  substances 
in  themselves  irritant,  or  rendered  so  by  their  solid  state  interfering  with 
absorption,  may  excite  inflammation,  ending  in  suppuration,  or  perhaps 
in  gangrene,  and  should,  therefore,  never  he  employed  in  this  way,  in 
reference  to  their  systemic  influence.  Besides,  when  the  sy>tem  happens 
to  be  in  a  state  threatening  erysipelas  or  gangrene  ;  or  when  these  con- 
ditions either  exist,  or  a  tendency  to  them  prevails  in  any  locality,  the 


CHAP.  III.]  APPLICATION   OF    MEDICINES.  81 

hypodermic  method  should  be  avoided,  or  used  only  under  the  most 
urgent  circumstances,  from  the  risk  that  would  be  incurred  of  exciting 
these  affections. 

In  some  rare  instances,  great  alarm  has  been  caused  by  the  unex- 
pectedly rapid  and  apparently  dangerous  action  of  medicines  injected 
into  the  areolar  tissue.  Thus,  morphia  has  sometimes  operated,  in  the 
ordinary  dose,  with  extreme  violence,  so  as  to  threaten  life  itself,  though 
I  have  not  found  recorded  any  absolutely  fatal  case  from  this,  or  any 
other  medicine  used  in  the  same  way.  This  occasional  violence  is  ascribed, 
and  probably  with  justice,  to  the  penetration  of  a  minute  vein,  and  the 
consequent  injection  of  the  whole  dose  at  once  into  the  current  of  the 
circulation.  Caution  should,  therefore,  always  be  observed  to  avoid  any 
visible  blood-vessel ;  and,  when  the  effect  of  the  medicine  is  experienced 
immediately,  the  instrument  should  be  at  once  withdrawn.  It  has  been 
advised,  in  reference  to  this  danger,  to  inject  the  medicine  rather  slowly, 
80  that  the  process  may  be  arrested,  on  the  occurrence  of  violent  symp- 
toms, before  the  whole  dose  has  been  injected.  In  all  instances,  extreme 
caution  should  be  observed  not  to  administer  excessive  doses  of  poi- 
sonous medicines  in  this  way;  the  danger  being  greater  than  when 
the  medicine  is  swallowed,  or  given  by  enema ;  as,  in  either  of  these 
cases,  it  may  be  evacuated,  while  no  such  opportunity  would  be  offered 
in  the  hypodermic  method.  Should  alarming  phenomena,  however,  re- 
sult at  any  time  from  too  rapid  or  copious  absorption  from  the  areolar 
tissue,  a  vacuum  should  be  immediately  produced,  by  the  application 
of  a  cupping-glass  over  the  puncture,  so  as  to  impede  or  prevent  the 
continuance  of  the  process.  In  the  treatment  of  systemic  diseases,  it 
is  often  desirable  to  maintain  an  equable  and  steady  impression  by 
means  of  medicine.  In  this  case,  the  exhibition  of  the  remedy  by  the 
mouth  would  be  preferable ;  as  absorption  is  maintained  continuously 
from  the  stomach ;  while,  given  by  subcutaneous  injection,  the  medicine 
acts  more  or  less  interruptedly,  or  by  starts. 

Operation.  When  circumstances  do  not  indicate  a  special  site  for  the 
operation,  the  arm  near  the  insertion  of  the  deltoid  is  perhaps  as  conve- 
nient a  locality  as  can  be  chosen.  When  the  operation  is  to  be  repeated, 
the  place  of  puncture  should  be  varied,  so  as  to  avoid  irritating  or  in- 
flaming the  part.  The  pain  from  the  operation  is  very  slight,  not  ex- 
ceeding that  of  the  prick  of  a  pin,  and  by  the  most  sensitive  soon  in 
general  comes  to  be  disregarded.  Sometimes  it  may  for  a  time  be  very 
acute  in  consequence  of  the  perforation  of  a  cutaneous  nerve ;  but  this 
rarely  happens. 

The  instrument  recommended   by  Mr.  Hunter  is  a  small  syringe, 

with  a  glass  barrel  and  silver  fittings,  the  piston  of  which  is  worked  by 

means  of  a  screw,  each  half  turn  of  which  expels  half  a  minim.     The 

pipe,  which  is  attached  by  a  screw,  is  of  silver,  with  a  hardened  gold 

VOL.  i. — 6 


82  APPLICATION    OF   MEDICINES.  [PART  I. 

point,  as  sharp  as  a  needle,  and  an  opening  on  one  side,  near  the  point, 
through  which  the  liquid  is  expelled.  No  incision  or  perforation  is  re- 
quired, other  than  that  made  by  the  sharp  point  of  the  pipe,  which  is  not 
more  painful  than  the  prick  of  a  pin.  The  liquid  to  be  injected  having 
been  introduced  into  the  instrument,  the  skin  is  made  tense,  and  the  point 
inserted  by  a  quick  movement  perpendicularly  through  the  skin,  after 
which  any  direction  may  be  given  to  it  that  may  be  deemed  desirable. 
Then  the  required  number  of  minims  is  injected  by  as  many  turns  of  the 
screw ;  so  that  the  dose  may  be  regulated  with  the  utmost  exactness. 
After  this  the  instrument  is  withdrawn,  and,  to  prevent  the  escape  of  the 
liquid,  the  perforation  is  covered  with  a  small  piece  of  adhesive  plaster, 
previously  warmed  for  the  purpose. 

Different  forms  of  the  instrument  have  been  recommended,  all  having 
in  common  the  sharp  perforated  point.  In  one  form,  instead  of  meas- 
uring the  amount  of  injected  liquid  by  the  turns  of  a  screw,  the  piston  is 
constructed  in  the  ordinary  manner,  and  the  dose  measured  by  a  grad- 
uation of  the  barrel  of  the  syringe,  or  of  the  piston  itself.  Instead  of  the 
hardened  gold  point,  this  is  sometimes  made  of  steel,  and  may  be  perma- 
nently affixed  to  the  instrument,  or  attached  by  a  screw,  and  removable 
at  pleasure. 

It  is  important  that  the  point  should  not  become  blunted  by  oxidation 
or  other  cause ;  as  the  success  of  the  operation,  and  the  avoidance  of 
subsequent  injury,  depends  much  on  the  perfect  cleanness  and  sharpness 
of  this  part  of  the  instrument.  The  syringe,  too,  should  be  thoroughly 
cleansed  after  each  operation,  especially  when  a  different  medicine  is  to  be 
injected.  A  second  dose  should  not  be  given  until  the  effects  6f  the  first 
have  subsided  ;  or,  if  previously  to  this  time,  it  should  be  reduced.  Mr. 
Hunter  thinks  it  advisable,  as  a  general  rule,  to  use  a  strong  solution, 
so  that  tlic  required  dose  may  be  thrown  in  by  three  or  four  turns  of 
the  piston.  The  quantity  thrown  in  at  once  should  never  exceed  thirty 
minims,  and  less  than  this  will  sometimes  cause  uneasiness  by  disten- 
sion, and  partially  escape  through  the  aperture.  The  whole  process  need 
not  consume  more  than  half  a  minute.  It  is  very  important  to  attend 
carefully  to  the  operation ;  as,  when  the  solution  is  very  strong,  a  few 
turns  of  the  screw,  in  excess,  may  produce  serious  results.  Mr.  Hunter 
recommends  that  not  more  than  half  the  full  ordinary  dose  of  a  narcotic 
medicine  for  a  man,  nor  more  than  a  third  of  it  for  a  woman,  should  be 
injected  at  flrst;  as  the  medicine  operates  rapidly,  and  with  the  entire 
force  of  the  quantity  introduced,  the  whole  being  absorbed. 

The  medicines  given  in  this  way  should  always  be  perfectly  dissolved ; 
and  if,  as  sometimes  happens  in  using  the  alkaloids,  some  acid  is  neces- 
sary for  their  complete  solution,  not  more  should  be  employed  for  the  pur- 
pose than  is  absolutely  required.  If  the  solution  is  turbid,  it  should  be 
filtered  before  being  injected.  Pure  water  is  the  best  solvent,  though 


CHAP.  III.]  APPLICATION   OP    MEDICINES.  83 

tinctures  may  be  used  when  deemed  advisable.  It  is  especially  im- 
portant that  the  tinctures  should  be  freshly  filtered,  as,  after  long  standing, 
they  are  apt  to  deposit  a  portion  of  their  contents ;  and  this  is  especially 
the  case  with  laudanum.  In  the  selection  of  medicines  to  be  injected, 
it  is  desirable  to  avoid  such  as  give  precipitates  with  the  alkaline  chlo- 
rides and  albumen,  both  of  which  they  might  encounter  in  the  areolar 
tissue. 

A  use  of  the  hypodermic  method  not  yet  referred  to,  has  been  sug- 
gested and  put  in  practice  by  Dr.  Eulenberg;  namely,  to  facilitate  laryn- 
goscopy  by  the  use  in  this  way  of  morphia,  or  other  medicine  calculated 
to  obtund  the  sensitiveness  of  the  fauces.  (Am.  Journ.  ofMed.  Sci.,  April, 
1866,  p.  436.) 

Still  another  application  of  subcutaneous  injection  has  been  brought 
to  the  notice  of  the  profession  by  Dr.  Luton,  of  Rheims,  in  France, 
under  the  name  of  parenchymatous  substitution.  He  refers  to  the  sub- 
cutaneous injection  of  irritating  substances,  with  the  view  of  exciting 
more  or  less  irritation,  which,  according  to  the  substances  injected,  may 
be  of  three  grades;  first,  simple  pain  with  insignificant  local  disorder, 
secondly,  an  irritative  congestion,  or,  thirdly,  inflammation  with  suppu- 
ration, etc.  The  remedial  influence  aimed  at  is  the  substitution  of  the 
new  excitation  for  a  pre-existing  disease  of  the  same  part;  a  principle  of 
therapeutical  action  identical  with  that  already  considered  in  this  work 
under  the  name  of  supersession.  (See  page  51.)  By  the  first  degree  of 
irritation  he  supersedes  neuralgia  and  other  painful  affections;  by  the 
second,  glandular  diseases,  acute  or  chronic,  and  especially  strumous 
engorgements ;  and  by  the  third,  white  swellings,  local  osteitis  or  perios- 
titis, caries,  etc.  He  obtains  these  gradations  of  effect  by  the  injection 
of  substances  of  various  degrees  of  irritating  power,  from  solution  of 
chloride  of  sodium,  alcohol,  etc.,  which  occasion  rather  severe  pain,  fol- 
lowed by  local  swelling,  in  general  readily  dissipated,  through  tincture 
of  iodine,  which  causes  non-suppurative  inflammation,  sometimes  fol- 
lowed by  atrophic  absorption,  to  solution  of  nitrate  of  silver,  sulphate  of 
copper,  etc.,  which  give  rise  to  phlegmons  with  suppuration.  {Arch. 
Gen.,  Oct.  1863,  p.  285.)  It  is  perceived  that  this  application  of  subcu- 
taneous injection  is  wholly  different  from  those  of  Dr.  Wood  and  Mr. 
Hunter,  the  former  of  which  aimed  at  the  relief  of  pain  by  the  local 
action  of  anodynes,  the  latter  to  the  production  of  remedial  impressions 
through  the  circulation.  It  is  yet  comparatively  new,  and  the  recorded 
experience  is  insufficient  to  justify,  on  that  basis,  a  positive  decision  as  to 
its  merits. 

In  relation  to  the  particular  substances  employed  in  hypodermic  medi- 
cation, their  therapeutic  application,  and  the  precise  dose  and  mode  of 
exhibition,  the  reader  is  referred  to  the  several  medicines  as  treated  of  in 
the  second  part  of  this  work. 


84  APPLICATION    OF    MEDICINES.  [PART  I. 

SUBSECTION  V. 
Other  Surfaces  of  Application. 

There  is  no  surface  attainable  from  without,  to  which  medicinal  appli- 
cations have  not  been  made,  with  reference  to  a  curative  influence  on 
the  surface  itself.  The  conjunctiva,  the  nasal  duct,  the  nostrils  and 
various  cavities  communicating  with  them,  the  mouth  and  fauces,  the 
pharynx  and  oesophagus,  the  internal  auditory  meatus,  the  Eustachian 
tube,  the  urethra  and  bladder,  the  vagina  and  uterus,  have  all  been 
the  seats  of  such  applications.  Particular  names  have  been  given  to 
certain  medicines  thus  employed.  Liquid  applications  to  the  eye  are 
called  collyria  or  eye-wafers;  substances  applied  to  the  nostrils,  errhines 
and  sternutatories;  liquids  to  the  fauces,  gargarismata,  collutorea,  or 
gargles;  solid  bodies  intended  to  be  chewed,  masticatories ;  and  those 
applied  to  the  urino-genital  passages,  if  liquids,  simply  injections,  if 
solids,  and  introduced  into  the  vagina,  pessaries. 

Of  all  these  surfaces,  those  of  the  nostrils  and  mouth  are  the  only  ones 
to  which  medicines  are  habitually  applied  in  reference  to  any  other  than 
a  local  effect.  In  consequence  of  the  strong  sympathies  of  the  nasal 
passages  with  the  brain,  errhines  and  sternutatories  are  not  unfrequently 
employed  to  rouse  the  nervous  centres,  and  sometimes  also  to  agitate 
the  respiratory  organs  by  the  act  of  sneezing.  Both  to  the  Schneiderian 
and  buccal  mucous  membrane,  medicines  are  occasionally  applied  with 
a  view  to  their  revulsive  impression,  and  to  the  latter  sometimes  in 
order  to  affect  the  system,  as  for  example  by  rubbing  the  medicine  upon 
the  gums.  It  must  be  confessed,  however,  that  this  latter  method  can- 
not be  looked  on  as  peculiarly  efficient ;  and  it  is  probable  that,  when 
any  considerable  effect  has  been  experienced,  it  has  been  the  result  rather 
of  the  portion  of  the  medicine  swallowed,  than  of  that  absorbed  from 
the  mucous  membrane  of  the  mouth.  There  is  reason,  nevertheless,  to 
believe  that  medicines  are  actually  absorbed  from  this  membrane,  par- 
ticularly from  the  surface  of  the  tongue;  and  substances  applied  to  this 
organ,  and  held  there  for  some  time,  are  asserted  to  have  exercised  the 
same  remedial  influence  as  when  swallowed,  without  unpleasant  effect 
upon  the  stomach. 

Even  to  the  serous  membranes,  applications  are  sometimes  made  with 
a  view  to  some  alterative  effect  on  these  tissues.  Thus,  injections  are 
thrown  into  the  tunica  vaginalis  for  the  cure  of  hydrocele ;  and  attempts 
have  been  successfully  made,  in  a  few  instances,  to  cure  dropsy  by  stim- 
ulant liquids  thrown  into  the  cavities  of  the  pleura  and  peritoneum;  but 
tliis  practice  is  too  hazardous  for  general  adoption. 

Blood-vessels.  Many  medicines,  when  injected  into  the  veins,  pro- 
duce the  same  effects  as  when  taken  into  the  stomach,  but  generally 


CHAP.  III.]  APPLICATION    OF   MEDICINES.  85 

operate  more  powerfully.  Hence  it  was  long  since  proposed  to  ad- 
minister medicines  in  this  way;  and  the  method  has  been  frequently 
tried.  In  some  instances  it  has  appeared  to  do  good;  but  the  general 
experience  of  its  results  has  by  no  means  been  such  as  to  counterbalance 
its  obvious  disadvantages;  and  it  is  only  under  the  most  urgent  circum- 
stances, and  in  cases  otherwise  desperate,  that  it  would,  in  my  estima- 
tion, be  justifiable. 

"When  medicines  are  absorbed  into  the  circulation,  they  frequently 
undergo  preliminary  changes,  which  probably  better  adapt  them  for 
admixture  with  the  blood.  Being  taken  up  gradually,  they  enter  the 
circulation  in  extremely  minute  quantities  at  one  time,  so  that  the  whole 
blood  becomes  equably  impregnated,  and  the  least  possible  shock  is  pro- 
duced either  on  the  circulating  fluid,  the  vessels,  or  the  system.  When 
injected  into  the  veins,  it  is  impossible  to  introduce  them  thus  gradually 
and  cautiously,  and,  if  the  attempt  were  made,  the  time  consumed  would 
greatly  aggravate  the  danger  of  the  operation.  The  blood,  therefore,  at 
the  point  of  injection  becomes  too  strongly  impregnated,  and  must  pro- 
duce on  the  tissues  more  than  the  desired  effect;  while  it  is  scarcely 
possible  to  calculate  what  injurious  influence  may  be  exercised  on  its 
own  qualities  or  constitution.  We  are  too  little  acquainted  with  the 
chemical  and  vital  reactions  which  take  place,  under  such  circumstances, 
to  be  able  to  infer  a  priori  what  results  would  ensue ;  and  experiments 
have  not  yet  been  sufficiently  numerous  and  varied  to  supply  this  defi- 
ciency. The  most  violent  effects  have  sometimes  been  produced  by 
substances  which,  in  other  modes  of  application,  are  quite  bland  and 
innocuous.  Besides,  there  are  the  dangers  of  injecting  air  into  the  veins 
along  with  the  medicine,  and  of  giving  rise  to  phlebitis  by  injury  of 
the  vein. 

Inoculation  has  recently  been  proposed  as  another  and  safer  method 
of  introducing  medicines  into  the  blood-vessels;  but  I  cannot  conceive  of 
any  advantage  it  possesses  over  the  eudermic  method,  while  it  is  liable 
to  the  great  disadvantage  that  the  medicine,  to  produce  any  effect  on  the 
system,  must  enter  the  blood  in  a  highly  concentrated  state,  and  thus 
endanger  too  strong  a  local  impression.  An  account  of  Langenbeck's 
method  of  applying  medicines  by  inoculation  is  contained  in  the  British 
and  Foreign  Medico -chirurgical  Review  for  January,  1857  (Am.  ed., 
p.  203). 

Attention  has  recently  been  called  by  Sir  J.  Y.  Simpson,  of  Edin- 
burgh, to  the  use  of  medicated  pessaries,  from  which  he  has  found 
advantage  in  the  production  of  specific  impressions  on  the  uterus  and 
vagina.  The  medicine  is  incorporated  with  some  soft  solid ;  and,  as  in 
the  case  of  suppositories,  cacao  butter  is  admirably  well  adapted  to  the 
purpose.  Opiates,  astringents  both  vegetable  and  mineral,  and  various 
other  medicines  may  be  employed  in  this  way.  (Edin.  Med.  Journ., 
May,  1865,  p.  1042.) 


86  CLASSIFICATION    OF   MEDICINES.  [PART  I. 


CHAPTER   IV. 
Classification  of  Medicines. 

THE  use  of  classification  is  to  facilitate  the  work  both  of  the  author 
or  teacher,  and  of  the  student.  To  the  former  it  is  highly  advantageous 
by  affording  him  the  opportunity  of  presenting,  in  one  view,  and  in  a 
comparatively  few  words,  all  the  common  properties  and  uses  of  any 
number  of  bodies;  so  that,  in  the  subsequent  description  of  these  bodies 
severally,  he  may  omit  whatever  is  not  peculiar  to  each,  and  thus  spare 
himself  a  vast  amount  of  repetition.  To  the  latter  it  is  almost  essential ; 
as,  by  fixing  in  his  mind  the  properties  of  classes,  and  thus  serving  to 
recall  these  properties  in  relation  to  any  individual,  upon  the  recollection 
simply  that  it  belongs  to  the  class,  it  aids  his  memory  beyond  all  other 
contrivance,  and  enables  him  to  gather  and  retain  an  amount  of  knowl- 
edge, which  would  be  quite  unattainable  were  he  to  study  each  object  in 
an  isolated  state.  The  only  kind  of  works  in  which  classification  is  un- 
necessary are  those  intended,  not  for  continuous  study,  but  for  occasional 
reference,  when  information  is  desired  upon  some  particular  name  or 
object,  such  as  dictionaries,  encyclopedias,  and,  to  a  certain  extent. 
dispensatories,  in  all  of  which  an  alphabetical  arrangement  is  most 
convenient. 

The  advantages  and  even  necessity  of  classification  being  admitted, 
the  next  point  for  consideration  is  the  plan  to  be  adopted.  Now  it  nuiy 
be  asserted,  without  fear  of  contradiction,  that  no  plan  is  faultless. 
Every  mode  of  classification  which  has  been  proposed  in  relation  to 
remedies  has  its  disadvantages;  and  it  is,  therefore,  no  valid  objection 
to  any  particular  one  which  may  be  suggested  that  it  is  not  perfect. 
That  one,  it  appears  to  me,  is  the  best,  which  best  promotes  the  great 
object  of  all  classification;  the  facilitating,  namely,  of  the  acquisition  of 
knowledge.  As  different  kinds  of  knowledge  are  required  of  the  same 
bodies  by  different  sets  of  students,  it  follows  that  the  classification 
should  be  different  also;  for,  to  be  productive  of  the  most  good,  it  must 
be  based  upon  the  relation  of  the  bodies  to  one  another  in  those  proper- 
ties which  are  the  special  object  of  study.  Thus,  in  reference  to  medi- 
cines, the  intention  may  be  to  study  them  as  objects  either  of  natural 
history,  pharmaceutical  management,  or  therapeutic  use;  and  they 
should  be  arranged  accordingly.  Their  classification,  therefore,  should 
be  based,  for  the  general  student,  upon  their  geological,  botanical,  or 


CHAP.  IV.]  CLASSIFICATION    OF    MEDICINES.  87 

mineralogical  relations ;  for  the  pharmaceutist,  either  upon  their  chem- 
ical properties,  or  their  resemblance  in  modes  of  preparation ;  for  the 
therapeutist,  undoubtedly  upon  their  effects  on  the  system,  through 
which  they  become  applicable  to  the  cure  of  disease.  It  is  in  the  last- 
mentioned  capacity  that  they  are  important  to  the  physician ;  and  in 
this  especially  he  should  be  taught,  from  the  earliest  period  of  his  studies, 
to  regard  them.  -  As,  therefore,  the  present  work  is  devoted  more  espe- 
cially to  the  therapeutic  consideration  of  medicines,  I  have,  without 
hesitation,  adopted  a  system  of  classification,  founded  upon  their  rela- 
tions to  one  another  in  their  modes  of  affecting  the  human  system. 

The  question  now  occurs,  admitting  the  effects  of  medicines  to  afford 
the  true  basis  of  classification,  whether  it  is  their  physiological  or  thera- 
peutical effects  to  which  we  should  have  recourse.  At  the  first  glance 
it  might  be  supposed  that  the  latter  should  be  preferred.  But  a  little 
consideration  will  decide  against  them.  Formerly,  when  the  notion 
prevailed  that  there  were  specific  remedies  for  particular  diseases,  or 
classes  of  disease,  an  .arrangement  of  medicines  based  on  this  principle 
was  to  a  certain  extent  naturally  adopted.  Hence  the  terms  antiphlo- 
gistics,  febrifuges,  antispasmodics,  antiscorbutics,  antisyphilitics,  anti- 
lithics,  etc.  But  the  fact  is,  that  there  is  no  specific,  strictly  speaking ; 
that  is,  there  is  no  remedy  which  is  especially  adapted  to  one  disease, 
and  one  only,  and  no  curable  disease  which  will  yield  only  to  one  remedy; 
and,  in  relation  to  classes  of  disease,  such  as  inflammations,  fevers,  and 
spasmodic  affections,  there  is  no  one  which  does  not  require,  in  different 
stages,  and  under  different  circumstances,  the  same  medicines  found  use- 
ful in  the  others ;  so  that  classes  founded  on  this  basis  would  be  con- 
stantly clashing,  each  containing  the  individuals  embraced  by  the  others ; 
and  thus  all  the  advantages  of  classification  would  be  lost.  For  example, 
in  the  treatment  of  the  three  sets  of  diseases  above  mentioned,  in  one  or 
another  of  their  stages  or  varieties,  we  employ  bleeding,  cathartics, 
emetics,  narcotics,  tonics,  stimulants,  revulsives,  etc.  The  physiological 
effects  must,  therefore,  be  resorted  to ;  and,  happily,  it  will  be  found  that, 
to  one  well  acquainted  with  pathology,  these  very  effects,  and  conse- 
quently the  medicines  producing  them,  are  suggested  by  the  therapeutic 
indications.  It  will  be  perceived  that,  in  the  following  plan,  all  the  old 
classes  founded  on  the  therapeutic  basis,  as  antispasmodics  and  antilithics, 
have  been  abandoned,  and,  except  in  the  instances  of  the  last  five  or  six, 
which  do  not  act  on  the  system  itself,  but  on  extraneous  matters  accident- 
ally contained  within  it,  and  operating  as  causes  of  disease,  all  the  classes 
have  a  purely  physiological  relation.  I  wish  it  to  be  specially  noticed 
that,  in  distributing  remedies  in  the  following  classes,  I  am  fully  aware 
that  the  members  of  one  class  often  possess  properties  which  charac- 
terize another;  and  that,  in  deciding  in  which  to  place  them,  I  have 
been  in  many  instances  influenced  by  their  practical  use,  giving  them  a 


83  CLASSIFICATION    OF    MEDICINES.  [PART  I. 

position  in  accordance  with  those  properties  which,  if  not  always  most 
striking,  are  those  which  constitute  their  chief  value  as  medicines,  or  at 
least  for  which  they  are  most  employed. 

Plan  of  Classification. 

Remedies  are  divided  primarily  into  those  which  operate  upon  the 
system,  and  those  upon  extraneous  bodies  accidentally  contained  within 
the  system.  The  former  division  embraces  the  great  body  of  remedies ; 
the  latter  includes  only  five  or  six  classes,  which  are  retained  for  the  sake 
of  practical  convenience ;  as  it  is  desirable  that  the  physician  should  have 
the  substances  belonging  to  them  associated  together  in  his  memory. 

I.  SYSTEMIC  REMEDIES. 

Some  remedies  extend  their  action  throughout  the  whole  living  sys- 
tem ;  others,  operating  upon  one  or  more  of  those  functions,  as  the  cir- 
••uhitory  and  nervous,  which  pervade  the  body,  are  apparently  felt  in  all 
parts  of  it,  though  not  strictly  universal  in  their  direct  influence.  All 
these  may  be  denominated  general  remedies.  Another  large  division 
act  specially  on  some  one  part  or  organ,  or,  if  they  affect  the  general 
system,  do  so  only  indirectly  or  secondarily.  These  may  be  called  local 
remedies ;  and  thus  we  have  the  basis  of  the  first  subdivision. 

I.  GENERAL  REMEDIES. 

The  general  remedies  are  necessarily,  as  before  stated,  either  stimu- 
lant, sedative,  or  alterative;  that  is,  either  elevate,  depress,  or  alter  the 
systemic  actions.  These  three  sets  constitute  the  second  subdivision. 

1.  General  Stimulants. 

If  the  operation  of  stimulant  substances  be  closely  observed,  it  will  be 
noticed  that,  while  some  are  slow,  moderate,  and  lasting,  others  are,  on 
the  contrary,  quick,  energetic,  and  proportionably  brief  in  their  action ; 
though  the  two  sets  run  together  by  almost  insensible  gradations. 
This  (liflerence  of  operation  was  made  by  Dr.  Murray,  of  Edinburgh,  the 
basis  of  a  division  <>f  the  general  stimulants  into  two  distinct  sets,  which 
he  named  respectively  permanent  and  diffusible  stimulants.  Though 
tln-M-  terms  are  neither  of  them  very  accurately  exprosive  of  the  dis- 
tinctive characters  of  the  two  divisions,  yet  it  may  not  l>e  easy  to  find 
l»etter,  and  it  is  advisable  not  to  adopt  new  names  unless  upon  some 
real  ground  of  preference.  I  have,  therefore,  admitted  this  division  with 
the  nomenclature. 


CHAP.  IV.]  CLASSIFICATION    OF    MEDICINES.  89 

1.  Permanent  Stimulants. 

There  is  a  very  striking  distinction  between  the  permanent  stimu- 
lants; one  section  confining  their  direct  influence  to  tb»  vital  function  of 
organic  contractility,  the  other  operating  upon  the  vital  functions  gen- 
erally. The  first  division  is  very  appropriately  denominated  astringents, 
the  second  less  appropriately  tonics.  They  constitute  two  of  the  ulti- 
mate classes  of  remedies. 

1.  ASTRINGENTS  are  medicines  which  produce  contraction  of  the  living 
tissues. 

2.  TONICS  are  characterized  by  their  general  stimulating  influence 
over  the  functions,  operating  slowly,  moderately,  and  somewhat  dura- 
bly, either  directly  through  the  circulation,  or  secondarily  through  the 
digestive  function. 

2.  Diffusible  Stimulants. 

Some  of  these  appear  to  be  universal,  such  as  heat  and  electricity; 
but  the  greater  portion,  and  perhaps  all  which  come  strictly  under  the 
denomination  of  medicines,  exhibit  a  special  tendency  to  one  or  the 
other  of  the  two  great  pervading  systems  or  apparatuses  of  the  body, 
the  circulatory,  namely,  and  the  nervous.  As  those  which  have  a  tend- 
ency to  the  circulation  operate  directly  rather  upon  the  arterial  than 
the  venous  side  of  it,  I  name  them  arterial  stimulants.  Those  acting 
specially  on  the  nervous  system  may  be  called  cerebro- spinal  stimulants. 

1.  ARTERIAL  STIMULANTS  are  scarcely  susceptible  of  further  profita- 
ble subdivision,  and  therefore  constitute  one  of  the  ultimate  classes. 
They  are  characterized  especially  by  their  property  of  increasing  the 
action  of  the  heart  and  arteries,  and,  along  with  this  effect,  and  proba- 
bly consequent  upon  it,  of  causing  an  elevation  of  the  animal  tempera- 
ture. 

2.  CEREBRO-SPINAL  STIMULANTS.     I  do  not  wish,  by  the  use  of  this 
term,  to  intimate  that  the  remedies  so  called  act  exclusively  on  the  brain 
and  spinal  marrow;  they  may  possibly,  and  probably  do,  in  some  in- 
stances, affect  the  ganglionic  system,  and,  indeed,  the  whole  nervous 
substance  wherever  they  may  meet  with  it.     There  is  a  marked  differ- 
ence between  the  members  of  this  subdivision.     Whilst  some  appear  to 
operate  equably  upon  the  whole  nervous  system,  showing  no  special  in- 
fluence over  the  proper  cerebral  functions,  others  act  with  great  energy 
on  the  brain,  as  evinced  by  their  power  of  deranging  sensation,  volun- 
tary motion,  consciousness,  and  the  various  intellectual  and  emotional 
functions.     The   former  I  denominate  nervous  stimulants,  the  latter 
cerebral  stimulants.     Besides  these  two  sets  of  cerebro-spinal  stimu- 
lants, there  is  at  least  one  medicine  which  acts  especially  and  power- 


00  CLASSIFICATION   OF   MEDICINES.  [PART  I. 

fully  on  the  spinal  marrow,  and  for  which  a  distinct  class  may  be 
formed  under  the  name  of  spinal  stimulants.  These  three  are  all  ulti- 
mate ela- 

a.  Nervous  Stimulants,  characterized  by  a  special  but  equable  influ- 
ence over  the  nervous   system,  generally  stimulate   in   some  degree, 
though  not  necessarily,  the  circulation  also.     They  are  sometimes  called 
nervines,  and  not  unfrequently  antispasmodics. 

b.  Cerebral  Stimulants,  with  more  or  less  influence  on  the  circula- 
tion, and  sometimes  a  powerful  influence,  are  peculiarly  characterized 
by  their  control  over  the  special  cerebral  functions.     They  arc  equiva- 
lent to  the  stimulant  narcotics  of  other  writers,  and  embrace  some  of 
the  most  energetic  articles  of  the  materia  medica,  such  as  alcohol  and 
opium. 

c.  Spinal  Stimulants  act  specially,  so  far  as  their  operation  is  known, 
on  the  reflex  motor  function. 

2.  General  Sedatives. 

These  are  remedies  which  directly  depress  the  vital  functions.  While 
A  ft1w  operate  universally,  as  cold  and  water,  most  of  them,  like  the  cor- 
responding stimulants,  act  especially  or  exclusively  on  one  of  the  two  great 
systems,  the  circulatory,  namely,  and  the  nervous;  some  prominently 
ulVe<Ming  the  former,  and  therefore  denominated  arterial  sedatives, 
others  the  latter,  and  named  cerebro-nervous  sedatives. 

1.  ARTERIAL  SEDATIVES  constitute  one  of  the  ultimate  classes.    They 
act  mainly,  if  not  exclusively,  in  their  primary  influence,  upon  the  heart 
and  arteries,  without  any  direct  effect  on  the  cerebro-spinal  functions. 
As,  among  the  results  of  the  circulatory  depression,  is  a  reduction  also 

'of  the  temperature,  they  are  frequently  called  refrigerants. 

2.  CEREBRO-SPINAL  SEDATIVES.     These  may  lie  advantageously  di- 
vided, like  the  corresponding  subdivision  of  stimulants,  into  the  nerv- 
ous, cerebral,  and  spinal,  which  form  ultimate  classes. 

a.  Nervous  Sedatives  are  such  as  reduce  generally  the  nervous  func- 
tions, without   any  special   reference   to   the  brain.     They  uniformly, 
either  by  a  conjoint  primary  action,  or  secondarily  thron-h  their  influ- 
enee  on  the  nerves,  reduce  the  force  of  the  circulation  also.     They  are 
usually  designated  as  sedative  narcotics. 

b.  Cerebral  Sedatives  are  remedies  which,  while  they  depress  the  cir- 
culation either  primarily  or  secondarily,  exert  a  special  and  marked  in- 
lluenee,  of  a  sedative  character,  on  the  cerebral  functions.     Like  the 
preceding  class,  they  would  rank  with  the  medicines  usually  known  as 
sedative  narcotics. 

c.  Spinal  Sedatives  act  by  directly  depressing  the  special  functions  of 
the  ,-piniil  marrow,  including  of  course  its  reflex  action,  with  little  if  any 
direct  influence  on  the  brain. 


CHAP.  IV.]  CLASSIFICATION   OF   MEDICINES.  91 


3.  General  Alteratives. 

These  are  remedies  which  insensibly  change  the  functions  or  organi- 
zation, without  any  necessary  elevation  or  depression  of  the  vital 
actions,  and  the  influence  of  which  is  mainly  recognized  by  their 
effects  in  disease.  They  may  be  stimulant  or  sedative,  and  they  may 
produce  various  local  effects  which  would  rank  them  in  other  classes ; 
but  it  is  not  through  these  that  the  special  curative  effects  are  produced, 
which  entitle  them  to  the  name  by  which  they  are  distinguished. 
Knowing  so  little  of  their  mode  of  action,  we  are  not  possessed  of 
grounds  for  subdividing  them,  and  they  therefore  rank  with  the  ulti- 
mate classes. 

II.  LOCAL  REMEDIES. 

I  do  not  include  in  this  division,  in  reference  at  least  to  their  peculiar 
and  characteristic  properties,  the  general  remedies  which  may  some- 
times be  made  to  act  locally  by  confining  them  to  a  particular  part;  as 
opium,  for  example,  and  belladonna,  both  of  which  are  sometimes  ap- 
plied to  the  surface,  with  the  view  of  affecting  exclusively  the  neigh- 
bourhood of  their  application.  The  division  includes  only  remedies 
which  either  have  a  special  direction  to  some  particular  organ  or  part  of 
the  body,  to  whatever  portion  of  it  they  may  be  applied,  or  which,  if 
possessed  of  general  powers,  are  employed  locally  for  some  effect  differ- 
ent from  the  general ;  as  when  potassa,  for  instance,  is  used  as  an  escha- 
rotic,  cantharides  for  blistering,  and  mustard  as  a  rubefacient,  which 
rll'ccts  are  not  incident  to  their  internal  use  as  medicines. 

With  a  few  exceptions,  all  the  local  remedies  are  more  or  less  stimu- 
lant; and  the  possession,  therefore,  of  this  property,  or  that  of  depression, 
does  not  constitute  a  sufficient  ground  of  distinction  between  them. 
Consequently,  some  other  basis  of  classification  must  be  sought  for; 
and  it  has  appeared  to  me  that  they  might  be  most  conveniently  ar- 
ranged, according  as  they  are  employed  to  affect  the  functions,  or  to 
change  the  organization,  or  to  act  merely  as  mechanical  agents. 

1.  Local  Remedies  acting  on  the  Functions. 

The  subdivisions  of  these  are -all  ultimate  classes  of  medicines,  and 
are  as  follows : 

1.  EMETICS,  which  operate  on  the  stomach,  producing  vomiting; 

2.  CATHARTICS,  which  operate  on  the  bowels,  producing  their  evacua- 
tion downward; 

3.  DIURETICS,  which  act  on  the  kidneys,  increasing  the  secretion  of 
urine; 

4.  DIAPHORETIC  .5,  which  act  on  the  skin,  causing  perspiration ; 


92  CLASSIFICATION    OF    MEDICINES.  [PART  I. 

5.  EXPECTORANTS,  which  act  on  the  lung?;,  causing  expectoration; 

6.  CHOLAGOGUES,  which  act  on  the  liver,  increasing  the  secretion  of 
bile; 

7.  EMMENAGOGUES,  which  act  on  the  uterus,  exciting,  increasing,  or 
restoring  the  menses; 

8.  UTERINE  MOTOR-STIMULANTS,  which  favour  uterine  contraction; 

9.  SIALAGOGDES,  which  increase  the  secretion  of  saliva;  and 

10.  ERRHINES  or  STERNUTATORIES,  which  operate  on  the  nostrils. 
causing  an  increased  secretion,  and  sneezing. 

2.  Local  Remedies  affecting  the  Organization. 

The  subdivisions  of  these  are  also  ultimate  classes,  and  are  as  follow- : 

1.  RUBEPACIENTS,  inflaming  the  skin; 

2.  EPISPASTICS,  producing  blisters;  and 

3.  ESCHAROTICS,   destroying  the  life  of  the  part,  and  producing  a 
slough. 

3.  Local  Remedies  acting  Mechanically. 

These  include,  besides  the  various  measures  enumerated  under  the 
head  of  "Mechanical  Influence"  (page  53),  the  following  classes  of 
medicines : 

1.  DEMULCENTS,  bland  viscid  liquids,  which  cover  surfaces  and  pro- 
tect them  from  irritation,  or  mingled  with  acrid  substances  obtund  their 
acrimony ; 

2.  EMOLLIENTS,  which  soften  and  relax; 

3.  DILUENTS,  which  dilute  the  fluids  of  the  body;  and 

4.  PROTECTIVES,  which  operate  by  covering  the  surface,  and  prevent- 
ing the  contact  of  the  air. 

II.  NON-SYSTEMIC   REMEDIES. 

These  are  remedies  acting  on  bodies  foreign  to  the  system,  but  within 
it.  They  embrace  the  five  classes  of 

1.  ANTACIDS,  which  neutralize  acid  in  the  stomach,  or  elsewhere  in 
the  system ; 

2.  ABSORBENTS,  which,  by  absorbing  acrid  or  irritating  matters,  pre- 
vent or  diminish  their  irritant  action; 

3.  SOLVENTS,  which  effect  the  solution  in  the  stomach  of  substances 
otherwise  insoluble; 

4.  DISINFECTANTS,  which  chemically  destroy  noxious  and  fetid  ex- 
halations; and 

6.  PARASITICIDES,  which  are  destructive  to  the  lower  forms  of  animal 
and  vegetable  existence,  seated  in  the  human  body,  and  acting  injuri- 
ously upon  it.  These  include  the  two  subclasses  of 


CHAP.  IV.]  CLASSIFICATION    OF    MEDICINES.  93 

a.  Anthelmintics,   which  favour  the  expulsion  of  worms  from  the 
bowels;  and 

b.  Antizymotics,  which  are  destructive  of  those  microscopic  organisms 
which  support  fermentation,  and  thus  probably  cause  and  sustain  the 
proper  zymotic  diseases. 

The  following  is  a  tabular  view  of  the  foregoing  classification;  the 
ultimate  classes  being  in  italics. 

SYSTEMIC  REMEDIES. 
General  remedies. 
Stimulants. 

Permanent  stimulants. 
Astringents. 
Tonics. 

Diffusible  stimulants. 
Arterial  stimulants. 
Cerebro-nervous  stimulants. 
Nervous  stimulants. 
Cerebral  stimulants. 
Spinal  stimulants. 
Sedatives. 

Arterial  sedatives. 
Cerebro-nervous  sedatives. 
Nervous  sedatives. 
Cerebral  sedatives. 
Spinal  sedatives. 
Alteratives. 
Local  remedies. 

Affecting  the  functions. 
Emetics. 
Cathartics. 
Diuretics. 
Diaphoretics. 
Expectorants. 
Cholagogues. 
Emmenagogues. 
Uterine  motor-stimulants. 
Sialagogues. 
Errhines. 

Affecting  the  organization. 
Eubefacients. 
Epispastics. 
Escharotics. 
Operating  mechanically. 
Demulcents. 


<»4  CLASSIFICATION    OF    MEDICINES.  [PART  I. 

Emollients. 
Diluents. 
Prolectives. 

NON-SYSTEMIC  REMEDIES. 
Antacids. 
Absorbent*. 
Solvents. 
Disinfectants. 
Parasiticides. 
Anthelmintics. 
Antizymotics. 

The  plan  of  arrangement  here  presented  does  not  claim  to  be  perfect. 
It  is,  however,  in  the  best  judgment  of  the  author,  as  little  objectionable 
as  any  that  has  been  proposed,  and  perhaps  as  nearly  perfect  as  the 
present  state  of  our  knowledge  on  the  subject  permits.  It  is  but  partially 
original.  In  forming  it,  the  author  has  preferred  adopting  what  seemed 
to  him  best  in  preceding  systems  of  classification,  and  modifying  where 
modification  was  called  for  by  the  progress  of  knowledge,  to  any  pre- 
sumptuous attempt  to  supersede,  by  crude  novelties  of  his  own,  plans 
which  have  in  their  favour  the  matured  observation  of  ages,  and  the 
judgment  of  the  soundest  thinkers  of  past  times.  The  present  plan  is  :i 
classification  of  results,  of  facts  well  known  and  generally  admitted, 
which  must  remain  true,  whatever  changes  the  progress  of  discovery 
may  hereafter  make  in  our  views  of  the  operation  of  remedies.  It  does 
not  profess  to  explain  the  modes  in  which  the  results  arc  produced. 
For  a  classification  upon  this  principle  we  are  not  yet  prepared.  Our 
knowledge  of  the  precise  modes  in  which  medicines  act  is  yet  too  uncer- 
tain to  admit  of  any  system  of  arrangement,  founded  upon  their  re- 
semblance in  this  respect;  and  it  may  be  confidently  predicted  that  any 
fmch  system  will  prove  unstable,  as  it  must  rest  upon  a  fluctuating  basi>. 

The  attention  of  the  reader  is  particularly  requested  to  a  few  con- 
siderations, which  are  necessary  to  a  proper  understanding  of  the  scope 
of  the  present  arrangement.  I  have  said  that  the  classification  is  not 
perfect.  In  the  first  place,  the  remedies  attached  to  the  several  cla- 
while  they  agree  in  the  possession  of  the  particular  property  which 
characterizes  the  class,  often  differ  very  much  in  otl:<T  respects,  and  in 
Mime  instances  are  applicable  to  very  diffen  :;t  purposes.  The  rule 
which  I  have  adopted  is  to  classify  them,  as  far  as  possible,  according 
to  their  mo.-t  di-iiiieti\e  property,  or  that  for  which  they  are  most 
valuable  thenijieutically,  and  then,  in  the  description  of  each  remedy,  to 
refer  to  all  its  other  remedial  properties  and  applications,  so  that  its  in- 
dividual character  may  be  well  understood.  In  many  instances,  the 
operation  of  the  remedy  is  altogether  peculiar,  except  in  the  single  point 


CHAP.  IV.]  CLASSIFICATION    OF    MEDICINES.  95 

in  which  it  conforms  with  the  other  individuals  of  its  class.  Thus,  while 
the  salts  of  lead  are  astringent,  they  are  in  every  other  respect  quite 
specific  in  their  manner  of  affecting  the  system. 

Again,  it  not  unfrequently  happens  that  a  remedy,  belonging  to  one 
class,  has  additional  powers  which  serve  to  rank  it  in  another.  In  such 
cases,  the  remedy  is  considered  in  both  classes ;  being  treated  of  at  large 
in  that  with  which  its  most  important  therapeutic  character  would  rank 
it,  and  in  the  other  only  so  far  as  may  concern  its  categorical  position. 
Thus,  digitalis  is  a  powerful  nervous  sedative,  and  is  more  strongly 
characterized,  and  probably  more  used  as  such  than  in  any  other  capa- 
city ;  but  it  is  also  a  very  efficient  diuretic.  It  is,  therefore,  treated  of  in 
general,  among  the  nervous  sedatives ;  while,  among  the  diuretics,  it  is 
again  referred  to,  but  only  in  relation  to  the  property  which  attaches  it 
to  that  class.  Indeed,  there  are  some  remedies  which,  in  this  manner, 
may  be  ranked  in  several  classes ;  as  the  antimonials,  for  example,  which, 
while  they  are  chiefly  arterial  sedatives,  belong  also  to  the  emetics,  dia- 
phoretics, and  expectorants.  Nor  is  there  any  inconvenience  in  con- 
sidering medicines  in  this  way.  In  therapeutics,  it  is  not  any  particular 
medicinal  substance  or  remedial  agent  that  we  have  in  our  minds,  but 
the  condition  of  disease  calling  for  certain  remedial  influences ;  and  it  is 
important  that  our  knowledge  should  be  so  arranged  in  the  memory  as 
most  readily  to  suggest  what  particular  remedy  may  be  best  calculated 
to  exert  this  influence.  This  object  will  certainly  be  better  attained  by 
ranking  all  the  remedies  together  calculated  to  meet  each  indication, 
and  to  have  them  thus  associated  in  our  minds,  than  by  having  the 
whole  character  of  each  body,  in  all  its  different  relations  and  applica- 
tions, impressed  upon  us  in  one  exclusive  view.  Thus,  it  will  be  more 
useful  practically,  when  we  have  occasion  for  an  arterial  sedative,  emetic, 
expectorant,  or  diaphoretic,  to  have  tartar  emetic  associated  with  each 
of  these  classes  in  our  recollection,  than  to  know  it  only  as  an  anti- 
monial,  having  a  great  diversity  of  properties,  and  thus  to  be  compelled 
to  think  over  it,  along  perhaps  with  a  number  of  other  bodies,  in  order 
to  ascertain  whether  any  one  of  these  properties  may  suit  our  present 
purpose. 

In  reference  to  the  modes  of  operating  of  the  several  remedies  in  pro- 
ducing the  effects  which  serve  to  classify  them,  I  shall  offer  and  enforce 
those  views  which  seem  to  me  most  in  accordance  with  reason  and  ex- 
perience, not  omitting,  however,  to  allude  to  others  which  may  have 
been  advanced,  and  wishing  always  to  be  understood  as  considering 
our  knowledge  upon  this  point  to  be  in  great  measure  provisional,  and 
liable  to  be  materially  modified  in  the  progress  of  discovery. 


PART    II. 

SPECIAL   THERAPEUTICS    AND 
PHARMACOLOGY. 


DIVISION   I. 

SYSTEMIC    REMEDIES. 

Subdivision  1. 
GENERAL    REMEDIES. 


CHAPTER  I. 
General  Stimulants. 

SECTION   FIRST. 
Permanent  Stimulants. 

CLASS  I. 
ASTRINGENTS. 

ASTRINGENTS  are  remedies  which  produce  contraction  of  the  living 
tissues.  I  do  not  here  refer  to  the  visible  contraction  which  takes  plac»: 
in  muscles  under  the  influence  of  the  will,  or  other  excitant  agency;  but 
to  a  certain  shrinking  or  condensation  of  structure,  which  is  not  attended 
with  visible  movement,  but  is  nevertheless  very  obvious  in  the  result,  as 
in  that  well-known  state  of  the  skin  called  goose-flesh,  produced  by  ex- 
posure to  cold.  That  astringents  have  this  effect  locally,  is  proved  by 
the  obvious  diminution  of  bulk  in  any  part  of  the  surface  to  which  they 
may  be  applied,  and  by  the  strong  puckering  sensation  occasioned  by 
them  when  taken  into  the  mouth.  There  can  be  no  doubt  that  they 
operate  upon  the  mucous  membrane  of  the  stomach  and  bowels,  when 
brought  into  direct  contact  with  it,  in  precisely  the  same  manner  as  upon 
the  mouth  and  skin.  It  has  been  denied  that  their  operation  extend* 
beyond  the  surface  of  application ;  but  the  effects  obtained  by  their  us*- 
VOL.  i.— 7  (  97  ) 


1)8  GENERAL    STIMULANTS.  [PART  II. 

in  disease  can  be  explained  only  by  the  admission,  that  they  exert  upon 
the  system  at  large  their  characteristie  influence;  though  it  must  be 
allowed  that  their  general  are  much  less  than  their  local  effects.  It  is 
not  impossible  that  a  portion  of  the  constitutional  impression  produced 
by  them  may  be  the  result  of  sympathy  or  nervous  communication;  in 
like  manner  a.>  the  similar  effect  of  cold  upon  the  skin  is  transmitted  to 
certain  internal  parts.  But  this  explanation  is  not  necessary  to  account 
for  the  result.  Experiment  has  satisfactorily  proved  that  astringents  are 
absorbed ;  and  the  probability  is  that  they  are  conveyed  everywhere  with 
the  blood,  and  thus  act  everywhere  by  direct  contact. 

The  fact,  recently  ascertained  through  the  experiments  of  Bernard, 
that  one  of  the  functions  of  the  sympathetic  nerve-system  is  to  produce 
contraction  of  the  capillaries,  very  much  facilitates  the  explanation  of  the 
general  action  of  astringents.  It  is  highly  probable  that,  reaching  the 
sympathetic  centres  through  the  circulation,  they  excite  these  centres 
to  increased  action,  and  thus,  in  part  at  least,  produce  the  contraction 
which  is  their  most  characteristic  effect.  This  explanation  does  not  in 
any  degree  invalidate  the  idea  that  they  act  also  directly  on  the  tissues 
through  the  blood.  There  is  nothing  in  the  least  inconsistent  in  these 
two  modes  of  operation,  which  may  be  in  action  at  the  same  time,  and 
thus  conjointly  produce  greater  effects  than  either  separately. 

1.  MODE  OF  OPERATION. 

Dead  animal  structure,  submitted  to  the  action  of  astringent  sub- 
stances, especially  to  those  of  vegetable  origin,  has  long  been  known  to 
undergo  condensation,  in  consequence  of  chemical  combination  between 
constituents  of  the  tissue  and  the  astringent  substance.  In  relation  to 
the  vegetable  astringents,  their  tannic  acid  unites  with  the  albumen  and 
gelatin  of  the  animal  product,  to  form  insoluble  tannates,  as  in  the  prep- 
aration of  leather  from  hides;  in  relation  to  the  mineral,  the  metallic 
salt  or  its  oxide  also  combines  with  albumen,  producing  compounds 
insoluble  in  water.  The  chemical  therapeutists  suppose  that  this  same 
reaction  takes  place  between  the  astringent  and  the  living  tissue,  and 
ascribe  the  effects  of  the  medicine  to  this  agency.  But  there  is  no  proof 
whatever  that  such  a  combination  takes  place  in  life.  It  could  not  do  so, 
to  any  considerable  extent,  without  destructively  disorganizing  the  part 
affected.  The  force  of  life  opposes  these  chemical  reactions,  and  suc- 
cessfully so  long  as  the  medicine  is  moderately  employed.  If  this  be 
applied  abundantly,  it  may  fir-4  exhaust  the  vital  forces  by  the  excess  of 
vital  reaction  it  excites;  and  the  chemical  affinities  may  then  triumph, 
with  the  effect  of  d.-t raving  the  life  of  the  part.  But,  under  such  cir- 
cumstances, it  ceases  to  be  a  medicine,  and  becomes  a  poison.  The 
rapidity,  moreover,  and  amount  of  local  astringent  effect  are  far  greater 
than  can  be  explained  on  the  chemical  principle.  Every  one  knows  how 


CHAP.  I.]  ASTRINGENTS.  99 

sudden  and  great  is  the  contraction  produced  in  all  the  tissues  of  the 
mouth  by  a  very  minute  quantity  of  alum.  It  appears  to  me  absurd  to 
ascribe  all  this  effect  to  chemical  combination.  Even  were  the  whole  of 
the  alum  which  could  possibly  be  absorbed  in  such  a  case  to  combine 
chemically  with  the  tissues,  it  could  not  produce  an  amount  of  contrac- 
tion in  any  degree  approaching  to  that  really  experienced.  Besides, 
the  contraction,  if  chemical,  would  be  much  more  permanent  than  it 
really  is. 

The  following  appears  to  me  to  be  the  true  explanation  of  the  phe- 
nomena, so  far  as  they  are  at  present  susceptible  of  explanation.  All 
the  living  tissues  have  a  certain  degree  of  vital  cohesion  essential  to  the 
due  performance  of  their  functions;  and  this  cohesion  probably  depends 
on  a  property  of  organic  contractility,  which  is  called  into  action  and 
sustained  by  the  healthy  stimulus  of  the  blood  and  nervous  influence. 
If  these  fail,  the  cohesion  diminishes,  and  a  condition  of  relaxation  takes 
place.  Now  astringent  substances  have  the  peculiar  property  of  stimu- 
lating this  organic  contractility;  and  it  is  this  property  by  which  they 
are  characterized  as  a  class  of  medicines.  All  that  we  know  upon  the 
subject  is  that,  in  consequence  of  the  contact  of  these  substances  with 
the  tissues,  the  contractility  of  the  latter  is  called  into  action,  and  they 
shrink.  The  effect  is  in  no  degree  more  singular  than  that  a  similar 
shrinking  should  take  place  under  the  influence  of  cold. 

It  is  a  very  singular  mistake,  which  still  prevails  with  some  writers, 
that  astringents  act  especially  or  peculiarly  on  the  muscles.  It  is  true 
that  they  do  increase  the  vital  cohesion  of  this  structure,  rendering  the 
muscle  firmer,  but  they  also  act  equally  on  every  other  tissue  capable  of 
shrinking;  as  may  be  distinctly  seen  in  their  effects  upon  the  skin,  and 
felt  in  their  effects  on  the  mucous  membrane  of  the  mouth. 

2.  EFFECTS  ON  THE  SYSTEM. 

The  observable  physiological  effects  of  astringents  are,  beside  the  gen- 
eral condensation  of  tissue  referred  to,  or  rather  as  a  part  or  result  of  it, 
shortening  of  fibres ;  diminished  caliber  of  the  arteries,  veins,  capillaries, 
absorbents,  and  ducts;  diminished  secretion,  exhalation,  and  absorption; 
constipation  of  the  bowels ;  and  increased  firmness  along  with  contraction 
of  the  pulse.  The  blood  becomes  more  coagulable,  in  consequence, 
probably,  of  the  same  influence  exerted  by  them  on  the  organized  con- 
stituents of  this  fluid  as  on  the  solids.  It  is  supposed  also  to  be  less 
disposed  to  putrefaction  after  death.  The  astringents  are  said  to  increase 
the  appetite,  and  invigorate  digestion.  This  effect  they  undoubtedly 
have,  in  debilitated  states  of  the  function,  connected  with  relaxation  of 
tissue.  It  is  reasonable  to  suppose  that,  even  in  health,  with  a  very 
moderate  degree  of  their  peculiar  influence,  they  may  produce  some 
slight  increase  of  the  functions.  Their  effect  is  to  bring  the  molecules 


100  GENERAL    STIMULANTS.  [PART  II. 

more  closely  together;  which  may  thus  be  rendered  capable  of  a  more 
enenretic  vital  reaction.  But.  whatever  may  be  the  case  with  the  per- 
fectly pure  astringents,  it  is  certain  that  many  of  the  medicines  ranked 
in  this  class  do  exercise  a  tonic  influence;  and  for  this  reason,  that  they 
unite  positive  tonic  powers  with  their  astringent  property.  Such  is  the 
case  with  the  vegetable  astringents,  which,  beside  their  characteristic 
ingredient,  not  unfrequently  contain  a  bitter  principle  also,  and  with  the 
preparations  of  iron,  which  are  essentially  and  powerfully  tonic,  while 
they  are  in  some  degree  astringent. 

It  must  be  obvious,  upon  a  little  consideration,  that,  though  astrin- 
gents are  stimulant  to  the  organic  contractility,  they  may  really  prove 
sedative  to  the  healthy  functions,  when  employed  too  freely,  or  continued 
too  long.  The  digestive  function  is  necessarily  impaired  in  consequence 
of  the  diminished  secretion  of  gastric  juice,  the  restrained  peristaltic 
movement  of  the  stomach  and  bowels,  and  the  impeded  absorption.  AH 
a  result  of  this  defective  digestion,  if  from  no  other  cause,  the  circulation 
is  enfeebled,  nutrition  suffers,  emaciation  takes  place,  and  a  general 
reduction  is  experienced  in  the  forces  and  functions  of  the  system. 

The  above  results  flow  from  an  excess  of  the  proper  astringent  influ- 
ence. But  a  still  greater  abuse  of  this  class  of  medicines  leads  to  other 
and  very  different  effects.  When  applied  to  delicate  surfaces  in  great 
excess,  instead  of  acting  simply  as  astringents,  they  become  irritants. 
In  the  denuded  skin  they  excite  inflammation,  and,  taken  into  the  stom- 
ach, cause  gastric  and  intestinal  pains,  nausea,  vomiting,  and  some- 
times diarrhoea;  their  astringent  influence  being  either  prevented  or 
overwhelmed  by  the  irritation. 

As  already  stated,  some  of  them,  in  very  great  excess,  overcome  the 
vital  resistance  of  the  tissue  to  their  chemical  affinity  for  one  or  more  of 
its  constituents;  and  disorganization,  with  the  death  of  the  part,  ensues. 
It  is  said  that,  under  such  circumstances,  putrefaction  does  not  readily 
take  place,  being  prevented  in  part  by  the  previous  expulsion  of  the 
liquids,  but  probably  in  chief  by  a  direct  preservative  or  antiseptic  effect, 
arising  from  the  union  of  the  astringent  with  the  animal  principles. 

3.  INDICATIONS,  AND  THERAPEUTIC  APPLICATIONS. 

The  indications  for  the  use  of  astringents  are  such  as  might  be  inferred 
from  their  physiological  effects.  They  are  three  in  number;  1.  to  check 
morbid  discharges,  2.  to  obviate  morbid  relaxation,  and  3.  to  check 
inflammation  in  its  earliest  stage.  For  the  first  two  purposes  they  may 
be  used  either  generally  or  locally;  for  the  third,  they  must  In-  applied 
directly  to  the  seat  of  the  inflammation.  It  will  be  most  convenient  to 
treat  first  of  their  internal,  and  afterwards  of  their  external  use;  including 
under  the  former  head  only  what  has  reference  to  their  entrance  into  the 
stomach,  under  the  latter  all  their  direct  local  applications  from  without. 


CHAP.  I.]  ASTRINGENTS.  101 

It  must  not,  however,  be  forgotten  that,  in  their  operation  upon  the  mu- 
cous membrane  of  the  alimentary  canal  when  taken  into  the  stomach, 
they  act  as  directly  as  upon  the  external  surfaces;  the  only  difference 
being  that  they  cannot  be  applied  so  freely  to  the  former,  in  consequence 
of  its  greater  sensitiveness,  the  greater  danger  of  any  excess  of  action, 
and  the  impossibility  of  limiting  the  extent  of  their  application,  or  readily 
removing  them  if  found  to  be  injurious. 

a.  Internal  Use  of  Astringents. 

1.  To  Check  Morbid  Discharges.  In  fulfilling  this  indication,  astrin- 
gents act  by  contracting  the  pores  in  the  blood-vessels  through  which 
the  discharge  takes  place.  Two  distinct  kinds  of  morbid  discharges  are 
affected  by  them;  the  one  consisting  in  excessive  or  deranged  secre- 
tion or  exhalation,  the  second  in  hemorrhage.  In  reference  to  their 
influence  in  checking  the  latter,  the  astringents  are  denominated  styptics. 
In  both,  some  cautions  are  required  in  their  use. 

When  the  discharge  depends  upon  some  local  or  general  disorder 
which  it  is  intended  to  relieve,  as  plethora,  active  congestion,  inflamma- 
tion, or  the  presence  of  noxious  matters  in  the  blood,  the  astringents 
are  as  a  general  rule  contraindicated;  and  the  same  remark  applies  to 
what  have  been  denominated  critical  discharges;  though,  strictly  speak- 
ing, these  belong  in  fact  to  one  of  the  preceding  categories.  As  the 
astringents  operate  in  general  by  merely  closing  the  avenues  by  which 
the  fluid  escapes,  and  have  no  effect  in  removing  the  disorder  which  the 
discharge  is  intended  to  relieve,  it  is  obvious  that  they  may,  under  these 
circumstances,  do  much  mischief.  If  they  check  the  discharge,  they  may 
increase  the  real  pathological  condition;  if  they  fail,  their  own  irritative 
effect  is  superadded  to  that  previously  existing. 

Again,  a  discharge,  though  originally  morbid,  may  have  become  hab- 
itual ;  and  the  processes  of  digestion  and  sanguification  having  taken  on 
increased  activity,  the  system  may  have  accommodated  itself  to  the 
drain.  Astringents  in  such  cases  might  disturb  this  balance,  and  give 
rise  to  dangerous  local  congestion,  or  general  plethora.  If  resorted  to, 
therefore,  they  should  be  applied  cautiously  and  gradually,  so  as  to  per- 
mit the  system  to  accommodate  itself  to  the  change ;  or  the  apprehended 
evil  should  be  counteracted  by  other  measures,  as  by  cathartics,  issues 
or  setons,  a  regulated  diet,  and  increased  exercise,  which  may  have  the 
effect  of  consuming  the  excess  of  blood. 

Astringents  are  applicable  when  the  discharge  is  purely  local,  and 
dependent  on  no  coexisting  disease ;  as,  for  example,  in  the  hemorrhage 
consequent  upon  an  accidental  rupture  of  a  blood-vessel,  either  from 
direct  violence,  or  from  a  sudden  and  temporary  congestion  produced 
by  straining,  position,  etc. 

They  are  also  applicable  when  the  affection  depends  upon  debility  or 


102  GENERAL    STIMULANTS.  [PART  II. 

rrhixation  of  the  coats  of  the  blood-vosscls.  either  original,  or  consequent 
upon  previous  excessive  excitement,  which  has  quite  disappeared.  This 
is  a  very  common  condition  in  the  advanced  stages  of  inflammation; 
and  it  is,  perhaps,  under  such  circumstances  that  astringents  are  upon 
the  whole  most  useful. 

Another  condition  which  sometimes  imperiously  calls  for  them,  even 
under  otherwise  opposing  indications,  is  when  the  discharge  is  so  copious 
as  itself  to  become  the  main  source  of  danger.  Thus,  a  hemorrhage- 
from  the  rectum,  intended  as  a  relief  to  serious  plethora  or  portal  con- 
gestion, may  be  so  frequent  or  abundant  as  to  put  life  at  risk:  and,  in 
this  case,  should  be  arrested  without  hesitation.  It  is  not  unfrequently 
necessary  to  choose  between  such  opposite  indications;  and  the  prudent 
practitioner  will  always  prefer  what  may  seem  to  him  the  least  of  the 
two  evils. 

The  position,  moreover,  of  the  discharge  may  sometimes  be  such  as 
to  render  this  the  greatest  danger;  as  in  a  case  of  haemoptysis  which 
threatens  to  overwhelm  the  lungs.  Here  astringents  may  be  employed, 
though  the  hemorrhage  might  have  been  the  result  of  a  congestion, 
and  may  have  a  tendency  to  relieve  it.  In  such  cases,  however,  tin- 
use  of  the  styptics  should  be  accompanied  with  measures,  calculated, 
in  a  safer  way,  to  accomplish  the  end  for  which  the  hemorrhage  was 
intended. 

1'inally,  there  are  certain  individuals  of  this  class  which,  with  their 
astringent  property,  unite  others  calculated  to  relieve  the  affection  in 
which  the  discharge  originated,  and  against  which,  therefore,  the  contra- 
indication above  mentioned  has  less  force  than  against  thejinembers  of 
the  class  generally.  Thus,  acetate  of  lead,  while  powerfully  astringent. 
is  also  antiphlogistic,  and  may  sometimes  be  advantageously  employed 
to  arrest  morbid  secretion  from  inflamed  surfaces,  when  others  would 
prove  only  injurious. 

It  is  unnecessary  to  detail  minutely  all  the  diseases  in  which  astrin- 
gents may  be  useful,  and  the  circumstances  in  each,  which  modify  the 
indication  for  their  employment  Guided  by  the  above  principles,  the 
practitioner  will  judge  for  himself  when  the  occasion  may  be  offered. 
It  will  be  sufficient,  for  the  sake  of  illustration,  to  trace  a  single  disease 
through  its  various  therapeutical  relations  with  astringents,  in  conformity 
with  the  foregoing  rules,  and  afterwards  simply  to  enumerate  the  other 
diseases  in  which  they  may  be  required,  to  meet  the  indication  now  in 
view. 

Diarrhoea  is  one  of  the  complaints  in  which  astringents  are  most  fre- 
•luently  employed.  But  this  affection  often  depends  on  inflammation  of 
the  bowels,  or  congestion  of  the  liver  and  whole  portal  circulation,  which 
it  has  the  purpose  and  effect  of  relieving.  Astringents,  if  they  succeed 
in  checking  the  increased  secretion,  which  is  at  once  the  agent  of  relief, 
and  the  cause  of  the  diarrhoea,  will  act  injuriously  on  the  inflammation 


CHAP.  I.]  ASTRINGENTS.  103 

or  congestion;  if  they  fail,  they  will  add  their  own  irritation  to  that  pre- 
existing. They  are,  therefore,  as  a  general  rule,  improper  under  such 
circumstances.  In  certain  kidney  affections,  urea  accumulates  in  the 
blood,  and  sometimes  seeks  an  outlet  through  the  bowels,  producing 
diarrhoea,  which  thus  protects  the  system,  in  some  measure,  against  the 
fatal  influence  of  that  agent  upon  the  brain.  Diarrhoea  is  sometimes 
critical ;  that  is,  occurs  at  the  termination  of  certain  diseases,  such  as 
-idiopathic  fever,  and  is  probably  one  of  the  processes  by  which  the  sys- 
tem relieves  itself  of  its  morbid  condition.  In  either  of  these  cases, 
astringents  might  do  serious  injury.  Lastly,  the  diarrhoea  may  have 
existed  so  long  that  the  system  has  accommodated  itself  to  the  increased 
discharge,  the  sudden  checking  of  which  might  occasion  dangerous  con- 
gestion of  the  liver,  lungs,  or  brain,  or  perhaps  dropsical  effusion.  Here, 
though  astringents  may  not  be  altogether  contraindicated,  they  should 
be  used  with  caution,  so  as  gradually  to  bring  about  the  cure  of  the 
complaint;  while,  in  the  mean  time,  measures  may  be  taken  to  obviate 
any  threatened  injurjfc 

There  is  reason  to  believe  that  diarrhoea  sometimes  results  from  a 
pure  relaxation  of  the  mucous  membrane  of  the  bowels,  permitting  the 
liquid  parts  of  the  blood  to  pass  through  the  walls  of  the  capillaries, 
almost  as  through  dead  membrane.  Very  frequently  inflammation  of 
the  mucous  coat  ends  in  such  a  state  of  debility  or  relaxation.  The  ves- 
sels, dilated  in  the  active  stage  of  the  disease,  with  pores  also  probably 
enlarged  so  as  to  admit  the  passage  of  the  liquor  sanguinis,  retain  this 
condition  upon  the  cessation  of  the  excitement;  and  the  extravasation 
and  consequent  diarrhoea  continue  long  after  the  occasion  for  them  has 
ceased.  .It  is  under  such  circumstances  that  astringents  prove  most 
useful  in  this  affection. 

Another  very  frequent  occasion  for  their  use  in  diarrhoea  is  when  the 
discharge,  no  matter  what  may  have  been  its  origin,  is  so  profuse  as  to 
endanger  the  safety  of  the  patient.  Such  is  the  case  in  epidemic  cholera; 
and  I  have  repeatedly  known  patients  in  danger  of  their  life  from  copi- 
ous white  alvine  evacuations,  dependent  on  portal  congestion  from  inert- 
ness of  the  capillaries  of  the  liver.  Here  astringents  are  sometimes 
indispensable. 

In  cases  of  diarrhoea  connected  with  vascular  irritation  of  the  mucous 
membrane,  perhaps  with  some  degree  of  acute  inflammation,  and  very 
often  in  chronic  inflammation,  it  may  be  proper,  even  though  the  dis- 
charge may  not  be  immediately  dangerous  by  its  quantity,  to  employ 
astringent  medicines,  having  along  with  their  astringency  a  sedative  or 
alterative  property,  which  renders  them  useful  in  the  treatment  of  the 
irritation  or  inflammation  itself;  and,  when  a  very  exhausting  discharge, 
originating  in  such  causes,  imperiously  demands  the  employment  of 
astringents,  it  is  to  this  set  of  them  that  we  should  preferably  have  re- 


104  OENKRAL   STIMULANTS.  [PART  II. 

course.  Acetate  of  lead  is  indicated  in  the  more  acute  of  these  cases, 
and  sulphate  of  zinc,  sulphate  of  copper,  or  alum  in  the  more  chronic; 
the  first  from  its  sedative,  the  three  latter  from  their  alterative  action 
upon  inflamed  surfaces. 

Dysentery  is  another  complaint  in  which  astringents  are  frequently 
recommended  by  writers.  But  a  cautious  discrimination  is  here  neces- 
-ai-y,  in  order  to  avoid  the  most  serious  consequences;  and,  in  ordinary 
acute  dysentery,  in  the  earlier  stages,  it  is  I  think  best  to  avoid  entirely 
their  internal  use,  -even  that  of  acetate  of  load,  which  has  been  com- 
mended by  some.  In  the  advanced  stages,  when  the  discharges  have 
become  more  copious,  the  grade  of  the  inflammatory  excitement  greatly 
reduced,  and  the  patient's  strength  exhausted,  they  may  sometimes  be 
employed  with  benefit;  though,  even  under  such  circumstances,  caution 
should  always  be  observed.  In  the  chronic  form  of  the  disease  they  are  not 
unfrequently  useful,  particularly  in  warm  climates,  where  there  is  greater 
laxity  of  system,  and  especially  of  the  bowels,  demanding  the  use  of 
this  class  of  remedies.  The  metallic  alterative  astringents  are  most  effi- 
cacious in  these  cases,  though  the  vegetable  are  also  not  unfrequently 
tjmployed. 

Other  morbid  secretory  affections,  in  which  the  internal  use  of  astrin- 
gents is  called  for,  are  diuresis  or  excessive  secretion  of  urine,  profuse 
and  exhausting  sweats,  catarrh  of  the  bladder,  excessive  bronchial 
accretion,  and  sometimes  possibly  dropsical  effusion  dependent  on  re- 
laxation of  the  tissues.  In  these  complaints  they  are  less  obviously 
efficacious  than  in  those  of  the  bowels ;  because,  in  the  latter,  they  are 
brought  directly  into  contact  with  the  diseased  tissue,  while,  in  t In- 
former, they  must  reach  it  through  the  medium  of  absorption.  A  rule 
in  these  cases  is  to  select  the  particular  astringent  which  experience  ha> 
shown  most  readily  to  reach  the  seat  of  the  discharge.  Thus,  uva  ursi 
and  chimaphila  are  especially  useful  in  the  affections  of  the  uriirary  pas- 
sages, from  their  well-known  quality  of  impregnating  the  urine. 

Hemorrhages  often  demand  the  use  of  astringents;  and  the  general 
rules  before  given  hold,  in  relation  to  this  set  of  discharges,  as  well  as 
t<>  morbid  secretions  and  exhalations.  When  active,  and  connected  with 
plethora  or  local  vascular  irritation,  unless  alarming  by  their  quantity, 
or  injurious  by  their  position,  they  should  be  treated  hesitatingly  with 
astringents ;  and,  should  this  class  of  remedies  be  indispensable,  t  host- 
should  be  selected  which  are  sedative  as  well  as  styptic,  such  as  cold, 
and  the  preparations  of  lead.  After  the  relief  of  the  plethora  or  con- 
gestion, and  a  sufficient  reduction  of  the  active  character  of  the  hemor- 
rhage, either  by  depletory  nie;i<ures,  or  in  the  course  of  the  complaint, 
astringents  may  be  employed  without  hesitation,  and  without  any  special 
reference  to  their  antiphlogistic  properties.  In  jjassive  hemorrhages  no 
particular  caution  is  requisite;  the  free  use  of  astringents  being  almost 


CHAP.  I.]  ASTRINGENTS.  105 

always  indicated  in  these.  Besides  the  mere  property  of  closing  the 
bleeding  orifices,  it  is  probable  that  many  of  the  astringents  exercise 
another  power  in  arresting  hemorrhage;  that,  namely,  of  increasing  tho 
coagulability  and  plasticity  of  the  blood. 

2.  To  Obviate  Morbid  Relaxation.     In  most  instances  morbid  relaxa- 
tion is  attended  with  morbid  discharge,  and  the  two  indications  are 
answered  at  the  same  time.     But  occasionally  there  is  an  unhealthy 
laxity  of  the  non-secreting  tissues;    and  even  the  secreting  may  be 
affected  in  the  same  way  without  increased  extravasation.     In  scrofu- 
lous diseases,  and  other  cachectic  affections  dependent  on  defective  or 
depraved  nutrition,  this  condition  is  not  uncommon;    and  astringents 
have  accordingly  been  much  and  advantageously  used  in  their  treatment. 
In  the  convalescence  from  febrile  and  other  acute  diseases,  especially 
when  somewhat  protracted,  the  same  condition  not  unfrequently  exists, 
•Milling  for  the  same  remedies.     It  is  probable  that  sulphuric  acid  and 
the  ehalybeates,  so  much  employed  under  these  circumstances,  may  prove 
useful  as  well  by  their  astringent  as  their  tonic  virtues.     In  chronic 
inflammation  of  the  mucous  membrane  of  the  stomach  and  bowels,  when 
all  acuteness  is  passed,  and  the  blood-vessels  are  merely  passively  dis- 
tended, or  ulcerations  exist,  which,  in  consequence  of  the  laxity  and 
feebleness  of  the  tissue,  are  unable  to  take  on  the  healing  process,  there 
would  appear  to  be  an  indication  for  astringency;  and  the  fact  is,  that, 
among  the  most  efficient  remedies  in  such  affections,  are  some  of  the 
mineral  substances  belonging  to  this  class,  as  sulphate  of  iron  and  sul- 
phate of  copper. 

3.  To  Check:  Inflammation.    The  indication  for  astringents  in  the  early 
stage  of  inflammation,  founded  on  their  property  of  contracting  the  ves- 
sels, and  thus  excluding,  in  some  measure,  the  blood  necessary  for  the 
support  of  the  inflammatory  process,  can  seldom  be  fulfilled  by  their  in- 
ternal use.     To  answer  this  purpose,  they  must  be  brought  to  act  upon 
the  inflamed  vessels  in  a  more  concentrated  state  than  would  be  safe,  or 
indeed  possible,  in  the  blood,  through  the  medium  of  absorption;  and 
they  would  consequently  be  wholly  inapplicable  to  any  inflammatory 
affection,  the  seat  of  which  could  be  reached  only  through  the  circula- 
tion.    Even  in  inflammations  of  the  alimentary  canal,  there  would  be 
too  much  risk  that,  if  used  largely  enough  to  have  any  powerful  effect, 
they  might  act  more  disadvantageously  as  irritants  to  the  sound  parts, 
than  usefully  as  astringents  upon  those  inflamed,  as  it  would  be  impos- 
sible to  limit  their  application  to  the  latter;  and,  besides,  there  is  always 
difficulty  in  deciding,  whether  the  inflammation  has  not  passed  the  point 
at  which  any  good  could  be  expected  from  them.    Hence,  the  astringents 
can  seldom  be  used  internally,  with  the  view  of  rendering  commencing 
inflammation  abortive;  and  it  is  only  externally  or  topically,  that,  as  a 
general  rule,  they  can  Vo  beneficially  applied  upon  this  principle. 


106  GENERAL   STIMULANTS.  [PART  II. 

b.  External  Use  of  Astringents. 

The  same  indications  exist  for  the  external  or  topical  as  for  the  internal 
use  of  astringents ;  and  they  are  even  more  effectual  by  the  former  method 
than  the  latter. 

1.  J<'»r  arresting  morbid  discharges  they  are  employed  in  excessive 
secretion,  resulting  from  advanced  or  chronic  inflammation,  or  debility 
of  the  vessels,  in  the  nostrils,  conjunctiva,  external  auditory  meatus, 
mouth  and  fauces,  urethra  and  bladder,  vagina  and  rectum.     Hence 
their  use  in  chronic  coryza  and  ozaena,  purulent  ophthalmia,  olirrhcea, 
slomaiorrhcea,  gonorrhoea  and  gleet,  cystirrhcea,  leucorrhcea,  and  mu- 
cous or  purulent  rectal  discharges.    Excessive  sweating,  and  osdema  of 
the  limbs,  may  also  be  treated  by  them  with  advantage.     They  are  the 
most  effective  remedies  in  hemorrhages  from  all  these  sources.     The 
same  caution  should  be  observed,  as  in  their  internal  use,  not  too  hastily 
to  arrest  a  discharge  which  is  effecting  some  useful  purpose.     But  they 
may  sometimes  be  employed  with  propriety  topically,  where  we  might 
hesitate  to  administer  them  by  the  mouth,  and  almost  always  with  much 
greater  freedom.     Any  irritation  they  may  excite  in  external  parts  is 
much  less  hazardous  than  an  equal  amount  in  the  stomach  or  bowels. 
Besides,  we  can  in  this  topical  method  precisely  limit  their  application, 
if  deemed  advisable,  and,  should  they  act  too  powerfully,  may  remove 
them.    They  may,  moreover,  be  used  much  more  effectively  than  by  the 
stomach,  because  in  a  more  concentrated  state. 

2.  For  obviating  relaxation,  not  essentially  connected  with  excessive 
discharge,  they  are  employed  in  a  great  variety  of  affections,  as  in  the 
different  forms  of  venous  distension,  including  varicocele,  hemorrhoids, 
and  varicose  veins  of  the  legs;  in  prolapsed  anus,  uvula,  and  uterus;  in 
indolent,  flabby,  mud  fungous  ulcers;  and  in  various  other  conditions  of 
local  debility,  attending  or  following  advanced  and  chronic  inflammation 
of  the  different  surfaces  mentioned  in  the  preceding  paragraph,  and  addi- 
tionally in  that  of  the  larynx. 

3.  In  the  forming  or  early  stage  of  inflammation,  wTith  the  view  of 
contracting  the  capillaries,  the  astringents  are  much  and  most  usefully 
employed.    When,  however,  that  process  is  in  full  vigour,  and  sustained 
by  a  plethoric  state  of  the  blood,  or  some  cause  acting  strongly  through 
the  constitution;  when,  too,  exudation  has  taken  place  in  the  tissue,  and 
blood  may  have  coagulated  in  some  of  tin;  vessels,  astringents  will  often 
fail  to  produce   ilu-ir  characteristic  effect,  and  may  even  increase  the 
inflaiiiimitioii  l.\  acting  as  irritants.    But,  even  under  such  circumstances, 
after  the  activity  of  the  inflammation  has  been  subdued  by  depletion, 
they  may  again  be  resorted  to,  and  will  now  not  unfrequently  succeed 
when-  they  hud  before  failed.      Hence,  astringents  are  used  locally  in 
inflammation  of  the  conjunctiva,  of  the  mout/i  and  fauces,  of  the  rec- 


CHAP.  I.]  ASTRINGENTS.  107 

turn,  of  Hie  mucous  membrane  of  the  genitourinary  passages,  and  of  the 
skin.  It  is  upon  this  principle,  in  part,  that  they  operate  so  usefully  in 
various  cutaneous  eruptions.  But,  in  the  choice  of  astringents  for  these 
purposes,  there  is  great  occasion  for  the  exercise  of  judgment.  From 
their  diversified  powers,  some  are  applicable  where  others  might  prove 
injurious.  It  is  obvious  that  those  which  possess  other  antiphlogistic 
powers,  besides  astringency,  must  be  more  efficient  in  answering  the 
indication  than  the  pure  astringents.  Hence,  the  mineral  are  generally 
more  efficacious  than  the  vegetable  substances  belonging  to  the  class. 

4.  DIVISION  OP  THE  ASTRINGENTS. 

There  is  sufficient  ground  for  arranging  astringent  medicines  in  two 
sections,  one  including  the  vegetable,  and  the  other  those  of  mineral 
origin. 

1.  The  vegetable  astringents  arc  distinguished  by  a  striking  similarity 
of  properties,  which  has  been  ascertained  to  depend  on  the  presence  of 
a  peculiar  proximate  principle,  or  set  of  principles,  denominated  tannin 
or  tannic  acid.  Though  this,  as  found  in  different  products,  has  been 
ascertained  to  differ  somewhat  in  chemical  character,  yet,  both  in  this 
respect,  and  in  its  sensible  and  therapeutical  properties,  it  is  so  nearly 
identical  that,  in  relation  to  its  medical  uses,  it  maybe  considered  as  one 
substance.  It  is  undoubtedly  the  main  astringent  principle.  This  rank 
was  at  one  time  claimed  for  gallic  acid,  which  is  associated  with  tannic 
acid  in  certain  astringents ;  and  there  are  some  who  seem  disposed  to 
revive  this  claim;  but  it  is  quite  sufficient  simply  to  taste  the  two  prin- 
ciples, to  be  convinced  that  gallic  acid  is  incomparably  inferior  in  styptic 
power,  and  that  little  of  the  effects  produced  by  astringent  vegetables 
can  be  justly  ascribed  to  it.  The  fact  would  seem  to  be,  that  it  is  more 
readily  absorbed  than  tannic  acid,  probably  because  it  does  not  like  this 
form  insoluble  compounds  with  albumen  and  gelatin;  and  its  constitu- 
tional effect  is  probably  greater  in  proportion  to  its  local  than  is  the  case 
with  the  more  astringent  substance;  but,  when  it  is  understood  that  the 
vegetable  astringents  which  have  been  most  used  internally,  and  in 
favour  of  which  experience  has  spoken  most  decidedly,  contain  no  gallic 
acid,  as  kino,  catechu,  and  extract  of  rhatany,  its  claim  to  be  considered 
the  prominent  astringent  principle  must  be  admitted  to  be  extremely 
feeble.  Tannic  acid  seems  to  be  purely  astringent,  and  destitute  of  any 
other  physiological  property.  The  vegetables,  therefore,  which  contain 
little  or  none  of  any  other  active  principle  than  this,  may  be  looked  on 
as  proper  representatives  of  the  class.  But  these  are  very  few.  Most 
of  the  vegetable  astringents  contain  also  a  bitter  principle,  which  some- 
what modifies  the  influence  of  their  tannic  acid,  and  might  entitle  them 
to  rank  with  the  tonics,  which  they  considerably  resemble  in  their  effects. 
But,  so  far  as  their  mere  astringency  is  concerned,  they  are  essentially 


108  GENERAL    STIMULANTS.  [PART  II. 

different  from  that  class  of  medicines;  resembling  them  only  in  this  sin- 
gle point,  that,  in  ra.-es  of  debility  connected  with  deficient  vital  cohe- 
•foo  of  the  tissues,  they  increase  strength  by  restoring  to  the  tissues  the 
compactness  necessary  for  the  proper  exercise  of  their  functions.  It  is 
obvious  that  the  bitter  astringents  are  less  applicable-  than  tannic  acid 
itself,  or  the  pure  astringents,  to  those  cases  in  which  it  is  desirable  to 
stimulate,  whether  locally  or  generally,  as  little  as  possible. 

2.  The,  mineral  astringents  have  in  general  nothing  in  common  but 
their  astringency.  Each  has  peculiar  properties  of  its  own,  which  render 
it  applicable  to  pecuMar  purposes.  Thus,  the  preparations  of  lead  are 
sedative,  alum  has  an'  alterative  influence,  sulphuric  acid  is  refrigerant 
and  tonic,  and  the  preparations  of  iron  have  remarkable  tonic  powers, 
and  a  peculiar  power  of  modifying  the  blood.  Between  the  sulphates  of 
zinc  and  of  copper,  however,  there  is  a  remarkable  coincidence  of  prop- 
erties, though  the  latter  is  vastly  more  powerful  than  the  former. 


COLD,  AS  AN  ASTRINGENT. 

Cold  is  primarily  sedative,  and  secondarily  stimulant  through  reac- 
tion. Its  astringent  influence,  in  relation  to  which  alone  it  is  here  con- 
sidered, is  merely  incidental  to  the  sedative.  The  effects  are  essentially 
the  same  as  those  already  described  as  the  result  of  the  action  of  astrin- 
gents generally,  and  need  not  be  repeated.  The  cittis  anserina,  or 
goose-flesh,  in  which  the  roughness  is  owing  to  the  shrinking  of  the 
skin  around  the  prominent  sebaceous  and  hair  follicles,  is  even  more  strik- 
ing than  the  similar  effect  from  other  astringents.  There  is  also  from 
cold  a  greater  degree  of  stiffness  or  firmness  in  the  contracting  tissue. 

1.  Mode  of  Operation.  The  astringent  effect  of  cold  is  partly  physi- 
cal, and  partly  vital.  It  is  a  general  law  of  heat,  that  bodies  expand 
with  its  increase  and  contract  with  its  diminution  ;  and  the  contraction 
produced  in  living  structure  by  cold  is  in  some  measure  undoubtedly 
the  result  of  this  law.  The  peculiar  density  and  stiffness  of  tissue  may 
be  ascribed,  in  part,  to  the  solidification  by  cold  of  the  oil  globules  of 
the  adipose  matter.  But  I  am  disposed  to  ascribe  the  diminution  of  bulk 
still  more  to  the  sedative  influence  of  the  cold  upon  the  vital  forces  of 
the  part,  and  the  consequent  inability  of  the  capillaries  to  receive  and 
carry  forward  the  blood.  According  to  this  view,  it  is  rather  the  part 
which  shrinks,  because  the  blood  does  not  enter  it  in  normal  proportion, 
than  the  blood  that  is  expelled,  because  the  capillaries  are  contracted; 
though  the  two  causes  probably  co-operate.  It  is  not  impossible  that  a 
diminution  of  heat  may,  in  some  unexplained  manner,  act  as  a  stimulant 
to  the  organic  contractility,  exactly  in  the  same  mode  as  the  medicinal 
ingents;  but  the  former  explanation  is  more  accordant  with  the  re- 


CHAP.  I.]  COLD,  AS    AN   ASTRINGENT.  100 

ccived  views  of  the  sedative  influence  of  cold,  which  would  seem  to  be 
a  necessary  corollary  to  the  stimulant  action  of  heat.  There  can  be  no 
doubt  that  the  astringent  influence  of  cold  is  transmitted,  through  nervous 
communication,  from  the  external  surface  where  it  is  applied,  to  certain 
internal  surfaces,  especially  those  of  the  respiratory  and  alimentary  mu- 
cous membranes,  and  the  lining  tissue  of  the  uterus. 

The  progress  of  physiology,  since  the  publication  of  the  firs^flition 
of  this  work,  enables  us  to  advance  one  step  further  in  explaining  the 
contraction  produced  by  cold,  though,  it  must  be  confessed,  still  some- 
what conjectural]/.  It  has  been  determined  that  one  of  the  offices  of 
the  cerebral  nerve-centres  is  to  promote  active  capillary  expansion,  while 
the  ganglionic  system  has  a  directly  contrary  effect.  Now  it  is  not  im- 
probable that  the  depressing  influence  of  cold,  transmitted  by  direct 
nervous  connection  to  the  cerebral  centres,  may  diminish  this  expansive 
action  of  the  former,  while  the  shock  it  produces  on  the  point  of  appli- 
cation may  prove  excitant  to  the  latter,  and  thereby  produce  contraction 
in  the  capillaries ;  the  two  influences,  though  so  different  in  their  nature, 
thus  co-operating  to  the  same  result. 

2.  Therapeutic  Effects.  The  therapeutic  effects  of  cold  as  an  astrin- 
gent are,  for  the  most  part,  the  same  as  those  of  the  class  in  general.  It 
is,  however,  seldom  resorted  to  with  the  view  of  checking  morbid  secre- 
tion. Sometimes  it  is  used  to  moderate  or  arrest  excessive  sweating, 
but  cautiously,  and  with  much  reserve.  By  far  the  most  extensive  and 
useful  application  of  this  agency  of  cold  is  to  the  suppression  of  hemor- 
rhage. In  this  it  exhibits  extraordinary  powers.  The  effect  is  generally 
ascribed  to  the  closure  of  the  bleeding  orifices,  and  no  doubt  correctly  in 
part;  but  I  am  inclined  to  think  that  still  more  is  due  to  the  depression 
of  the  local  circulating  forces  through  the  sedative  influence  of  the  cold. 
The  styptic  effects  of  the  remedy  have  also  been  attributed,  in  some 
measure,  to  an  increased  coagulability  of  the  blood  ;  but  this  is  probably 
a  mistake ;  as  cold  retards  rather  than  hastens  coagulation,  and  for  a 
very  good  reason;  for,  otherwise,  exposure  to  a  very  low  temperature 
might  endanger  coagulation  of  the  blood,  and  consequent  inevitable  gan- 
grene, in  the  most  exposed  parts.  Blood  may  even  be  frozen  without 
coagulating,  and,  upon  thawing,  may  still  retain  the  property.  Hence, 
frozen  parts  may  by  proper  management  often  be  restored,  which  could 
not  happen  if  the  blood  had  all  coagulated  in  the  vessels.  Almost  all 
forms  of  hemorrhage  may  be  treated  advantageously  by  cold,  unless  the 
vital  forces  have  been  so  much  prostrated  as  to  be  able  to  bear  no  further 
reduction. 

This  remedy  is  less  applicable,  than  other  astringent  measures,  to  the 
treatment  of  simple  relaxation ;  at  least  in  reference  to  its  direct  and 
primary  action.  It  may,  however,  sometimes  be  advantageously  used 
in  varicocele,  and  in  hemorrhoidal  and  aneurismal  tumours.  It  has  been 


HO  GENERAL    STIMULANTS.  [PART  II. 

employed  also  to  aid  in  the  reduction  of  strangulated  hernia,  in  which  it 
is  supposed  to  be  useful  by  diminishing  the  bulk  of  the  contents  of  the 
sac,  in  greater  degree  than  it  contracts  the  hernial  orifice,  so  as  to  favour 
the  return  of  the  former  through  the  latter;  but  this  is  scarcely  an  ex- 
ample of  the  mode  of  operation  here  referred  to. 

Fo^ulfilling  the  third  indication  for  the  use  of  astringents,  that, 
nam^Pf  of  obviating  early  inflammation  by  emptying  the  vessels,  cold 
is  an  admirable  remedy;  but  it  is  still  more  useful  in  that,  affection  as  a 
sedative,  and  will  be  fully  treated  of,  in  relation  to  its  antiphlogistic 
action,  under  the  head  of  sedative  remedies. 

3.  Modes  of  Application.  Cold  as  an  astringent  may  be  applied  by 
means  of  cold  air,  cold  water,  ice  or  snow,  evaporating  liquids,  and  frig- 
orific  mixtures.  Cold  water  may  be  applied  upon  linen  rags  or  towels, 
by  means  of  the  douche,  or  by  affusion,  and  may  vary  in  temperature 
from  32°  to  00°,  according  to  the  amount  of  effect  desired,  fee  and 
snow  maybe  applied  in  bladders,  or  wrapped  up  in  cloths:  and  the 
former  may  be  used  in  larger  or  smaller  fragments,  or  finely  pounded. 
Ether  is  the  liquid  most  frequently  employed  with  a  view  to  the  produc- 
tion of  cold  by  evaporation;  and  its  effects  in  this  way  may  be  greatly 
increased  by  blowing  on  it,  by  means  of  a  pair  of  bellov.  8,  as  it  is 
dropped  upon  the  surface.  Brought,  in  the  state  of  spray,  by  means  of 
the  atomizer,  into  contact  with  any  part  of  the  body,  it  is  capable  of  pro- 
ducing an  intense  degree  of  cold,  so  as  to  aci  as  a  complete  local  anaes- 
thetic; but  of  this  application  of  the  liquid  more  will  be  said  hereafter. 
The  most  convenient  frigorific  mixture,  in  the  absence  of  cold  water  or 
ice,  is  made  by  mixing,  in  a  pint  of  water,  four  ounces  of  sal  ammoniac 
and  the  same  quantity  of  nitre,  which  may  be  applied  in  a  bladder. 

The  following  applications  are  made  of  cold  in  one  or  another  of  the 
above  forms.  Cold  air  is  sometimes  useful  in  arresting  traumatic  hem- 
orrhage, and  checking  profuse  perspiration.  In  the  same  kind  of 
hemorrhage,  very  cold  water  or  ice  may  sometimes  be  advanta- 
geously resorted  to,  when  the  bleeding  vessels  are  too  small  to  be 
tied,  or  not  conveniently  reached,  as  in  some  operations  about  the  rec- 
tum, vairina,  etc. 

In  t'jnutaxis  the  water  or  ice  may  be  applied  over  the  nose,  to  the  back 
of  the  neck,  to  the  genitals  in  obstinate  cases,  or  by  affusion  to  the  head. 

Tli.-  .-ame  application  may  be  made,  in  very  obstinate  haemoptysis,  to 
the  breast  or  axilla;  but  in  this  variety  of  hemorrhage  the  remedy 
should  l,e  iHed  with  caution,  from  the  danger  of  producing  congestion 
in  the  pulmonary  parenchyma. 

In  haematemesis,  the  most  effectual  method  of  employing  iliis  remedy 
i»  to  allow  the  patient  to  swallow  small  pieces  of  ice,  which,  by  dissolv- 
ing in  the  stomach,  will  keep  up  a  constant  frigorific  effect  on  the  organ. 
There  might  be  danger,  in  the  external  use  of  cold  in  this  affection,  of 


CHAP.  I.]  ASTRINGENTS. GALLS.  Ill 

producing  congestion  of  the  portal  circle,  which  might  more  than  coun- 
terbalance the  sympathetic  astringent  effect  on  the  mucous  membrane. 

In  haemaluria,  uterine  hemorrhage.,  and  bleeding  from  the,  rectum, 
the  applications  may  be  made  over  the  sacrum,  to  the  perineum,  and 
over  the  pubes;  and  the  douche,  falling  from  a  considerable  height  upon 
the  lower  part  of  the  abdomen,  is  often  more  efficient  than  the  s:inple 
contact  of  the  water  or  ice.  Very  cold  water  has  sometimes  been  in- 
jected into  the  rectum  and  vagina;  and  pieces  of  ice  have  been  intro- 
duced into  the  same  cavities,  and  even  into  the  uterus,  when  a  very 
strong  impression  was  desired. 

In  varicose  swellings  and  aneurismal  tumours,  one  or  another  of  the 
several  modes  of  application  mentioned  may  be  employed,  according  to 
the  situation  of  the  part,  or  other  circumstances  affecting  their  conve- 
nience or  efficiency.  In  strangulated  hernia,  recourse  has  been  occa- 
sionally had  to  the  evaporation  of  ether,  as  well  as  to  other  frigorific 
measures,  especially  to  pounded  ice  or  snow  in  cloths  or  bladders. 

Hut  in  all  these  cases,  especially  when  ice  or  snow  is  employed,  care 
should  be  taken  not  to  allow  so  long  a  continuance  of  the  application  as 
to  endanger  the  freezing  and  consequent  mortification  of  the  part;  and, 
when  ice  is  introduced  either  into  the  stomach  or  rectum,  to  guard  with 
special  caution  against  a  too  great  depressing  effect 


I.  GALLS. 

GALLA.  U.S.,Br. 

Origin.  Galls  are  excrescences  upon  the  young  branches  of  Quercus 
infectoria,  a  small  tree  growing  in  Asia  Minor,  Syria,  Persia,  and  other 
parts  of  central  Asia.  They  result  from  punctures  in  the  tender  shoots, 
made  by  an  insect,  which  deposits  its  egg  in  the  puncture.  They  are 
brought  from  the  Levant  and  India. 

Sensible  Properties.  Galls  are  spherical,  varying  in  bulk  from  the 
size  of  a  pea  to  that  of  a  large  cherry,  studded  with  small  tuberositics, 
but  smooth  in  the  intervals ;  of  a  dark-bluish,  greenish,  gray,  or  yellow- 
i-h-white  colour;  inodorous,  and  of  a  bitter,  very  astringent  taste. 

Varieties.  There  are  two  varieties,  one  denominated  blue,  green,  or 
black  galls,  the  other  white  galls.  The  former  are  smaller,  harder,  more 
compact,  relatively  heavier,  and  of  a  darker  colour  than  the  latter,  and, 
having  been  gathered  before  the  escape  of  the  insect  into  which  the 
deposited  egg  has  become  developed,  have  no  hole  leading  to  their 
interior.  The  white  galls  are  large,  light,  frequently  hollow  in  the 
centre,  generally  of  a  dirty  yellowish-white  colour,  with  a  round  per- 


112  GENERAL    STIMULANTS.  [PART  II. 

forating  hole  in  their  surface,  through  which  the  insect  has  escaped ; 
and  are  much  inferior  in  astringency  to  the  other  variety. 

Active.  Principles.  These  are  tannic  acid,  of  the  variety  which  forms 
bluish-black  precipitates  with  the  salts  of  the  sesquioxidc  of  iron  ;  gallic 
acid;  and  probably  a  distinct  bitter  principle.  It  is  the  tannic  acid 
upon  which  the  virtues  of  the  medicine  chiefly  depend.  Galls  impart 
their  active  properties  to  water  and  alcohol. 

Incompatibles.  A  strong  infusion  yields  precipitates  with  concen- 
trated muriatic  and  sulphuric  acids;  lime-water;  the  carbonates  of  po- 
tassa  and  ammonia;. the  soluble  salts  of  iron,  manganese,  lead,  and 
copper;  the  nitrates  of  silver  and  mercury;  tartar  emetic;  the  infusions 
of  all  vegetable  substances  which  contain  an  organic  alkali,  as  opium, 
ipecacuanha,  Peruvian  bark,  etc.,  and  of  various  other  active  vegetable 
medicines,  as  columbo  and  digitalis;  and  solutions  of  starch,  albumen, 
and  gelatin. 

Effects  on  the  System.  As  galls  contain  a  very  large  proportion  of  the 
astringent  principle,  they  are  among  the  most  powerful  medicines  be- 
longing to  the  class.  Their  effects  are  those  already  described  in  the 
general  observations  on  astringents ;  but  they  exercise  also  some  tonic 
influence,  probably  connected  with  their  bitterness. 

Therapeutic  Application.  Though  not  less  efficacious  than  other 
astringents,  in  the  diseases  in  which  simple  astringency  is  indicated, 
they  are  little  used  internally;  and  of  late  have  been  almost  entirely 
superseded  by  the  tannic  acid  extracted  from  them,  which  has  their 
astringent  virtues,  in  a  concentrated  state,  without  their  bitterness. 
They  are,  however,  occasionally  used  in  diarrhoea;  and  may  be  ad- 
vantageously employed  in  obstinate  flatulence  and  tympanites,  dependent 
upon  an  atonic  state  of  the  stomach  and  bowels.  I  have,  in  this  affec- 
tion, prescribed  with  great  apparent  benefit  an  infusion  of  galls  and 
fennel-seed,  made  in  the  proportion  of  half  an  ounce  of  the  former,  and 
two  drachms  of  the  latter,  to  a  pint  of  boiling  water,  and  given  in  the 
dose  of  a  small  wineglassful  three  times  a  day.  It  probably  acts,  in  the 
correction  of  flatulence,  in  some  degree,  by  constriuging  the  capillaries, 
and  preventing  the  evolution  of  gaseous  matter  from  the  blood. 

(Jails  have  been  recommended  as  an  antidote  to  the  vegetable  alka- 
loids, and  the  medicines  containing  them,  as  opium,  belladonna,  stra- 
monium, hyoscyamus,  conium,  and  nux  vomica,  upon  Che  supposition 
that,  the  tannates  of  these  principles  being  insoluble  in  water,  they  art- 
rendered  less  active  by  the  combination.  But  it  has  been  shown  that. 
in  respect  to  one  at  least  of  these  alkaloids,  namely  quinia,  the  tannate  is 
scarcely  if  at  all  less  efficacious  than  the  soluble  salts;  and  the  same 
i.-.  probably  true  of  all  of  them.  Galls  should  not,  therefore,  be  relied  on 
as  an  antidote  in  any  case  of  poisoning  with  these  organic  alkalies 
whether  isolated  or  in  their  native  state  of  combination;  and,  if  ex- 


CHAP.  I.]  ASTRINGENTS. — GALLS.  113 

hibited  at  all,  should  be  used  merely  as  an  adjuvant  to  measures  cal- 
culated to  evacuate  the  poison  from  the  stomach  and  bowels.  The  same 
may  be  said  of  their  presumed  efficacy  in  cases  of  poisoning  from  tartar 
emetic;  at  least  this  antimonial  has  been  repeatedly  known  to  vomit 
actively,  when  prescribed,  in  the  ordinary  emetic  dose,  in  connection 
with  substances  containing  tannic  acid. 

Administration.  The  dose  of  powdered  galls  is  from  ten  to  twenty 
grains,  which  may  be  given  three  or  four  times  a  day.  An  infusion, 
made  in  the  proportion  of  an  ounce  to  a  pint  of  boiling  water,  may  be 
administered  as  often  in  the  dose  of  a  wineglassful. 

The  officinal  Tincture  (TINCTURA  GALL.E,  U.  S.)  is  more  used  as  a 
chemical  test  than  as  a  medicine,  but  may  be  given  in  the  dose  of  from 
one  to  three  fluidrachms.  By  time  and  exposure  the  tannic  acid  con- 
tained in  it  is  apt  to  be  converted  into  gallic  acid;  and  its  virtues, 
whether  as  a  test  or  as  a  medicine,  may  be  thus  impaired. 

A  powerfully  astringent  preparation  was  much  used,  in  obstinate 
cases  of  diarrhoea,  by  the  late  Drs.  Physick  and  Parrish,  of  this  city, 
made  by  introducing  into  a  cup  two  or  three  drachms  of  coarsely  pow- 
dered galls,  pouring  over  the  powder  three  or  four  fluidounces  of  brandy, 
putting  upon  iron  skewers  placed  near  each  other  over  the  top  of  the  cup 
several  pieces  of  loaf  sugar,  then  setting  fire  to  the  brandy,  and  allowing 
it  to  burn  until  the  alcohol  was  so  far  consumed  that  it  would  burn  no 
longer.  The  sugar  was  melted  in  the  flames,  and,  falling  into  the  liquid, 
made  a  rich  syrup,  which  was  carefully  poured  off  from  the  dregs,  and 
given  in  the  dose  of  a  fluidrachm. 

Externally  galls  are  much  and  efficaciously  employed.  In  the  form  of 
infusion,  prepared  as  above  mentioned,  the  medicine  may  be  used  as  a 
gargle  in  chronic  angina  and  relaxed  uvula,  as  an  injection  in  gleet, 
leucorrhosa,  and  prolapsus  of  the  uterus  and  rectum;  and  as  a  lotion 
in  piles  and  flabby  ulcers.  A  strong  decoction,  made  by  boiling  an 
ounce  and  a  half  of  galls,  for  fifteen  minutes,  in  half  a  pint  of  water,  and 
filtering,  has  been  strongly  recommended  in  chilblains,  with  or  without 
ulceration ;  being  applied  two  or  three  times  daily  to  the  diseased  surface. 

The  Ointment  of  Galls  (UNGUENTUM  GALL^E,  U.  /S.),  made  by  rubbing 
one  part  of  powdered  galls  with  seven  parts  of  lard,  is  an  excellent 
local  application  in  piles,  prolapsus  ani,  and  flabby  and  indolent  ulcers; 
and  may  be  rendered  still  more  efficacious,  in  the  two  former  affections, 
particularly  when  in  an  irritated  state,  if  combined  with  a  little  powdered 
opium,  as  in  the  Unguentum  Gallse  cum  Opio  of  the  British  Pharma- 
copoeia, which  contains  thirty-two  grains  to  each  avoirdupois  ounce  of 
the  simple  ointment  of  galls,  equivalent  very  nearly  to  thirty-five  grains 
to  the  troyounce. 

Two  officinal  preparations  considerably  used  are  made  from  galls, 
namely,  tannic  and  gallic  acids. 

VOL.  I. — 8 


114  GENERAL    STIMULANTS.  [PART  II. 

1.  TANNIC  ACID.— ACIDUM  TANNICUM.  U.  S.,  Br.—  Tannin  of 
Galls — Gallo-tannic  Acid. 

Origin.  This  is  the  variety  of  tannic  acid  which  precipitates  the  salts 
of  sesquioxide  of  iron  of  a  bluish-black  colour.  Besides  galls,  it  is  found 
in  different  products  of  the  oak,  and  in  other  vegetable  astringents. 
Other  varieties  of  taunic  acid  precipitate  the  salts  of  iron  of  a  greenish- 
black  or  grayish-black  colour,  and  are  apt  to  be  associated  with  a  reddish 
or  reddish-brown  colour  in  the  medicine  containing  them,  as  in  kino, 
catechu,  and  rhatany.  These  all  differ  from  that  now  under  considera- 
tion, in  not  being  convertible  into  gallic  acid,  upon  exposure  in  the  state 
of  infusion  to  the  atmospheric  air.  They  probably  differ  among  them- 
selves, and  may  be  distinguished  from  the  tannic  acid  here  referred  to, 
and  from  one  another,  by  design ative  epithets  derived  from  the  medi- 
cine. Thus,  the  variety  derived  from  kino  may  be  called  kino-tannic 
acid,  that  from  catechu,  catechu-tannic  acid,  etc.  Tannic  acid  is  ex- 
tracted from  galls  by  means  of  ether  containing  a  little  water.  The  liquid 
is  passed  through  powdered  galls,  and  after  passing  separates  into  two 
layers,  the  lower  of  which  holds  the  tannic  acid  in  solution,  and  yields  it 
on  evaporation. 

Sensible  and  Chemical  Properties,  Gallo-tannic  acid  is  solid,  spongy, 
light,  white  with  frequently  a  yellowish  or  greenish-yellow  tint,  inodorous, 
and  of  a  strongly  astringent  taste,  without  bitterness.  It  is  freely  soluble 
in  water,  less  so  in  alcohol  and  ether,  and  insoluble  in  tin;  fixed  and  vola- 
tile oils.  Its  incompatibilities  are  the  same  with  those  of  galls  (see  page 
112),  which  owe  their  chemical  relations  with  other  substances  chiefly  to 
this  principle.  Exposed  in  solution  to  the  air,  it  is  slowly  changed  into 
gallic  acid,  with  the  escape  of  carbonic  acid. 

Effects  on  the  System.  Tannic  acid,  being  the  peculiar  active  prin- 
ciple of  the  vegetable  astringents,  must  affect  the  system  in  the  same 
manner  as  these  medicines,  so  far  as  their  astringency  is  concerned,  with 
this  difference  only,  that  it  exceeds  them  all  greatly  in  power.  In  refer- 
to  topical  effect  alone,  it  is  probably  the  most  energetic  astringent 
known.  In  its  general  action,  it  is  inferior  to  some  of  the  mineral  sub- 
r-tunri-.-  belonging  to  the  class.  In  consequence  of  its  strong  affinity  for 
some;  <»f  the  proximate  constituents  of  the  tissues  and  of  the  blood,  as 
albumen,  gelatin,  and  fibrin,  with  which  it  forms  insoluble  compounds,  it 
is  probably  never  taken  unchanged  into  the  circulation.  Indeed,  it  could 
s.-areely  exist  as  tannic  acid  in  the  blood.  Experiments  with  tunnie  acid 
upon  dogs  have  shown  that,  when  it  is  given  freely  to  these  animals,  the 

urine  bee. s  darker,  and  yields  evidences,  upon  chemical  examination. 

of  the  presence  of  gallic  and  pyrogallic  acids.  Into  these  acids,  therefore, 
or  into  something  intermediate  between  them  and  itself,  the  tannic  acid 
is  probably  converted  on  enl.  ring  the  circulation.  This  presumption  is 
rendered  more  plausible  by  the  fact,  that  gallic  acid  does  not,  like  the 


CHAP.  I.]  ASTRINGENTS. — TANNIC  ACID.  115 

tannic,  form  insoluble  compounds  with  the  animal  principles  above  men- 
tioned. Now,  as  this  acid  is  far  less  astringent  than  the  tannic,  we  can 
readily  account  for  the  much  greater  power  of  the  latter  as  a  local  than 
as  a  general  astringent.  Among  its  local  effects  are  of  course  those 
which  it  produces  in  the  bowels;  for  with  the  mucous  membrane  of 
these  it  is  brought  into  as  close  contact  as  with  the  skin. 

In  moderate  doses,  tannic  acid  is  said  to  produce  warmth  in  the 
stomach,  and  somewhat  to  excite  the  appetite.  It  undoubtedly  tends  to 
diminish  the  number  and  quantity  of  the  stools.  Largely  given,  it  causes 
a  feeling  of  constriction  in  the  epigastrium,  not  unfrequently  nausea,  and 
sometimes  obstinate  constipation.  But  it  is  asserted  that  a  drachm  or 
more  may  be  given,  in  the  course  of  a  day,  not  only  with  impunity,  but 
with  advantage,  if  it  be  administered  in  the  liquid  form,  or  followed,  if  in 
the  pilular  form,  by  food  or  drink;  and,  in  these  large  doses,  it  is  said 
greatly  to  increase  the  secretion  of  urine.  (P.  Gamier,  ArchivesGenerales, 
Janv.  1859,  pp.  28-35.) 

Therapeutic  Application.  When  pure  astringcncy  is  required,  tannic 
acid  is  preferable  to  the  crude  medicines  containing  it,  from  its  compara- 
tively small  dose,  its  less  unpleasant  taste,  its  less  liability  to  offend  the 
stomach,  and  from  the  circumstance  that,  not  being  associated  with  prin- 
ciples having  a  different  action  from  its  own,  it  can  be  given  in  cases  in 
which  the  crude  medicine,  in  consequence  of  containing  such  principles, 
may  be  contraindicated. 

1.  Internally,  it  may  be  used  most  advantageously  in  affections  of  the 
stomach  and  bowels,  with  the  inner  surface  of  which  it  comes  into  direct 
contact.  In  all  cases  of  diarrhoea  and  chronic  dysentery,  demanding 
the  use  of  astringents,  especially  in  the  former  of  these  diseases,  it  is 
very  useful.  It  may  even  be  employed  in  these  affections,  in  some  in- 
stances, when  the  medicines  containing  it  could  not,  in  consequence  of 
associating  too  much  of  a  tonic  or  stimulating  property  with  their  astrin- 
gency.  In  cholera  infantum  it  may  frequently  be  associated  usefully 
with  the  other  medicines  employed.  It  is  asserted  to  have  produced 
extraordinary  effects  in  epidemic  cholera,  in  which  it  may  be  given  at 
any  stage  so  long  as  copious  evacuations  continue.  From  the  rapidity 
and  violence  of  this  disease,  it  must  be  used  more  largely  than  in  most 
other  affections;  from  five  to  ten  grains  being  required,  to  be  repeated 
every  half  hour  or  hour  until  the  discharges  are  checked.  In  hemorrhage 
from  the  stomach  and  bowels,  not  connected  with  high  vascular  irrita- 
tion or  acute  inflammation,  it  is  an  excellent  remedy.  In  hsematemesis 
it  should  be  given  preferably  in  solution,  as  it  will  thus  act  more 
promptly  and  equably  upon  the  bleeding  surface.  In  intestinal  hemor- 
rhage, on  the  contrary,  the  pilular  form  is  to  be  preferred,  because,  in 
this  state,  the  medicine  will  be  more  likely  to  pass  through  the  stomach 
unaltered,  and  thus  reach  the  seat  of  its  destined  action.  In  all  these 


116  GENERAL    STIMULANTS.  [PART  II. 

affections,  it  should  generally  be  combined  with  opium,  and  often  also 
with  ipecacuanha,  the  proportions  of  which  should  vary  to  suit  the  par- 
ticular circumstances  of  the  case.  Acetate  of  lead  is  generally  indicated 
at  the  name  time.  Should  this  and  the  tannic  acid  have  been  employed 
separately  without  success,  they  may  be  given  conjointly;  for,  though  the 
tannate  of  lead  would  be  formed,  yet  there  is  reason  to  suppose  that  this 
might  prove  more  efficacious,  in  certain  cases,  especially  in  the  intestinal 
affection,  than  either  of  the  two  medicines  alone. 

Though  less  efficacious  in  complaints  the  seat  of  which  it  cannot 
directly  reach,  tannic  acid  has  yet  been  highly  recommended,  as  an  inter- 
nal remedy,  in  various  morbid  discharges,  whether  secretory  or  hemor- 
rhagic,  proceeding  from  other  sources  than  the  alimentary  canal.  Pro- 
fuse and  exhausting  expectoration,  whether  mucous  or  purulent,  colli- 
qualive  sweats,  excessive  diuresis,  chronic  catarrh  of  I  he  bladder,  hae- 
moptysis, hxmaluria,  and  menorrhagia,  are  the  affections  of  this  kind 
in  which  it  has  been  used.  But  in  all  of  them  I  should  prefVr  the  min- 
eral astringents;  and  the  probability  is  that  gallic  acid  might  prove  little 
less  effective  than  the  tannic.  It  is  said,  given  to  the  extent  of  nine 
grains  daily,  to  have  proved  very  serviceable  in  cases  of  purulent  infec- 
tion or  pysemia,  in  which  sulphate  of  quinia  was  thought  to  have  acted 
injuriously.  (Med.  T.  and  Gaz.,  Aug.  1862,  p.  149.) 

Dr.  S.  Scott  Alison  recommends  the  acid  as  an  excellent  remedy  in 
dyspepsia,  in  which  he  states  that  it  promotes  the  appetite,  relieves  flatu- 
lence, and  not  unfrequently,  instead  of  constipating,  produces  a  healthy 
action  of  the  bowels.  It  would  probably  prove  not  less  efficacious  than 
galls,  in  obstinate  Jlalulence  and  tympanites  dependent  on  relaxation  of 
the  bowel.  It  is  asserted  to  have  been  very  successful  in  the  cure  of 
intermittents,  and  has  been  given  as  an  anthelmintic,  in  the  dose  for 
children  of  from  five  to  ten  grains.  It  has  been  strongly  recommended 
in  dropsy  with  albuminous  urine,  in  the  quantity  of  from  thirty  grains 
to  a  drachm  in  twenty-four  hours.  (Arch.  Gen.,  Janv.  1850,  p.  35.) 
Taunic  acid  has  also,  like  galls,  been  recommended  as  an  antidote  to  the 
poisonous  vegetable  alkaloids,  and  certain  metallic  salts,  especially  tartar 
emetic;  but,  for  reasons  already  mentioned,  it  should  not  be  relied  on  to 
the  exclusion  of  other  measures.  (See  pages  112-3.) 

Administration.  The  dose  is  from  two  to  ten  grains,  to  be  repeated, 
in  chronic  cases,  three  or  four  times  a  day;  in  those  requiring  a  speedy 
impression,  every  hour,  two,  or  three  hours.  The  medicine  may  lie 
given  in  pill  or  solution.  In  the  latter  form,  it  is  best  administered  in 
connection  with  syrup;  which  may  be  either  simple,  or  medicated  by  the 
addition  of  some  agreeable  flavouring  substance,  as  one  of  the  aromatic 
volatile  oils  or  tinctures.  Syrup  of  orange  peel  or  of  ginger  may  be  u-.-d 
for  the  purpose.  The  strength  of  the  solution  should  he  such,  that  from 
one  to  four  fluidrachms  may  contain  the  required  dose  of  the  medicine. 


CHAP.  I.]  ASTRINGENTS. — TANNIC   ACID.  117 

*/  2.  Externally,  tannic  acid  may  bo  used  for  all  the  purposes  for  which 
astringents  are  indicated,  and  will  be  found  among-  the  most  effective  of 
them.  It  has  been  specially  recommended  in  the  purulent  ophthalmia  of 
infants;  in  epistaxis  and  chronic  coryza ;  in  common  and  pseudomem- 
branous  angina,  prolapsed  uvula,  ulcerous  affections  of  the  mouth  and 
fauces,  excessive  salivation,  bleeding  and  spongy  gums,  bleeding  from 
the  socket  of  an  extracted  tooth,  etc.;  in  gonorrhoea,  gleet,  leucorrhosa, 
and  prolapsed  uterus ;  in  bleeding  from  the  rectum,  prolapsus  ani,  and 
hemorrhoidal  affections  generally;  and  finally,  in  flabby  and  fungous 
ulcers,  and  various  eruptive  affections.  In  these  complaints  it  may  be 
used  in  solution,  powder,  or  ointment.  For  injection  into  the  eye,  the 
nostrils,  the  urethra  or  vagina,  and  the  rectum,  and  for  gargles,  the  form 
of  solution  should  be  used,  the  medium  strength  of  which  may  be  five 
grains  to  the  fluidounce  of  water.  A  much  stronger  solution,  containing 
one  part  of  the  acid  to  three  of  water,  has  been  recommended  in  puru- 
lent ophthalmia,  and  for  ulcers  and  specks  on  the  cornea;  while  one  con- 
siderably weaker,  containing  not  more  than  a  grain  or  two  in  the  fluid- 
ounce,  to  begin  with,  may  be  used  as  a  collyrium  in  commencing  or 
retreating  inflammation  of  the  conjunctiva,  of  the  catarrhal  character. 
Indeed,  it  is  asserted  that  from  one  to  two  drachms  in  the  fluidounce  of 
water  may  be  emplo3red  in  common  acute  ophthalmia,  dropped  into  the  eye, 
not  only  without  inconvenience,  but  with  extraordinary  curative  effect 
(G.  R.  Sheraton,  Med.  T.  and  Gaz.,  Sept.  1863,  p.  272.)  A  solution  of  the 
strength  of  a  drachm  to  the  fluidounce  has  been  strongly  recommended  in 
chilblains.  Nsevi  have  been  cured  by  the  injection  into  them  of  a  solution 
of  the  same  strength.  (Hayncs  Walton,  Med.  Times  and  Gaz.,  xvi.  612.) 
As  a  local  application  tannic  acid  has  also  been  employed  dissolved  in 
glycerin,  and  has  proved  very  advantageous  in  the  hands  of  some 
practitioners.  In  the  form  of  powder,  it  has  been  used  in  epistaxis, 
being  snuffed  up  by  the  nostril,  or  blown  up  through  a  quill ;  and  as  a 
remedy  in  spongy  gums,  and  foul  old  and  bleeding  ulcers,  to  which  it 
may  be  applied  by  sprinkling  or  dusting  it  over  the  surface.  It  has  been 
thought  to  be  very  efficacious  in  chronic  inflammation  of  the  lachrymal 
sac;  being  applied,  by  means  of  a  fine  camel's-hair  pencil,  to  the  vicinity 
of  the  puncta  lachrymalia,  after  the  matter  has  been  evacuated  from  the 
sac  by  pressure. 

An  ointment  is  now  officinal  (UNGUENT LTM  ACIDI  TANNICI,  U.  £),  made 
by  rubbing  thirty  grains,  first  with  thirty  minims  of  water  into  a  paste, 
and  afterwards  with  a  troyounce  of  lard;  and  the  preparation  may  be 
weakened  by  adding  any  desirable  quantity  of  lard.  In  this  form  it 
may  be  used  in  piles,  cutaneou.-,  eruptions,  sore  nipples,  old  ulcers,  and 
chronic  inflammation  of  the  uterus  and  vagina.  In  the  form  of  lozenges 
(Tnocinsci  ACIDI  TANNICI,  Br.),  each  containing  half  a  grain  of  the 
acid,  it  may  be  employed  in  cases  of  chronic  angina  and  relaxation  of 


118  GENERAL    STIMULANTS.  [PART  II. 

the  uvula;  the  lozenge  being  held  in  the  mouth,  and  swallowed  as  it 
slowly  di.-r-i-lvi's. 

uiTcl  has  found  great  advantage,  in  cases  of  chronic  disease  of 
the  uterus,  from  the  introduction  into  the  cavity  of  the  organ  of  cylin- 
drical sticks  of  tannic  acid,  about  an  inch  long  by  two  or  three  lines  in 
diameter,  made  by  rubbing  four  parts  of  the  acid,  and  one  of  tragacanth, 
with  enough  crumbs  of  bread  to  give  them  due  plasticity.  (Ann.  de 
Therap.,  A.D.  1860,  p.  164.)  Sir  J.  Y.  Simpson,  of  Edinburgh,  also, 
among  other  medicated  pessaries,  recommends  one  of  tannic  acid, 
made  by  incorporating  ten  grains  of  the  acid  with  a  sufficient  quantity 
of  cacao  butter.  (Ed.  Med.  Journ.,  May,  1865,  p.  1042.) 

The  British  Pharmacopoeia  directs  suppositories  of  tannic  acid, 
made  by  mixing  the  acid  with  lard,  wax,  and  glycerin;  each  supposi- 
tory weighing  twenty  grains,  and  containing  two  grains  of  tannic  acid. 
A  hotter  excipient,  however,  would  be  the  cacao  butter.  The  remedy 
may  be  used  in  prolapsus  ani,  piles,  and  anal  leucorrhoea. 

Tannic  acid  in  solution  is  one  of  the  substances  which  has  been 
recently  used  in  the  form  of  spray,  by  means  of  the  atomizer.  It  has 
been  employed  in  O3dema  of  the  glottis,  laryngeal  ulcerations  and  excres- 
cences, and  in  chronic  bronchitis.  The  strength  of  the  solution  for  these 
purposes  varies  from  one  to  twenty  grains  to  the  fluidounce  of  water. 
A  stronger  solution,  containing  thirty  grains  to  the  fluidounce,  luts  been 
used  in  haemoptysis.  (Da  Costa,  N.  Y.  Med.  Journ.,  Oct.  1866,  p.  35.) 

2.  GALLIC  ACID.— ACIDUM  GALLICUM.  U.S.,  Br. 

Origin.  Gallic  acid  is  procured  from  galls,  either  through  the  gallic 
acid  fermentation  which  these  undergo  when  exposed,  in  the  state  of 
powder,  to  water  and  atmospheric  air,  or  through  the  reagency  of  sul- 
phuric acid. 

Sensible  and  Chemical  Properties.  The  acid  is  in  delicate,  silky, 
acicular  crystals,  colourless  when  quite  pure,  somewhat  brownish  as 
commonly  kept  in  the  shops,  inodorous,  of  an  acidulous  slightly  astrin- 
gent taste,  sparingly  soluble  in  cold,  but  freely  in  hot  water,  very  soluble 
in  alcohol,  and  slightly  soluble  in  ether.  It  produces  a  deep  bluish- 
black  colour  with  solutions  of  the  salts  of  sesquioxidc  of  iron,  but  has 
no  effect  on  that  of  sulphate  of  the  protoxide,  and  differs  from  tannic  acid 
in  not  causing  precipitates  with  gelatin,  albumen,  or  salts  of  the  organic 
alkalies. 

Effects  on  the  System.  In  small  doses,  gallic  acid  produces  no  sensi- 
ble; effect  when  swallowed,  and,  in  the  largest  ever  given  for  medical 
purposes,  is  said  to  occasion  only  a  feeling  of  internal  hrut.  Kxicmally 
applied,  it  produces  little  of  the  corrugating  effects  characteristic  of  the 
astringents. 

Therapeutic  Application.  This  substance  has  but  recently  been  em- 
ployed as  a  medicine.  Formerly  supposed  to  be  the  active  principle 


CIIAP.  I.]  ASTRINGENTS. — GALLIC   ACID.  119 

of  the  vegetable  astringents,  though  not  used  in  the  isolated  state,  it  lost 
this  reputation  almost  entirely  upon  the  discovery  of  the  much  greater 
astringency  of  tannic  acid;  and  it  is  only  within  a  few  years,  that  it  has 
partially  recovered  its  original  credit 

There  can  be  no  doubt  of  its  great  inferiority  to  tannic  acid  in  affec- 
tions of  the  skin,  alimentary  canal,  and  all  those  parts  with  which  the 
medicine  can  be  brought  into  direct  contact.  But,  not  having  those 
chemical  relations  which  render  the  absorption  of  tannic  acid  as  such 
impossible,  it  may  enter  the  circulation,  and  thus  reach  all  parts  of  the 
system ;  and,  as  tannic  acid  may  possibly  be  converted  into  gallic  acid 
before  being  absorbed,  and  through  this  agent  produce  all  its  general 
effects  upon  the  system  at  large,  the  inference  is  not  unreasonable,  that 
the  latter  medicine  might,  perhaps,  be  substituted  for  the  former,  with- 
out disadvantage,  in  all  cases  in  which  the  effects  are  to  be  produced 
through  admixture  with  the  blood.  We  might  go  further,  and  calculate 
upon  results  even  more  favourable  from  the  gallic  than  the  tannic  acid; 
as,  independently  of  its  more  ready  entrance  into  the  circulation,  it  is 
less  apt  to  disturb  the  stomach  and  constipate  the  bowels,  and  thus  to 
interfere  with  digestion.  Experience,  however,  upon  these  points  is  not 
yet  settled;  and,  though  gallic  acid  has  been  of  late  much  employed, 
very  different  opinions  have  been  given  of  its  powers.  These  remarks 
on  the  relative  efficiency  of  gallic  and  tannic  acids,  have  reference  only 
to  the  latter  acid  as  it  is  procured  from  galls. 

The  complaints  in  which  gallic  acid  may  be  most  advantageously  given 
are  the  hemorrhages,  and  especially  those  proceeding  from  parts  which 
are  conveniently  accessible  only  through  the  circulation,  as  haemoptysis, 
haemaluria,  and  menorrhagia  or  uterine  hemorrhage.  In  the  last-men- 
tioned affection  it  is  thought  to  have  proved  peculiarly  efficacious;  and 
in  hasmaturia  it  might  reasonably  be  expected  to  be  so,  as  it  passes  out  of 
the  system  through  the  kidneys.  In  all  these  complaints,  it  has  the 
great  advantage  of  being  quite  destitute  of  irritant  or  general  stimulant 
properties,  at  least  in  medicinal  doses,  and  it  is  not  improbable  that  it 
is  somewhat  sedative  to  the  circulation,  or  refrigerant,  like  many  other 
vegetable  acids.  The  power  has  been  claimed  for  it  of  arresting,  in 
some  degree,  the  escape  of  albumen  from  the  blood  in  cases  of  albumin- 
ous urine;  and  it  has  been  employed  with  supposed  benefit  in  simple 
diuresis,  and  in  chronic  mucous  discharges  from  the  urinary  organs. 
It  has  been  found,  moreover,  one  of  the  most  effective  remedies  in  cases 
of  chylo-serous  or  spontaneously  coagulable  urine. 

The  dose  is  from  five  to  twenty  grains  three  times  a  day.  It  may  be 
given  in  the  form  of  pill,  made  with  conserve  of  roses,  or  with  syrup  and 
powdered  gum  arabic ;  in  the  form  of  powder ;  or  in  liquid  mixture. 


120  GENERAL   STIMULANTS.  [PART  II. 


II.  OAK  BARK. 

WHITE-OAK  BARK.— QUERCUS  ALBA.  U.  S. 

BLACK-OAK  BARK.— QUERCUS  TINCTORIA.  U.  S. 

QUERCUS.      Quercus  pedunculata.  Br. 

The  bark  of  most  of  the  oaks  is  possessed  of  properties  very  nearly  iden- 
tical, so  that  one  species  may  generally  be  substituted  for  another  with- 
out great  disadvantage.  Q.  Robur  and  Q.  pedunculata,  the  latter  of  which 
is  the  common  British  oak,  arc  the  species  most  used  in  Europe ;  Q.  alba 
or  American  white-oak,  Q.  prinus  or  white  chestnut-oak,  Q.  montana  or 
rock  chestnut-oak,  Q.falcata  or  Spanish  oak,  and  other  indigenous  species, 
have  been  indifferently  used  in  this  country.  Our  Pharmacopoeia  has 
adopted  Q.  alba  or  white-oak,  as  the  representative  of  the  oaks  in  general, 
being  one  of  the  most  astringent,  and  Q.  tinctoria  or  black-oak,  as  pos- 
sessing somewhat  different  properties,  and  requiring  a  separate  con- 
sideration. It  is  the  inner  bark,  in  all  the  species,  which  is  principally 
efficacious;  and  this,  therefore,  should  be  employed  to  the  exclusion  of 
the  epidermis,  when  the  latter  is  readily  separable.  The  bark  is  better 
from  the  young  branches  than  the  old,  and  gathered  in  the  spring  than 
at  other  seasons. 

Sensible  Properties.  The  inner  bark  has  a  coarse,  fibrous  texture; 
a  light-brownish  or  reddish-brown  colour;  a  slight  peculiar  odour,  little 
perceptible!  in  single  pieces,  but  very  obvious  in  mass;  and  a  rough, 
astringent,  bitterish  taste. 

Active  Principles.  These  are  tannic  acid  of  the  kind  found  in  galls, 
gallic  acid,  and  a  bitter  crystallizable,  neuter  substance,  called  quercin, 
which  has  been  found  in  the  bark  of  European  oaks,  and  probably  exists 
in  most  or  all  of  the  species.  Of  these  principles,  tannic  acid  is  the 
most  abundant  and  most  important.  They  are  all  extracted  by  water 
and  alcohol. 

Incompatible^.  These  are  the  same  essentially  as  those  of  galls;  but 
the  bark  of  the  British  oak  is  said  not  to  precipitate  tartar  emetic. 

Peculiarities  of  Q.  tinctoria,  or  Black-oak  Bark.  This  variety  is  more 
bitter  than  most  of  the  others,  and  differs  also  in  staining  the  saliva  yel- 
low when  chewed.  Besides  the  tannic  and  gallic  acids,  it  contains  a 
peculiar  colouring  principle,  called  quercitrin,  which  renders  it  valuable 
as  a  dye-r-iufV,  in  which  capacity  the  coarsely  powdered  bark  is  consider- 
ably used  under  the  name  of  quercitron. 

Effects  on  the  ,S//.s/r//i.  The  effects  of  oak  bark  are  those  of  a  mild 
astringent  and  tonic.  Experiments  performed  with  it  at  the  veterinary 
school  of  Lyons  appear  to  show  that,  when  largely  taken,  it  renders  the 


CHAP.  I.]  ASTRINGENTS. — OAK    BARK.  121 

blood  redder,  thicker,  and  more  viscid,  and  at  the  same  time  diminishes 
the  putrefactive  tendency  after  death.  The  blood  of  a  horse,  which  was 
made  to  take  twenty  pounds  of  the  bark  in  a  month,  was  said,  at  the  end 
of  that  time,  to  have  undergone  the  change  referred  to;  and  the  body  of 
the  animal,  which  was  killed,  remained  two  months  without  the  least  sign 
of  putrefaction. 

Black-oak  Bark  is  said  to  differ  from  the  other  varieties  in  having 
some  tendency  to  operate  on  the  bowels. 

Therapeutic  Application.  Oak  bark  has  been  used  internally  in 
chronic  diarrhoea  and  dysentery,  in  passive  hemorrhage  from  the 
bowels,  and  in  intermittent  fever;  but  it  is  little  employed  in  this  way. 
The  inhalation  of  the  odorous  matter  which  exhales  from  large  quantities 
in  mass,  has  been  thought  to  be  advantageous  in  phthisis;  because  this 
disease  has  been  observed  to  prevail  less  among  tanners  than  with  other 
classes  of  people;  but  more  accurate  and  copious  statistical  details  are 
wanted  to  establish  the  fact.  The  black-oak  bark,  in  consequence  of  its 
supposed  irritant  effects  on  the  bowels,  should  not  be  given  in  cases  of 
diarrhoea. 

The  topical  use  of  the  bark  is  much  greater  than  the  internal.  The 
decoction  has  been  employed  as  a  bath,  especially  for  children,  in  maras- 
mus, scrofula,  chronic  diarrhoea,  cholera  infantum,  and  intermittent 
fever.  It  has  also  been  found  useful  as  a  gargle  in  prolapsus  of  the 
uvula  and  inflammation  of  the  fauces;  as  an  injection  in  leucorrhcea, 
prolapsus  uteri,  prolapsus  ani,  and  dropsical  cysts;  and  as  a  wash,  or 
in  the  form  of  poultice,  in  piles,,  old  and  obstinate  ulcers,  edematous 
swellings  of  the  limbs  and  joints,  and  even  in  the  cure  of  reducible 
hernias,  aided  by  the  use  of  a  truss.  The  powder  made  into  a  cataplasm 
is  said  to  have  been  useful  in  external  gangrene;  and  the  infusion  taken 
from  tanners'  vats  has  been  beneficially  employed  in  old,  jlabby,  and  ill- 
conditioned  ulcers. 

Administration.  The  dose  is  from  thirty  grains  to  a  drachm.  An 
extract  made  by  boiling  the  decoction  to  dryness  has  been  given  in  half 
the  quantity.  The  decoction  (DECOCTUM  QUERCUS  ALB^:,  U.  S.),  made 
in  the  proportion  of  an  ounce  to  a  pint  of  water,  is  given  in  the  dose  of 
two  fluidounces.  In  each  instance,  the  dose  may  be  repeated  from  three 
to  six  times  in  a  day.  For  external  use,  the  decoction  may  be  made 
with  twice  the  proportion  of  bark  just  mentioned. 

The  fruit  of  the  oak,  or  acorn,  is  more  astringent  and  bitter  than  the 
bark,  and  has  been  considerably  used  in  scrofulous  affections.  It  is  said 
to  be  more  efficacious  when  previously  roasted,  in  consequence  of  a  sup- 
posed beneficial  influence  of  the  resulting  empyreumatic  products  upon 
the  nervous  system.  The  most  agreeable  form  for  use  is  that  of  an 
infusion  or  decoction,  prepared  from  the  roasted  and  ground  fruit,  ex- 
actly in  the  manner  of  coffee,  and  taken  like  that  with  sugar  and  cream. 


122  GENERAL    STIMULANTS.  [PART  II. 

For  an  adult,  half  an  ounce  of  acorns  may  thus  be  prepared  for  each 
morning  and  evening  meal ;  for  a  child,  from  half  a  drachm  to  a  drachm, 
with  a  convenient  quantity  of  water. 

Acorns  have  been  sometimes  used  as  food  in  periods  of  famine ;  but 
they  are  said  to  produce  for  a  time  obstinate  constipation,  followed  in 
the  end  by  diarrhoea  and  cholera. 


III.  KINO.  U.S.,Br. 

The  name  of  kino  was  first  conferred  upon  an  astringent  product, 
introduced  into  use  by  Dr.  Fothergill  of  London,  about  the  middle  of  the 
last  century,  and  supposed  to  have  been  the  concrete  juice  of  Pterocarpus 
erinaceus,  a  tree  growing  on  the  western  coast  of  Africa.  But  the 
same  name  has  since  been  extended  to  similar  products  from  other 
sources,  and  may  now  be  considered  as  a  generic  title  for  various  con- 
crete juices,  of  a  reddish-brown  or  blackish  colour  and  astringent  taste, 
and  existing  either  in  the  state  of  minute,  shining,  angular  fragments,  or 
of  larger  masses  very  readily  breaking  into  such  fragments.  The  varie- 
ties now  in  use  are  the  East  India  kino,  the  West  India  or  Jamaica 
kino,  and  the  South  American  or  Caracas  kino.  The  East  India 
variety  is  most  employed. 

1.  EAST  INDIA  KINO  is  the  inspissated  juice  of  Pterocarpus  Marsu- 
pium,  a  large  tree  growing  in  the  mountains  upon  the  Malabar  coast  of 
Hindostan.     It  is  in  small,  irregular,  angular,  brittle,  glistening  frag- 
ments, of  a  dark  reddish-brown  almost  black  colour,  redder  and  lighter 
in  powder,  inodorous,  of  a  bitterish  strongly  astringent  taste  followed 
by  a  sense  of  sweetness,  softening  in  the  mouth  when  chewed,  adhering 
somewhat  to  the  teeth,  and  staining  the  saliva  blood-red.     Water  and 
alcohol  dissolve  all  its  active  matter,  receiving  from  it  a  deep-red  colour. 

Its  active  principle  is  tannic  acid,  of  the  variety  called  kino-tannic 
acid,  which  precipitates  the  salts  of  sesquioxide  of  iron  of  a  greenish  or 
olive-black  colour.  This  differs,  moreover,  from  the  tannic  acid  of  galls, 
in  being  converted,  by  exposure  to  the  atmospheric  air,  into  a  brick-red, 
tasteless,  and  inert  matter,  instead  of  into  gallic  acid.  Besides  this 
principle,  there  is  also  extractive  mailer,  upon  which  possibly  the  bitter- 
ness may  depend. 

Its  chemical  reactions  are  the  same  with  those  of  the  tannio  acid  of 
galls,  except  that  the  alkalies  favour  its  solubility  in  water,  while  they 
destroy  its  astringency. 

2.  WEST  INDIA,  or  JAMAICA  KINO,  is  said  to  be  an  extract  of  the 
wood  and  bark  of  Coccoloba  uvifera,  growing  in  the  West  Indies ;  but 
this  origin  is  somewhat  doubtful;   and  specimens  which  I  have  seen 


CHAP.  I.]  ASTRINGENTS. —  KINO.  123 

under  that  name,  had  the  appearance  of  an  inspissated  juico,  and  proba- 
bly were  so ;  as,  on  chemical  examination,  they  were  found  to  contain  a 
resinous  ingredient. 

In  sensible  properties,  in  the  characters  of  its  active  principle,  in 
solubility,  and  general  chemical  reactions,  it  is  not  materially  different 
from  the  preceding  variety;  except  that,  instead  of  being  imported  in 
minute  fragments,  it  has  been  brought  to  this  country  in  a  compact  mass 
in  gourds,  and  breaks  into  rather  larger  and  more  rectangular  fragments, 
less  glistening,  and  not  quite  so  dark. 

3.  SOUTH  AMERICAN,  or  CARACAS  KINO,  is  brought  from  the  northern 

coast  of  South  America;  but  its  botanical  source  is  unknown.     It  is  in 

> 

large  irregular  masses,  which,  after  importation,  are  broken  up  into  small 
irregular  fragments,  less  sharply  angular,  glistening,  and  dark-coloured 
than  the  E.  India  variety,  and  in  these  respects  closely  resembling  that 
from  the  W.  Indies.  In  taste  and  smell,  solubility,  the  character  of  its 
active  principle,  and  in  general  chemical  relations,  it  resembles  the  pre- 
ceding variety. 

Besides  those  varieties  of  kino,  there  is  the  Botany  Bay  kino,  from 
Eucalyptus  resinifera  of  New  South  Wales,  and  a  product  named  Bu- 
tea  gum,  from  Butea  frondosa  of  Hindostan,  both  of  which  have  the 
general  properties  of  this  drug,  but  are  little  used  in  the  United  States. 
(Sec  U.  S.  Dispensatory.) 

Effects  on  the  System.  So  far  as  they  have  been  investigated,  the 
effects  of  kino  are  not  essentially  different  from  those  of  galls;  but  it  is 
doubtful  whether  they  exert  an  equal  influence  through  the  circulation ; 
as  their  tannic  acid  is  not  capable,  like  that  of  galls  and  oak  bark,  of  being 
converted  into  absorbable  gallic  acid,  but  passes,  through  the  reagency 
of  oxygen,  into  the  state  of  a  tasteless,  insoluble,  and  inert  matter. 

Therapeutic  Application.  Kino  is  one  of  the  best  of  the  vegetable 
astringents  for  internal  use,  on  account  of  its  purity,  and  general  accepta- 
bility to  the  stomach.  It  is  employed  chiefly  in  diseases  of  the  alimen- 
tary canal;  and,  though  occasionally  prescribed  internally  for  haemopty- 
sis, menorrhagia,  and  leucorrhcea,  it  probably,  for  reasons  already  given, 
exerts  little  influence  in  these  complaints.  In  those  forms  of  diarrhoea 
and  advanced  or  chronic  dysentery,  in  which  astringents  are  indicated, 
it  is  a  very  useful  remedy,  and  much  employed  in  this  country.  It  may 
also  be  sometimes  used  advantageously  in  epidemic  cholera,  in  order  to 
check  the  excessive  evacuations.  Pyrosis,  hxmatemesis,  and  intestinal 
hemorrhage  are  among  the  complaints  in  which  good  effects  may  be 
expected  from  it.  In  the  last-mentioned  affection,  occurring  in  the  ad- 
vanced stages  of  low  fevers,  it  is  an  admirable  remedy.  I  have  seen  it 
promptly  check  the  most  alarming  hemorrhage  attendant  on  enteric  or 
typhoid  fever;  but  it  must  be  given  very  freely,  much  more  so  than 


124  GENERAL   STIMULANTS.  [PART  II. 

under  ordinary  circumstances.     In  all  those  complaints  it  should  gener- 
ally be  associated  with  opium. 

ily,  in  the  form  of  powder,  it  is  sometimes  efficacious  in  arresting 
hemorrhage  from  bleeding  surfaces.  In  a  bloody  tumour  of  the  roof  of 
the  mourh.  which  bled  alarmingly  upon  being  cut  into,  I  once  succeeded 
in  checking  the  hemorrhage,  after  trying  other  means  unsuccessfully,  by 
filling  the  incision  with  the  powder,  and  causing  a  piece  of  patent  lint, 
on  which  the  powder  was  thickly  sprinkled,  to  be  pressed  firmly  by  the 
tongue  against  the  tumour.  In  the  same  form,  it  may  sometimes  be 
sprinkled  beneficially  upon  the  surface  of  flabby  ulcers.  In  the  form  of 
infusion  also  it  is  sometimes  topically  applied,  as  in  cases  of  epislaxia, 
relaxation  of  the  uvula,  aphthae,  leucorrhoea,  and  obstinate  gonorrhoea; 
but  its  liability  to  stain  everything  which  it  touches  is  some  objection  to 
this  mode  of  employment 

Administration.  The  dose  is  from  five  to  thirty  grains,  which  may  be 
repeated  every  two,  three,  or  four  hours  in  cases  of  urgency,  and  three 
or  four  times  a  day  in  the  more  chronic.  In  bowel  complaints,  it  is  fre- 
quently associated  with  prepared  chalk  or  oyster  shell,  and  one  of  the 
liquid  preparations  of  opium,  in  the  form  of  mixture,  made  by  suspending 
the  insoluble  ingredients  in  some  aromatic  water,  by  means  of  gum 
arabic  and  loaf  sugar. 

In  the  form  of  pill,  kino  may  be  given,  combined  with  acetate  of  lead 
and  opium,  in  cholera  and  diarrhoea.  Though  the  salt  of  lead  is  probably 
decomposed  by  the  tannic  acid,  experience  has  proved  the  efficacy  of  the 
combination. 

Kino  may  also  be  prescribed  in  the  form  of  an  electuary,  made  by 
mixing  the  powder  with  syrup  or  molasses;  and  powdered  cinnamon, 
powdered  opium,  and  prepared  chalk,  one  or  all,  may  be  added  as  cir- 
cumstances may  seem  to  require. 

A  more  elegant  preparation  is  an  infusion,  made  in  the  proportion  of 
two  drachms  of  kino  and  a  drachm  of  powdered  cinnamon  to  eight  fluid- 
ounces  of  boiling  water,  and  filtered  when  cold.  Of  this  one  or  two 
table-spoonfuls  may  be  given  for  a  dose,  sweetened  with  loaf  sugar,  and 
mixed,  in  cases  of  diarrhoea,  with  a  fluidrachm  of  camphorated  tincture 
of  opium,  or  an  equivalent  quantity  of  some  other  liquid  preparation  of 
that  narcotic.  If  the  effects  of  chalk  are  required,  this  antacid  may  be 
mixed  with  the  infusion  by  the  intervention  of  powdered  gum  and  sugar. 
Tincture  of  Kino  (TiNCTURA  KINO,  U.S.}  is  an  officinal  preparation, 
and,  in  cases  where  the  alcoholic  menstruum  is  not  objectionable,  may 
l>e  -riven,  in  the  dose  of  one  or  two  fluidrachms,  added  to  rivtari-uiis  mix- 
tmvs.  or  other  liquid  astringent  preparation.  It  should,  however,  be 
;  recently  madr;  as  it  is  apt  to  gelatinize  by  time,  and  to  lose  its 
astringency. 


CHAP.  I.]  ASTRINGENTS. — CATECHU.  125 

IV.  CATECHU.  U.S. 

CATECHU  NIGRTIM.    Black  Catechu.    Acacia  Catechu.  />?*. 

Origin  and  Properties.  Catechu  is  an  extract  prepared  from  the  inner 
wood  of  Acacia  Catechu,  a  small  tree  growing  in  Hindostan,  Pegu,  and 
other  parts  of  India.  It  is  in  masses  or  fragments  of  diversified  shape 
and  si/e,  usually  rusty-coloured  externally,  reddish-brown  internally, 
with  a  fracture  generally  smooth  and  somewhat  shining  but  sometimes 
rough,  inodorous,  and  of  a  bitterish  very  astringent  taste,  with  a  sweetish 
after-taste.  It  yield?  its  virtues  to  water  and  alcohol. 

Active  Principle.  This  is  fannic  acid,  of  the  variety  which  yields  with 
the  salts  of  sesquioxide  of  iron  a  greenish-black  or  olive-black  precipitate, 
and  may  be  called  catechu-tannic  acid.  Another  constituent,  to  which 
it  probably  owes  its  sweetness,  is  catechuic  acid,  which,  however,  is  not 
known  to  possess  any  medical  virtues. 

Its  chemical  relations  are  the  same  as  those  of  kino. 

Effect*  on  the  System.  So  far  as  the  effects  of  catechu  upon  the  sys- 
tem can  be  traced,  they  are  almost  precisely  those  of  the  medicine  last 
described. 

Therapeutic  Application.  Its  therapeutic  uses  are  almost  the  same 
as  those  of  kino,  and  need  not,  therefore,  be  repeated  here.  It  is,  how- 
ever, I  believe,  less  used  internally  in  this  country,  probably  because  less 
elegant  in  appearance,  and  usually  less  pure.  Some  writers  speak  of  it 
as  specially  advantageous  in  checking  excessive  expectoration;  but  I 
cannot  think  that  it  has  much  power  of  this  kind.  As  a  topical  applica- 
tion, in  the  form  of  infusion,  it  has  the  advantage  over  kino  of  staining 
less.  Ffom  its  greater  hardness,  it  is  better  adapted  to  the  treatment  of 
chronic  angina,  with  relaxation  or  elongation  of  the  uvula,  in  which  it 
sometimes  proves  very  useful  by  being  held  in  the  mouth  between  the 
cheek  and  teeth,  and  allowed  slowly  to  dissolve.  Its  solution  in  the 
saliva  is  thus  brought  constantly,  as  it  is  swallowed,  into  contact  with 
the  diseased  parts,  and  keeps  up  a  steady  astringent  action  upon  them. 
In  the  same  way  it  is  said  to  be  used  by  professional  singers  and  speak- 
ers, to  relieve  the  hoarseness  consequent  on  an  excessive  use  of  the  voice. 
In  the  form  of  powder,  it  is  also  occasionally  useful  in  spongy  gums,  to 
which  it  may  be  applied  by  means  of  a  camcl's-hair  pencil.  The  tincture 
is  preferable  to  that  of  kino,  in  consequence  of  being  less  liable  to  change 
by  keeping. 

The  dose  of  the  powder  is  from  ten  to  thirty  grains,  that  of  the  officinal 
Tincture  (TINCTURA  CATECHU,  U.  S.),  from  thirty  minims  to  three  flui- 
drachms.  An  infusion  (IxrusuM  CATECHU  COMPOSITUM)  is  directed 
both  by  the  U.  S.  and  British  Pharmacopeias,  made,  according  to  the 
former,  with  half  an  ounce  of  catechu  and  a  drachm  of  cinnamon  to  a 


126  GENERAL   STIMULANTS.  [PART  II. 

pint  of  boiling  water.  The  dose  is  one  or  two  fluidounccs  three  or  four 
times  daily.  The  modes  of  administration,  not  specially  noticed,  are 
precisely  the  same  as  those  already  sufficiently  described  under  kino. 

GAMBIR. 

CATECHU  PALLIDUM.  Pale  Catechu.  Uncaria  Gambir  (Nauclea  Gam- 

bir).  Br. 

This  is  probably  the  old  terra  Japonica.  It  is  usually  ranked  with  the 
varieties  of  catechu,  which  it  closely  resembles  in  virtues ;  but  it  has  a 
wholly  different  origin,  being  an  extract  from  the  leaves  and  young 
shoots  of  Nauclea  Gambir  (Uncaria  Gambir,  De  Candolle),  which  is  a 
native  of  Eastern  India.  It  is  in  the  form  of  cubes,  of  about  an  inch  in 
size,  light  and  porous,  of  a  yellowish  or  reddish-brown  colour,  lighter 
within,  an  earthy  fracture,  and  a  strongly  astringent,  bitter,  and  sweetish 
taste.  It  is  closely  analogous  in  composition  to  catechu,  and  may  bo 
used  for  the  same  purposes,  and  in  the  same  dose. 


V.  RHATANY. 
KRAMERIA.  U.  S.,  Br. 

Origin  and  Properties.  Rhatany  is  the  root  of  Krameria  triandra, 
a  shrub  growing  in  Peru.  It  is  usually  in  long,  cylindrical  pieces,  from 
the  size  of  a  straw,  to  half  an  inch  or  more  in  diameter,  sometimes  in  the 
form  of  radicles  attached  to  a  short,  thick,  common  head.  The  root  con- 
sists of  a  reddish-brown  bark,  in  which  the  virtues  chiefly  reside,  and  of 
an  interior  lighter-coloured,  but  still  reddish  ligneous  portion.  It  yields 
a  reddish  powder,  is  inodorous,  but  of  a  slight  peculiar  srncll  in  decoction, 
and  has  a  bitter,  very  astringent,  and  slightly  sweetish  taste.  Its  virtues 
are  extracted  by  water  and  alcohol,  but  are  impaired  by  boiling.  The 
infusion  and  tincture  are  reddish-brown. 

Active  Constituents  Its  chief  active  principle  is  a  variety  of  tannic 
acid,  somewhat  peculiar  in  properties,  affording  a  deep  grayish-brown 
precipitate  with  the  salts  of  sesquioxide  of  iron,  and  converted  by  oxida- 
tion, especially  at  an  elevated  temperature,  into  an  inert  apotheme.  It 
contains,  also,  bitter  extractive,  which  may  have  tonic  virtues;  and  a 
peculiar  acid  called  krameric,  for  which  some  influence  over  the  .system 
ha*  been  claimed,  but  of  which  little  is  known. 

hemical  reactions  are  the  same  essentially  as  those  of  the  other 
vegetable  astringents  in  general. 

Effects  on  the  System.  Rhatany  combines  the  effects  of  a  powerful 
astringent  with  those  of  a  gentle  tonic,  and  does  riot,  in  these  respects, 
differ  observably  from  kino  and  catechu.  Like  these,  also,  it  may  operate 
less  forcibly,  through  the  route  of  the  circulation,  than  the  taunic  acid  of 


CHAP.  I.]  ASTRINGENTS. RHATANY.  127 

galls  or  the  astringents  containing  it;  because  its  active  principle,  in- 
stead of  being  converted  by  oxidation  into  gallic  acid,  which  is  at  once 
absorbable  and  astringent,  becomes  under  that  process  an  insoluble  and 
inert  apothcme.  But  this  view  of  its  action  on  the  system  must  be  con- 
sidered as  somewhat  theoretical. 

Therapeutic  Application.  Rhatany  has  been  employed  for  all  the 
purposes  of  the  vegetable  astringents  generally,  and  may  be  considered 
as  identical  in  its  therapeutic  application,  both  internal  and  external  or 
topical,  with  kino  and  catechu.  To  mention,  therefore,  in  this  place, 
the  several  affections  for  which  it  has  been  recommended  would  be  mere 
repetition.  There  is  one  use  of  it,  however,  which  requires  special 
notice;  as,  though  there  can  be  little  doubt  that  either  of  the  astringents 
just  mentioned  would  answer  the  same  purpose,  yet  they  have  not  been 
put  so  fully  as  rhatany  to  the  test  of  experiment.  The  use  referred  to  is 
in  the  cure  of  that  most  painful  and  obstinate  affection,  known  by  the 
name  of  fissure  of  the  anus.  M.  Bretonneau  found  injections  of  kra- 
meria  an  almost  certain  remedy  in  that  complaint;  and  his  experience 
has  been  confirmed  by  that  of  M.  Trousseau.  The  injection  employed 
by  him  consisted  of  a  drachm  and  a  half  of  the  extract  of  rhatauy,  dis- 
solved in  five  fluidounces  of  water,  to  which  about  a  fluidrachm  of  the 
tincture  of  rhatany  was  added.  This  was  administered  daily,  the  rectum 
having  been  previously  cleared  out  by  an  enema  of  warm  water,  or  some 
mucilaginous  fluid  The  patient  usually  experienced  relief  in  the  course 
of  a  week,  and  was  effectually  cured  in  two  or  three  weeks.  In  the  use 
of  the  remedy,  the  pains  are  at  first  sometimes  aggravated;  but  this 
should  not  prevent  a  perseverance  with  it.  Great  care  must  be  taken, 
after  the  cure,  to  keep  the  evacuations,  by  means  of  laxatives  if  neces- 
sary, in  a  soft  state,  so  as  to  prevent  a  reproduction  of  the  fissures. 
MM.  Trousseau  and  Blache  have  employed  the  same  remedy,  with  great 
benefit,  in  the  treatment  of  fissures  and  excoriations  of  the  nipple  in 
nursing  women.  They  first  wash  the  part  with  a  liquid  consisting  of  5 
parts  of  the  extract,  10  of  the  tincture,  and  100  of  water,  and  then  in- 
troduce into  the  fissures  the  extract  brought  into  a  proper  consistence  by 
means  of  the  white  of  eggs. 

Administration.  The  dose  of  the  powdered  root  might  be  from  a 
scruple  to  a  drachm ;  but  the  medicine  is  seldom  used  in  this  form.  The 
most  elegant  preparation,  and  one  of  the  most  useful  of  all  the  vegetable 
astringents,  is  the  officinal  Extract  (EXTRACTUM  KRAMERIJE,  U.  S.),  pre- 
pared according  to  the  directions  of  our  national  code.  The  dose  of  it  is 
from  ten  to  twenty  grains.  The  Tincture  of  Rhatany  (TINCTURA  KRA- 
MERS, U.  S.),  and  Syrup  of  Rhatany  (SYRUPUS  KRAMERT^,  U.  S.),  are 
also  officinal  preparations,  the  former  of  which  is  given  in  the  dose  of 
one  or  two  fluidrachms,  and  the  latter,  which  is  especially  adapted  for 
children,  in  that  uf  half  a  fluidounce  for  an  adult,  and  twenty  or  thirty 
minims  for  a  child  a  year  or  two  old. 


128  GENERAL   STIMULANTS.  [PART  II. 

VI.  LOGWOOD. 
H^EMATOXYLON.  U.  S.— H^MATOXYLUM.  Br. 

Oriyin.  This  is  the  inner  or  heart-wood  of  H&matoxijlon  Campechi- 
anum,  a  tree  of  medium  size,  growing;  in  Campeachy  and  on  the  shores 
of  the  Bay  of  Honduras,  in  the  Peninsula  of  Yucatan,  and  in  Jamaica 
and  other  West  India  islands,  into  which  it  is  said  to  have  been  in- 
troduced from  the  Continent. 

Sensible  Properties.  It  comes  in  billets  of  various  magnitude,  hard, 
compact,  and  heavy,  of  a  red  or  yellowish-red  colour,  becoming  darker  and 
almost  black  by  exposure,  of  a  peculiar  not  disagreeable  odour,  and  a 
sweet  somewhat  astringent  taste.  As  kept  in  the  shops  for  use,  it  is  in 
small  chips,  or  in  the  form  of  a  coarse  powder  produced  by  rasping.  It 
yields  its  virtues,  with  a  deep  purplish  red  colour,  to  water  and  alcohol. 

Active  Principles.  Its  chief  constituents  are  a  variety  of  lannic  acid 
in  small  proportion,  in  which  its  astringency  resides,  and  a  peculiar 
colouring  principle  called  h&matoxylin,  to  which  it  owes  its  colouring 
properties  and  sweetness. 

Chemical  Reactions.  The  decoction  of  logwood  produces  precipitates 
with  lime-water,  acetate  of  lead,  and  alum,  a  deep-violet  blue  with  the 
salts  of  sesquioxide  of  iron,  and  reddish  curdy  flakes  with  a  solution  of 
gelatin. 

Effects  on  the  System.  The  effects  of  logwood  on  the  system  are  those 
of  a  pure  mild  astringent,  without  bitterness,  and  without  irritant  prop- 
erties. The  colouring  principle  appears  to  be  absorbed,  as  the  urine  is 
reddened  by  the  internal  use  of  the  medicine. 

Therapeutic  Application.  This  astringent  is  applicable  to  mild  cases 
of  diarrhoea  and  chronic  dysentery,  in  which  simple  astringency  is  re- 
quired, and  more  irritating  substances  might  be  injurious.  It  is  especi- 
ally suited  to  the  diarrhoea  of  children,  and  has  been  considerably  em- 
ployed in  that  form  of  it  which  succeeds  cholera  infantum,  after  the 
violence  of  the  disease  has  been  subdued.  It  may  be  used  also  for  the 
general  purposes  of  the  vegetable  astringents,  but  is  too  feeble  for  much 
effect,  unless  in  cases  of  the  kind  above  referred  to. 

Administration.  The  only  two  forms  in  which  it  is  used  are  those  of 
the  Decoction  (DECOCTUM  H^EMATOXYLI,  U.  S.)  and  Extract  (EXTRACTUM 
H/EMATOXYLI,  U.  S.),  both  of  which  are  officinal.  In  the  former  U.  S. 
Pharmacopoeia,  the  process  of  which  I  prefer,  the  decoction  was  pre- 
pared by  boiling  an  ounce  of  the  rasped  wood  with  two  pints  of  water 
to  a  pint ;  and  two  drachms  of  bruised  cinnamon  might  sometimes  be 
usefully  added  at  the  end  of  the  boiling.  The  dose  is  two  or  three  fluid- 
ounces  for  an  adult,  two  or  three  fluidrachms  for  a  child  of  two  years,  to 


CHAP.  I.]  ASTRINGENTS. — GERANIUM.  129 

be  repeated  three  or  four  times  a  day,  or  more  frequently  if  required. 
The  dose  of  the  extract  is  from  ten  to  thirty  grains.  It  may  be  given  in 
the  form  of  pill  or  solution ;  but,  if  pills  are  preferred,  they  should  be  taken 
freshly  prepared ;  as  they  are  said  to  become  so  hard,  by  long  keeping, 
as  sometimes  to  pass  through  the  bowels  unchanged*. 


VII.  CRANESBILL. 

i 

GERANIUM.  U.S. 

Origin  and  Properties.  This  name  has  been  given  to  the  root,  or  rather 
rhizome  of  Oeranium  maculatum,  a  small,  herbaceous,  perennial  plant, 
growing  in  woods  throughout  the  United  States.  It  is  in  pieces  from 
one  to  three  inches  long,  somewhat  flattened,  wrinkled,  tuberculated,  com- 
pact, externally  brown,  internally  reddish-gray,  inodorous,  and  of  a  pure 
astringent  taste,  without  bitterness,  or  other  disagreeable  quality. 

Active  Principle.  This  is  tannic  acid,  having  the  general  properties 
of  that  principle,  but  of  what  precise  character  is  yet  undetermined; 
though  if  it  be  true,  as  stated  by  some,  that  the  root  contains  also  gallic 
acid,  it  must  be  of  the  kind  found  in  galls.  From  a  recent  analysis  of 
the  root  by  the  Messrs.  Tilden,  who  recognized  the  presence  both  of 
tannic  and  gallic  acids,  it  may  be  inferred  that  these  are  its  only  active 
constituents. 

Effects  and  Uses.  Cranesbill  has  the  effects  on  the  system  of  an  effi- 
cient and  pure  astringent.  From  its  want  of  unpleasant  taste,  it  is 
particularly  suited  to  infants,  and  persons  of  delicate  palate  and  stomach. 
It  may  be  used  for  all  the  purposes  of  the  vegetable  astringents  already 
detailed,  whether  external  or  internal ;  but  has  been  most  highly  recom- 
mended, as  an  internal  remedy,  in  chronic  diarrhcea  and  dysentery, 
and,  as  a  topical  application,  in  cases  of  aphthous  ulceratiov  >f  the  mouth 
and  fauces.  It  is  peculiarly  applicable  to  the  looseness  of  bowels  fol- 
lowing cholera  infantum,  in  consequence  of  its  exemption  from  irritant 
properties. 

Administration.  The  dose  of  the  powdered  root  is  from  twenty  to 
thirty  grains.  It  is,  however,  more  frequently  given  in  the  form  of 
decoction,  which  may  be  prepared  by  boiling  an  ounce  of  the  bruised 
root  in  a  pint  and  a  half  of  water  to  a  pint,  and  given  in  the  dose  of  one 
or  two  fluidounces,  repeated  three  or  four  times  a  day.  For  infants  the 
decoction  in  milk,  in  the  proportion  of  an  ounce  to  a  pint,  is  an  eligible 
preparation,  and  may  be  given  to  a  child  a  year  or  two  old  in  the  dose 
of  one  or  two  fluidrachms,  or  more  largely  if  required.  An  extract  and 
tincture  have  been  recommended,  but  are  little  used. 
VOL.  i. — 9 


130  GENERAL    STIMULANTS.  [PART  II. 

VIII.  BLACKBERRY  ROOT. 
RUBUS.  U.S. 

Origin.  Under  this  name  the  present  IT.  S.  Pharmacopoeia  unites  the 
roots  of  the  Rubus  villosus  or  common  blackberry,  and  the  Rubus  Gana- 
densis  (R.  trivialis,  Pursh)  or  dewberry ;  and,  as  there  is  no  known  dif- 
ference in  effects  between  them,  they  have  been  very  properly  consoli- 
dated, instead  of  being  designated,  as  in  the  old  Pharmacopoeia,  by 
distinct  officinal  titles.  These  two  species  of  Rubus  are  indigenous 
briers,  growing  in  different  parts  of  the  United  States. 

Properties.  The  roots  are  cylindrical  or  branching,  with  a  brown  or 
ash-coloured  bark,  and  a  central  woody  portion,  the  former  of  which  is 
of  a  bitter  and  strongly  astringent  taste,  the  latter  is  tasteless,  and  both 
are  without  smell.  The  woody  part  is  inert;  and  either  the  smaller 
roots,  or  the  bark  only  of  the  larger,  should  be  employed.  Water  and 
alcohol  extract  all  their  virtues. 

Active  Principles.  These  are  tannic  acid,  and  probably  a  peculiar 
bitter  principle,  which,  however,  has  not  yet  been  isolated. 

Effects  on  the  System.  There  is  no  observable  difference  in  the  effects 
of  these  roots.  Both  are  gentle  tonics,  and  energetic  astringents. 

Therapeutic  Application.  Blackberry  and  dewberry  root  may  be  em- 
ployed for  the  same  purposes  generally  as  the  bitter  vegetable  astrin- 
gents; but  are  seldom  given  except  for  bowel  complaints,  in  which  they 
are  highly  esteemed  popular  remedies.  I  have  used  them  in  diarrhoea 
with  advantage.  They  are  applicable  only  to  chronic  cases  of  this  dis- 
ease, or  to  such  as  are  connected  with  intestinal  debility ;  and  should  not 
be  employed  when  there  is  general  fever,  or  any  acute  inflammation  of 
the  mucous  membrane  of  the  bowels.  They  are  a  favourite  domestic 
remedy  in  the  diarrhoea  which  follows  cholera  infantum. 

Administration.  They  are  usually  given  in  the  form  of  decoction, 
made  by  boiling  an  ounce  of  the  bruised  roots  in  a  pint  and  a  half  of 
water  to  a  pint,  and  administered  in  the  dose  of  a  wineglassful  for  an 
adult,  a  dessert-spoonful  for  a  child  two  years  old,  three  or  four  times  a 
day,  or  more  frequently.  It  may  be  well  to  add  to  the  decoction,  at  the 
end  of  the  boiling,  half  an  ounce  of  bruised  orange  peel,  or  two  drachms 
of  bruised  cinnamon,  in  order  to  qualify  the  flavour,  arid  render  the 
preparation  more  acceptable  to  the  stomach. 


CHAP.  I.]  ASTRINGENTS. — UVA    URSI.  131 


IX.  UVAURSI.  U.S.,Br. 

Origin  and  Properties.  Uva  ursi  consists  of  the  leaves  of  Arcto- 
staphylos  Uva  Ursi,  or  bearberry,  a  low  evergreen  shrub,  growing  in 
the  northern  parts  of  Asia,  Europe,  and  America,  and  extending  in  the 
United  States  as  far  south  as  New  Jersey,  where  it  is  found  abundantly. 
The  leaves  are  from  half  an  inch  to  an  inch  long,  somewhat  wedge- 
shaped,  thick  and  coriaceous,  with  a  smooth  rounded  margin ;  on  the 
upper  surface  smooth,  shining,  and  brownish-green,  on  the  lower  lighter 
coloured  and  reticulated  ;  inodorous  when  fresh,  of  a  hay-like  smell  when 
dried,  and  of  a  strongly  astringent,  bitterish,  and  ultimately  sweetish 
taste.  Water  and  officinal  alcohol  extract  all  their  virtues. 

Active  Principles.  These  are  tannic  acid  of  the  kind  found  in  galls, 
gallic  acid,  a  bitter  substance,  and,  according  to  Mr.  Hughes,  a  peculiar 
crystallizable  principle  called  by  him  ursin,  which  he  found  diuretic  in 
the  dose  of  a  grain.  (Am.  Journ.  of  Pharm.,  xix.  90.)  Two  other  crys- 
tallizable principles,  denominated  by  their  discoverers  respectively  arbu- 
tin  and  ursone,  have  been  detected  in  the  leaves;  but,  as  they  have  not 
been  proved  to  possess  active  properties,  they  cannot  be  considered  of 
much  importance.  (See  U.  S.  Dispensatory.) 

The  incompatibilities  of  uva  ursi  are  essentially  the  same  as  those  of 
galls. 

Effects  on  the  System.  Uva  ursi  is  astringent  and  gently  tonic,  with 
the  property  of  slightly  increasing  the  secretion  of  urine,  and  at  the  same 
time  altering  its  colour.  Its  astringent  principle  is  said  to  have  been 
detected  in  the  urine ;  but  it  was  probably  the  gallic  acid.  In  over- 
doses it  is  apt  to  produce  nausea  and  vomiting. 

Therapeutic  Application.  This  medicine  is  probably  capable  of  pro- 
ducing, in  a  greater  or  less  degree,  all  the  effects  of  the  vegetable  astrin- 
gents, but  is  less  powerful  than  most  of  those  already  described.  Towards 
the  close  of  the  last,  and  at  the  beginning  of  the  present  century,  it  was 
very  highly  esteemed  and  much  employed  in  various  affections  of  the 
urinary  and  genital  apparatus,  and  even  acquired  some  reputation  in 
pulmonary  consumption,  which,  however,  it  soon  lost.  It  was  used  in 
chronic  inflammation  and  ulceration  of  the  kidneys,  gravel,  diabetes, 
cystirrhcea,  strangury  and  bloody  urine,  paralysis  of  the  bladder,  in- 
continence of  urine,  leucorrhcea,  and  menorrhagia ;  and  was  believed 
by  many,  if  not  to  dissolve  stone  in  the  bladder,  at  least  greatly  to 
relieve  the  symptoms  of  that  affection.  That  its  virtues  were  over- 
estimated there  can  be  no  doubt ;  but,  in  the  natural  reaction  which  has 
followed,  it  has  appeared  to  me  that  the  credit  which  it  now  enjoys  is 
scarcely  equal  to  its  merits.  The  circumstance  that  it  changes  the  char- 
acter of  the  urine  would  seem  to  show,  that  some  one  or  more  of  its 


132  GENERAL   STIMULANTS.  [PART  II. 

constituents  passes  out  with  that  fluid  ;  and  it  is  not  improbable  that  it 
thus  directly  exercises  an  astringent,  somewhat  corroborant,  and  per- 
haps alterative  effect  upon  the  surface  of  the  mucous  membrane,  lining 
the  pelvis  of  the  kidney,  the  ureter,  and  the  bladder.  Experience  has, 
I  think,  shown  that  it  possesses  this  power;  and  it  is  probably  to  this 
alone  that  it  owes  any  peculiar  therapeutic  efficacy  which  it  may  possess. 
No  one  now  believes  that  it  is  capable  of  materially  modifying  the  symp- 
toms of  stone  in  the  bladder,  in  any  other  way  than  by  invigorating  the 
kidneys  when  relaxed  or  debilitated,  or  by  relieving  the  attendant  inflam- 
mation of  the  urinary  passages ;  and  any  efficacy  which  it  may  possess 
in  gravel  must  be  ascribed  to  the  same  cause.  It  should  not  be  em- 
ployed in  acute  inflammation  of  these  organs,  as  its  excitant  property, 
under  such  circumstances,  could  prove  only  injurious ;  but  in  chronic 
affections,  when  the  membrane  is  relaxed,  when  atonic  ulceratiou  may 
be  suspected,  and  the  urine  is  loaded  with  pus  or  mucus  in  excess,  it 
may  be  used  with  great  propriety,  and  with  reasonable  hope  of  ad- 
vantage. 

The  complaints  in  which  it  has  proved  most  efficacious,  in  my  experi- 
ence, are  chronic  inflammation  of  the  pelvis  of  the  kidney  with  puru- 
lent impregnation  of  the  urine,  and  the  similar  affection  of  the  bladder, 
known  as  catarrh  of  that  organ,  or  cystirrhcea.  In  cases  of  this  kind, 
persevered  in  for  a  long  time  continuously,  for  several  months  if  neces- 
sary, I  believe  that  it  will  occasionally  effect  cures  even  unaided,  and 
will  often  prove  a  serviceable  adjuvant  to  other  measures.  Though 
apparently  indicated  in  atonic  hsematuria,  I  have  not  found  it  equally 
efficacious.  It  sometimes  appears  to  do  good  in  spermatorrhoea,  prob- 
ably by  an  invigorating  effect  upon  the  mucous  membrane  at  the  neck 
of  the  bladder,  or  origin  of  the  urethra;  and,  by  a  similar  influence, 
extended  sympathetically  to  the  sphincter,  it  is  occasionally  useful  in 
nocturnal  incontinence,  though  it  must  be  confessed  that  it  much  more 
frequently  fails. 

Administration.  The  dose  of  the  powdered  leaves  is  from  a  scruple  to 
a  drachm  ;  but  the  Decoction  (DECOCTUM  UVJE  URSI,  U.  S.),  made  in  the 
proportion  of  an  ounce  of  the  leaves  to  a  pint  of  water,  is  a  more  eligible 
preparation.  It  may  be  given  in  the  dose  of  one  or  two  fluidounces, 
three  or  four  times  daily.  A  fluid  extract  (EXTRACTUM  UV^E  URSI  FLU- 
IDUM,  U.  S.)  is  directed  by  our  officinal  code,  the  dose  of  which  is  from 
thirty  minims  to  a  fluidrachm. 


CHAP.  I.]  ASTRINGENTS. — PIPSISSEWA.  133 

X.  PIPSISSEWA. 
CHIMAPHILA.  U.S. 

Origin  and  Properties.  This  consists  of  the  leaves  of  Chimaphila 
umbellata,  a  low  evergreen  plant,  growing  in  the  northern  parts  of  Asia, 
Europe,  and  America,  and  abundant  in  the  United  States.  These  leaves 
are  about  an  inch  and  a  half  long,  wedge-shaped,  pointed  at  the  end, 
notched  on  the  border,  coriaceous,  shining  and  of  a  bright  sap-green 
colour  on  the  upper  surface,  paler  beneath,  of  a  peculiar  odour  when  fresh 
and  bruised,  and  of  an  astringent,  bitterish,  somewhat  sweetish,  and  not 
disagreeable  taste.  Water  and  alcohol  extract  their  virtues. 

Active  Principles.  These  are  tannic  acid,  and  bitter  extractive.  It  is 
probable  that  the  matter  indicated  by  the  latter  title  is  really  complex, 
and  that  among  its  constituents  is  a  peculiar  principle,  upon  which  all 
the  virtues  of  the  medicine,  not  connected  with  its  astringency,  depend. 
A  cry  stall  izable  principle  was  obtained  from  the  leaves  by  Mr.  Samuel 
Fairbank,  and  denominated  by  him  chimaphilin,  though  its  claims  to 
this  title  are  doubtful,  as  it  is  probably  destitute  of  active  properties. 
(See  U.  S.  Dispensatory,  12th  ed.) 

Effects  on  the  System.  The  fresh  leaves,  bruised  and  applied  to  the 
skin,  are  said  to  be  rubefacient  and  even  vesicating.  Internally,  they 
are  mildly  astringent  and  tonic,  with  the  property  of  somewhat  increasing 
the  secretion  of  urine,  to  which  they  probably  impart  some  degree  of 
remediate  power.  It  is,  I  think,  scarcely  doubtful  that  their  peculiar 
active  principle,  through  which  they  stimulate  the  kidneys,  passes  off, 
either  changed  or  unchanged,  with  the  urine. 

TJierapeulic  Application.  Pipsissewa  was  much  employed  by  the 
aborigines  of  this  country,  to  whom  it  owes  the  name  by  which  it  is  now 
generally  designated.  It  is  sometimes  called  wintergreen;  but,  as  this 
name  has  also  been  applied  to  Gaullheria  procumbens,  it  should  be 
abandoned  for  both.  From  the  Indians  the  medicine  passed  into  popu- 
lar use,  whence  it  was  adopted  by  the  profession.  It  was  used  chiefly 
in  scrofula,  rheumatism,  and  affections  of  the  kidneys  and  urinary 
passages.  Its  diuretic  powers  have  recommended  it  in  dropsy,  and  it 
has  been  employed  with  asserted  advantage  in  cases  of  this  disease 
attended  with  debility ;  but  little  reliance  can  be  placed  upon  its  efficacy ; 
and  at  best  it  should  be  used  only  as  an  adjuvant  to  other  more  powerful 
diuretics. 

In  scrofula,  it  is,  I  think,  a  valuable  remedy.  The  late  Dr.  Joseph 
Parrish  used  it  very  extensively  in  this  affection,  and  had  great  confi- 
dence in  its  powers.  I  have  myself  been  in  the  habit  of  employing  it, 
in  cases  of  external  scrofula,  during  the  whole  period  of  my  practice,  and 
have  found  few  remedies  which  have  appeared  to  me  more  efficacious. 


134  GENERAL   STIMULANTS.  [PART  II. 

Its  mildly  astringent  and  tonic  properties  adapt  it  admirably  to  the  treat- 
ment of  the  scrofulous  cachexia,  in  which  a  general  laxity  of  the  tissues, 
and  debility  of  the  functions,  call  for  these  two  remedial  influences;  while 
the  chronic  character  of  the  affection  requires  that  the  medication  should 
be  gentle,  in  order  that  it  may  be  long  sustained,  without  injury  to  the 
organs.  In  the  earlier  stages  of  the  disease,  I  have  been  in  the  habit  of 
directing,  in  connection  with  its  use,  a  saline  laxative  twice  or  three 
times  a  week,  and  in  anemic  cases  have  had  recourse  also  to  the  chaly- 
beates;  but  in  many  instances  the  pipsissewa  has  been  the  remedy 
mainly  relied  on.  It  has  seemed  to  me  to  exercise  a  favourable  alterative 
influence  in  scrofula,  independently  of  its  astringency  and  tonic  power;  but 
it  is  extremely  difficult  to  discriminate,  in  affections  of  this  kind,  between 
the  course  of  nature  and  the  effects  of  remedies,  so  that  it  is  proper  to 
speak  of  the  latter  with  some  reserve.  Fully  aware  of  the  necessity  of 
this  caution,  I  am  still  of  opinion,  as  the  result  of  considerable  experience, 
that  pipsissewa  deserves  to  rank  next  to  cod-liver  oil,  and  the  prepara- 
tions of  iodine  and  of  iron,  in  the  treatment  of  scrofula;  and  may  often 
be  usefully  combined  with  one  or  more  of  these  remedies.  In  order  that 
its  full  effects  may  be  obtained,  it  should  be  long  continued,  with  inter- 
ruptions now  and  then,  should  any  considerable  degree  of  fever  super- 
vene. In  cases  attended  with  ulcers  of  an  indolent  or  flabby  character, 
it  may  be  used  with  advantage  in  decoction  as  a  wash,  at  the  same  time 
that  it  is  administered  internally. 

The  resemblance  in  properties  between  pipsissewa  and  uva  ursi  would 
suggest  the  employment  of  the  former  also  in  complaints  of  the  urinary 
organs ;  but  I  have  had  little  experience  with  it  in  these  affections,  and 
cannot,  therefore,  speak  with  confidence  of  its  utility,  though  it  has  been 
recommended  by  others. 

Administration.  The  Decoction  (DEOOCTUM  CHIMAPHIL.E,  U.  £),  pre- 
pared by  boiling  an  ounce  of  the  bruised  leaves  in  a  pint  of  water,  for 
fifteen  minutes,  and  then  adding  enough  water  to  make  a  pint,  is  the 
most  eligible  form  for  administration,  and  may  be  taken  in  the  dose  of 
from  two  to  four  fluidounces  four  times  a  day.  A  pint  may  generally 
be  taken  by  an  adult  in  twenty-four  hours  without  inconvenience.  Some 
recommend  the  medicine  as  an  ordinary  drink  in  scrofula,  in  the  form 
of  beer,  which  may  be  made  by  fermenting  together  sugar,  water,  and 
the  bruised  leaves,  with  the  addition  of  yeast  An  extract  has  also 
been  recommended,  and  may  be  given  in  the  dose  of  twenty  or  thirty 
grains. 


The  vegetable  astringents  above  described  are  those  probably  most 
used  in  the  I"  ultra  States,  and  are  numerous  enough  to  afford  all  desira- 
ble latitude  of  choice  to  the  physician.  There  are,  however,  several 
others  having  similar  virtues,  and  some  not  less  efficient  than  the  preced- 


CHAP.  I.]  ASTRINGENTS. — RED    ROSE.  135 

ing,  with  a  general  notice  of  which  I  shall  content  myself,  from  the  fear 
of  needlessly  embarrassing  the  memory  of  the  student,  referring  him  for 
a  particular  account  of  them  to  the  United  States  Dispensatory. 

1.  RED  ROSE  (RosA  GALLICA,  U.S.,  Br.)  consists   of  the   unex- 
panded  petals  of  Rosa  Gallica,  a  European  species  of  the  rose,  occasion- 
ally cultivated  in  our  gardens  as  an  ornamental  plant.     They  are  used 
chiefly  in  preparing  a  Confection  (CoNFEOTio  ROS.E,  U.  S.),  much  em- 
ployed as  a  vehicle  for  substances  made  into  pill,  and  one  of  the  ingre- 
dients of  the  officinal  mercurial  pill;  and  the  Compound  Infusion  of 
Hoses  (INFUSUM  Ros^;  COMPOSITUM,  U.S.),  which  consists  of  an  infusion 
of  the  flowers  made  with  the  addition  of  a  small  proportion  of  sulphuric 
acid,  and  the  virtues  of  which  depend  mainly  on  the  latter  ingredient. 
There  is  an  officinal  Honey  of  Roses  (MEL  ROS.E,  U.S.),  and  a  Syrup 
(SYRUPUS  ROS.E  GALLICS,  U.S.,  Br.),  both  of  which  are  used  as  agreea- 
ble additions  to  liquid  astringent  mixtures,  such  as  mouth-washes  and 
gargles,  "but  have  no  great  merit  of  their  own. 

2.  TORMENTIL  (ToRMENTiLLA,  U.S.)  is  the  root  or  rhizome  of 
Polentilla  Tormentilla,  or  septfoil,  a  European  plant.     This  is  a  simple 
and  powerful  astringent,  formerly  much  employed,  but  neglected  since 
the  general  introduction  of  kino  and  rhatany  into  use. 

3.  WATER  AVENS,  the  root  of  Geum  rivale,  indigenous  in  Europe 
and  the  United  States,  is  tonic  and  powerfully  astringent. 

4.  HARDHACK  (SpiR^iA,  U.S.)  is  the  root  of  Spiraea  iomentosa,  an 
indigenous  shrub,  all  parts  of  which  are  bitter  and  astringent,  though 
the  root  only  is  officinally  recognized. 

5.  POMEGRANATE  RIND  (GRANATi  FRUCTUS  CORTEX,  U.  S.)  is 
the  rind  of  the  fruit  of  Punica  Granatum,  or  pomegranate  tree,  indigen- 
ous in  the  warmer  latitudes  of  the  old  continent,  and  cultivated  in  the 
southern  section  of  the  United  States.     This  is  bitter  and  astringent, 
and  is  used  chiefly  as  a  gargle  in  sore-throat,  in  the  form  of  decoction. 

6.  BISTORT,  the  root  of  Polygonum  Bisiorta,  growing  in  Europe 
and  Northern  Asia,  was  formerly  much  more  used  than  at  present,  and 
is  now  seldom  imported.     It  is  an  efficient  astringent. 

7.  ALUM-ROOT  (HEUOHERA,  U.S.)  is  the  root  of  Heuchera  Ameri- 
cana, an  indigenous  plant,  very  strongly  astringent. 

8.  MARSH  ROSEMARY  (STATICE.  U.S.)  is  the  root  of  Statice  Car- 
oliniana,  an  indigenous  maritime  plant.     It  is  an  active  astringent,  and 
is  used  to  a  considerable  extent  in  some  parts  of  the  United  States. 

9.  PERSIMMON  (DIOSPYROS,  U.S.)  is  the  unripe  fruit  of  Diospyros 
Virginiana,  an  abundant  indigenous  tree.    This  fruit,  though  sweet  and 
edible  when  quite  mature,  is  in  the  unripe  state  exceedingly  astringent, 
and  may  be  beneficially  employed  whenever  a  simple  vegetable  astrin- 
gent is  indicated. 


136  GENERAL   STIMULANTS.  [PART  II. 

XL  ALUM. 
ALUMEN.  U.S.,Br. 

Origin.  Alum  is  a  double  salt,  composed,  in  the  crystalline  state,  of 
one  equivalent  of  sulphate  of  alumina,  one  of  sulphate  of  potassa,  and 
twenty-four  of  water;  and  denominated,  chemically,  sulphate  of  alumi- 
na and  potassa.  It  is  prepared  either  by  the  direct  combination  of 
its  constituents,  or  by  various  processes  from  certain  minerals  called 
alum  ores,  containing  ingredients,  by  the  mutual  reaction  of  which, 
under  favourable  circumstances,  and  with  necessary  additions,  the  salt 
is  generated. 

Sensible  and  Chemical  Properties.  The  salt  is  in  octohedral  or  more 
rarely  cubic  crystals,  or,  as  it  is  usually  found  in  commerce,  in  irregular 
crystalline  masses  or  fragments,  whitish  and  translucent,  slightly  efflo- 
rescent, inodorous,  and  of  a  strongly  astringent,  sweet,  and  acidulous 
taste.  Exposed  to  heat,  it  first  melts,  then  boils  up,  loses  its  water  of 
crystallization,  and  becomes  white  and  opaque,  and  readily  reducible  to 
powder.  In  this  state  it  is  called  burnt  alum,  or,  officinally,  Dried  Alum 
(ALUMEN  EXSICCATUM,  U.  £).  By  a  strong  heat  it  is  quite  decomposed. 
In  the  crystalline  state,  it  is  soluble  in  about  eighteen  parts  of  cold,  and 
three-quarters  of  its  own  weight  of  boiling  water;  is  entirely  insoluble 
in  absolute  alcohol,  and  very  nearly  so  in  proof  spirit.  It  has  an  acid 
reaction  with  vegetable  colours. 

Incompalibles.  Alum  is  incompatible  with  alkalies  and  their  carbo- 
nates, lime-water,  magnesia  and  its  carbonate,  tartrate  of  potassa,  phos- 
phate of  soda,  and  acetate  and  subacetate  of  lead,  with  all  of  which  it 
produces  precipitates.  Those  thrown  down  by  the  alkalies  are  dis- 
solved by  an  excess  of  alkali.  It  also  precipitates  solutions  of  albumen, 
gelatin,  and  many  of  the  vegetable  astringents,  and  coagulates  milk. 

Effects  on  the  System.  When  applied  externally,  or  taken  internally 
in  such  manner  and  quantity  as  not  to  excite  irritation,  alum  acts,  so  far 
as  can  be  observed,  purely  as  an  astringent,  contracting  the  tissues, 
diminishing  the  caliber  of  the  blood-vessels,  and  thus  lessening  the  colour 
of  the  part,  and  diminishing  secretion  and  exhalation.  On  the  mucous 
membrane  of  the  mouth  and  fauces  its  astringent  effect  is  strong,  and 
the  impression  which  it  leaves  behind  it  durable.  I  have  often  observed 
that,  when  used  as  a  gargle  at  bedtime,  it  so  affects  the  tongue  and  palate 
that  the  sense  of  taste  remains  much  blunted  in  the  morning.  Acting 
directly  on  the  alimentary  mucous  membrane,  it  lessens  the  number  and 
quantity  of  the  stools. 

There  can  be  no  doubt  that,  when  taken  internally,  it  exerts  its  pecu- 
liar action  also  on  the  whole  system,  though  its  general  is  much  less 
powerful  than  its  local  operation.  The  probability  is  that  it  is  absorbed, 


CHAP.  I.]  ASTRINGENTS. ALUM.  137 

as  alumina  has  been  found  in  the  urine  and  viscera  of  animals  to  which 
it  has  been  administered ;  but  in  what  state  precisely  it  enters  the  cir- 
culation has  not  been  determined.  Its  effects  upon  the  system  at  large 
are  more  observable  in  disease  than  in  health ;  but  dryness  of  the  throat 
and  fauces,  with  thirst,  has  been  noticed  as  one  of  the  results  of  its  inter- 
nal use. 

It  is  believed  by  some,  and  not,  I  think,  without  reason,  to  be  some- 
what refrigerant  or  sedative  in  its  influence  on  the  circulation. 

Some  ascribe  the  astringent  effects  of  alum  to  its  chemical  reaction 
with  the  tissues.  Considering  how  instantaneous  and  considerable  is 
the  shrinking  of  the  mucous  membrane  of  the  mouth,  when  a  strong 
solution  is  applied  to  it,  I  cannot  conceive  that  the  result  is  owing  to  a 
mere  chemical  change.  Not  only  in  this  case,  but  in  every  other,  I  be- 
lieve that  it  operates  by  calling  the  vital  property  of  contractility  into 
action. 

When  used  either  outwardly  or  inwardly  in  large  quantities,  though 
primarily  astringent,  it  becomes  irritant  after  a  time,  and  at  length,  if 
continued,  may  excite  inflammation.  This  effect  will  follow  the  appli- 
cation even  of  small  quantities  to  a  very  delicate  or  unprotected  surface,, 
as  to  the  conjunctiva  of  the  eye,  or  to  the  skin  recently  denuded  of  the 
epidermis.  In  such  cases,  its  peculiar  astringent  effect  is  overwhelmed 
by  the  inflammatory  action.  Thus,  when  swallowed  in  the  quantity  of 
a  drachm  or  more,  it  not  unfrequently  causes  nausea  and  vomiting,  and 
sometimes  produces  griping  pains  and  purging.  Devergie  found  about 
six  drachms  of  dried  alum,  given  to  a  dog,  to  produce  death  when  the 
oesophagus  was  tied,  so  as  to  prevent  vomiting.  Under  such  circum- 
stances, the  mucous  membrane  of  the  stomach  and  bowels  has  been 
observed  to  be  much  inflamed.  The  same  quantity,  when  the  oesophagus 
is  not  tied,  is  discharged  by  vomiting  without  any  permanent  evil  effects. 
OrTila  found  that  seven  drachms  of  powdered  crystallized  alum  produced 
vomiting  in  dogs  in  from  ten  to  thirty  minutes.  Dried  alum,  applied  to 
a  denuded  surface,  acts  as  a  mild  caustic,  and  is  sometimes  used  with 
reference  to  this  effect-. 

When  used  for  a  considerable  time,  in  doses  insufficient  to  nauseate, 
alum  not  unfrequently  produces  a  sense  of  stricture  in  the  epigastrium, 
precordial  oppression,  and  other  dyspeptic  feelings,  probably  by  interfer- 
ing with  the  secretion  of  the  gastric  juice,  and  thus  impairing  digestion. 
Therapeutic  Application.  Alum  is  useful,  as  an  internal'  remedy,  in 
those  forms  and  states  of  diarrhoea  and  chronic  dysentery  to  which 
astringents  are  applicable,  and  in  hemorrhage  from  the  bowels  under 
similar  circumstances.  It  is  not  so  well  adapted  to  hemorrhage  of  the 
stomach,  in  consequence  of  its  liability  to  produce  nausea  and  vomiting; 
but  might  nevertheless  be  employed  in  this  affection,  in  considerable 
doses,  should  other  remedies  fail,  and  the  case  be  urgent.  In  the  treat- 


138  GENERAL   STIMULANTS.  [PART  II. 

ment  of  the  bowel  affections,  it  has  not  unfrequently  been  associated  with 
some  of  the  vegetable  astringents,  such  as  tannic  acid,  kino,  extract  of 
rhatanv,  etc.;  and,  though  it  undergoes  chemical  change  through  reac- 
tion with  these  substances,  yet  it  does  not  follow  that  the  resulting  pro- 
ducts are  inert;  and  experience  has  shown  that  the  combination  is  often 
effectual.  In  the  dose  of  ten  or  twelve  grains  three  or  four  times  a  day, 
with  an  equal  quantity  of  bitartrate  of  potassa,  it  has  been  found  by  Sir 
James  Murray  very  useful  in  the  chronic  gastric  affection,  characterized 
by  vomiting  of  glairy  mucus. 

In  comparing  the  remedial  efficacy  of  alum  with  that  of  the  vege- 
table astringents,  it  will  probably  be  found  to  be  relatively  more  effica- 
cious, when  operating  through  the  medium  of  the  circulation,  than 
directly  upon  the  stomach  and  bowels.  It  is,  indeed,  sometimes  given 
very  advantageously  in  menorrhagia  or  uterine  hemorrhage,  and  in 
cases  of  bloody  urine.  In  obstinate  haematuria  connected  with  disease 
of  the  kidneys,  I  have  known  it  apparently  to  produce  the  happiest  re- 
sults, after  vain  trials  of  other  methods.  There  would  seem  to  be  no 
reason  why  it  should  not  also  prove  serviceable  in  haemoptysis;  but  it 
is  less  used  in  that  affection ;  and  I  have  myself  so  seldom  employed  it, 
that  I  should  not  be  justified  in  giving  an  opinion,  upon  the  ground  of 
experience. 

In  all  the  above  affections,  alum  may  be  used  in  combination  with 
small  doses  of  opium,  which  generally  co-operates  to  the  same  result, 
and  may  also  serve  to  obviate,  in  some  measure,  its  tendency  to  irritate 
the  stomach.  For  the  latter  purpose,  one  of  the  aromatics  is  also  not 
unfrequently  conjoined  with  it,  as  nutmeg  or  cinnamon,  especially  when 
it  is  given  in  powder. 

With  reference  to  its  astringent  property,  alum  has  also  been  given  in 
dilatation  of  the  heart,  and  aneurism  of  the  aorta,  and  sometimes,  it 
has  been  thought,  with  advantage.  Incontinence  of  urine  from  debility 
of  the  sphincter  muscle  of  the  bladder,  spermatorrhoea,  obstinate  leucor- 
rhoea,  colliquative  sweating,  and  diuresis,  are  other  complaints  in  which 
it  has  been  used  with  supposed  benefit,  and  in  which  it  would  seem  to 
be  indicated.  Little  good  can  be  expected  from  it  in  proper  diabetes,  in 
which  it  has,  nevertheless,  been  recommended. 

It  was  formerly  supposed  to  possess  febrifuge  properties ;  and  Cullen 
states  that  he  succeeded  with  it  in  intermittent  fever ,  given  in  connec- 
tion with  nutmeg,  in  anticipation  of  the  paroxysm.  But  it  is  not  to  be 
relied  on,  and  is  not  now  employed  in  that  disease. 

Of  much  greater  importance  is  it  as  a  remedy  in  colica  pictonum  or 
lead  colic.  So  long  ago  as  the  middle  of  the  last  century,  it  was  em- 
ployed in  that  affection  by  Grashius,  a  physician  of  Holland,  and  after- 
wards by  Dr.  Thomas  Percival  of  England ;  but  it  did  not  attract  par- 
ticular attention  until,  at  a  comparatively  recent  period,  it  was  brought 


CHAP.  I.]  ASTRINGENTS. — ALUM.  139 

into  notice  by  M.  Kapeler,  physician  to  one  of  the  hospitals  of  Paris. 
Since  that  time,  it  has  been  extensively  used,  and  experience  has  pro- 
nounced decidedly  in  its  favour.  I  have  myself  employed  it  with  the 
best  results,  even  where  the  opiate  and  mercurial  treatment  had  failed. 
Its  mode  of  operating  is  quite  unknown.  Some  suppose  that  it  cures 
the  disease  by  converting  the  poisonous  preparation  of  lead,  which  may 
have  caused  it,  into  the  insoluble  and  inert  sulphate  of  that  metal.  But 
it  is  by  no  means  always  that  lead-colic  proceeds  from  a  preparation  of 
that  metal  swallowed.  Quite  as  often,  probably,  it  originates  through 
the  inhalation  of  the  fumes  of  the  metal,  or  of  vapours  impregnated  with 
one  of  its  salts;  and  there  is  in  such  cases  no  poison  in  the  bowels  to 
neutralize.  Besides,  even  when  the  poison  has  been  swallowed,  it  prob- 
ably acts  much  more  through  absorption  into  the  blood  than  by  mere 
contact  with  the  membrane.  If  alum,  therefore,  act  merely  as  a  chemical 
antidote,  it  must  do  so  by  entering  into  the  circulation,  and  there  pro- 
ducing the  insoluble  sulphate,  which,  in  this  position,  would  probably 
produce  as  much  mischief  mechanically  as  the  poison  had  done  physio- 
logically. But,  independently  of  these  considerations,  it  is  a  sufficient 
refutation  of  the  notion  of  the  chemical  action  of  alum,  that  the  same 
curative  effect  is  not  obtained  from  Epsom  or  Glauber's  salt,  or  other 
soluble  sulphate,  or  from  sulphuric  acid  itself,  which  ought  to  be  equally 
efficacious,  if  the  chemical  theory  were  true.  All  that  we  can  say  on  the 
subject,  in  the  present  state  of  our  knowledge,  is  that,  though  alum  and 
lead  are  both  astringent,  yet  each  has  its  own  specific  or  peculiar  mode 
of  action,  and  that  the  influence  of  the  former  is  incompatible  with  that 
of  the  latter;  in  other  words,  alum  cures  the  poison  of  lead  on  the  prin- 
ciple, already  sufficiently  discussed,  of  supersession.  (See  page  51.) 

The  remedy  is  asserted  to  have  been  found  effectual  in  other  forms  of 
colic;  and  it  may  be  employed,  with  hope  of  special  benefit,  in  those 
cases  of  intestinal  neuralgia  which  are  occasionally  met  with,  bearing  a 
close  resemblance  in  their  symptoms  to  colica  pictonum.  In  this  disease, 
alum  is  given  in  doses  larger  than  are  thought  appropriate  to  most  other 
cases  in  which  it  is  used.  From  a  scruple  to  a  drachm  or  more  may  be 
administered  every  three  or  four  hours,  dissolved  in  some  mucilaginous 
liquid,  to  which  sulphate  of  morphia  may  be  very  advantageously  added, 
in  such  quantities  as  may  be  necessary  to  allay  the  sufferings  of  the 
patient. 

Alum  has  been  recommended  in  hooping-cough  by  Dr.  Davies,  editor 
of  Underwood's  treatise  on  the  diseases  of  children. 

As  an  emetic,  it  has  been  advantageously  employed  in  the  treatment 
of  pseudomembranous  croup,  by  the  two  Drs.  Meigs,  father  and  son,  of 
Philadelphia.  A  teaspoonful  of  the  powdered  salt  is  given  to  the  child 
every  ten  or  fifteen  minutes  until  it  vomits.  A  second  dose  is  seldom 
required  to  produce  the  effect. 


140  GENERAL    STIMULANTS.  [PART  II. 

But  it  is  topically  that  alum  is  most  used.  In  arresting  morbid  dis- 
charges, it  is  among  the  most  effectual  of  the  local  remedies  in  our 
possession.  Epixtaxis  very  rarely  fails  to  yield  to  a  solution  of  the  salt, 
containing  fifteen  or  twenty  grains  to  the  fluidounce,  injected  up  the 
nostril.  When  the  bleeding  proceeds  from  a  readily  accessible  part  of 
the  membrane,  the  solution  may  be  applied  by  means  of  a  piece  of  lint. 
In  peculiarly  obstinate  cases,  it  has  been  recommeded  to  snuff  or  blow  up 
the  powder;  but  the  method  is  I  believe  less  effective,  as  the  remedy 
cannot  be  in  this  manner  so  thoroughly  applied  to  the  whole  surface. 

The-  same  solution  is  scarcely  less  effectual  in  the  hemorrlwidal  jlux, 
and  in  hemorrhage  proceeding  from  a  point  higher  up  the  rectum.  Three 
or  four  fluidounces  of  it  should  be  injected  at  once,  along  with  two  or 
three  fluidrachms  of  the  solution  of  sulphate  of  morphia,  of  the  U.  S. 
Pharmacopoeia. 

It  may  also  be  used  in  hemorrhage  from  the  mouth  or  throat,  and  to 
arrest  bleeding  from  leech-biles.  The  latter  is,  often  extremely  obsti- 
nate, and  has  even  proved  fatal.  A  method  I  have  long  used,  with  uni- 
form success,  is  to  make  a  saturated  solution  of  alum  in  hot  water,  to 
impregnate  a  dossil  of  raw  cotton  with  this  before  it  begins  to  crystal- 
lize on  cooling,  and  then  to  press  the  cotton  upon,  the  bite.  In  this  way 
the  salt  is  applied  more  effectually  than  it  can  be  by  any  other  method ; 
as  the  saturated  hot  solution  is  vastly  stronger  than  the  cold,  and  still 
retains  the  alum,  at  a  temperature  at  which  it  may  be  well  tolerated  by 
the  skin.  It  is  even  better  than  the  powder  itself,  which  acts  probably 
only  so  far  as  it  is  dissolved,  and  is  less  soluble  in  the  blood  than  it  is 
in  hot  water.  The  same  application  may  be  made,  with  prompt  effect, 
in  the  bleeding  from  the  socket  of  an  extracted  tooth,  which  it  is  some- 
times very  difficult  to  arrest. 

In  severe  uterine  hemorrhage,  recourse  may  also  be  had  to  the  strong 
solution  of  alum  as  a  local  styptic;  the  liquid  being  injected,  or  applied 
by  means  of  a  sponge  saturated  with  it,  and  introduced  into  the  vagina. 

Morbid  secretions  may  sometimes  be  advantageously  treated  by  the 
topical  use  of  alum.  Thus,  its  solution  has  been  employed  in  leucor- 
rhcea,  gonorrhoea  and  gleet,  profuse  salivation,  colliquative  sweating, 
to  check  excessive  suppuration  from  ulcerated  surfaces,  and  in  cases  of 
purulent  ophthalmia.* 

As  an  injection  into  serous  cysts,  a  solution  of  alum,  containing  four 
or  five  grains  in  the  fluidounce,  has  been  employed  with  the  effect  of  pro- 

*  Dr.  Pereira  states  that,  "in  the  treatment  of  the  purulent  ophthalmia  of  infante, 
no  remedy  is  perhaps  equal  to  an  alum  wash;"  and  Dr.  F.  J.  Farre,  editor  of  the 
abridged  edition  of  Pereira's  Materia  Medica  (p.  103),  adds  that  "the  wash  should 
contain  eight  grains  of  alum  in  an  ounce  of  water,  and  should  be  introduced 
between  the  lids  entry  quarter  of  an  hour.  Thus  used,"  he  says,  "the  wash  seldom 
fails."  (Note  to  the  third  edition.) 


CHAP.  I.]  ASTRINGENTS. — ALUM.  141 

ducing  a  cure ;  but  care  is  necessary  thoroughly  to  evacuate  the  cyst 
afterwards,  for  fear  of  exciting  inflammation. 

To  obviate  relaxation  of  tissue,  alum  is  locally  used,  commonly  in 
solution,  in  flabby  and  fungous  ulcers,  and  in  prolapsus  of  the  uvula, 
rectum,  and  uterus.  It  is  employed  also  in  aneurism  from  anastomosis, 
in  order  to  produce  contraction  of  the  vessels.  A  cataplasm  of  aluin- 
curd  may  sometimes  be  preferable,  in  the  cases  of  ulcer  and  anastomotic 
aneurism.  On  the  same  principle  of  obviating  relaxation,  may  be  ex- 
plained the  asserted  advantage  of  alum  gargles  in  some  cases  of  loss  or 
alteration  of  voice.  (Bennati,  Bullet.  Gen.  de  Therap.,  i.  256.) 

In  the  earliest  stage  of  inflammation,  before  any  other  change  has 
taken  place  than  mere  congestion  of  the  vessels,  alum  applied  to  the  part 
sometimes  arrests  the  disease,  by  diminishing  the  caliber  of  the  capilla- 
ries, and  thus  excluding  an  excess  of  blood.  For  this  purpose,  it  is  much 
used  in  mucous  inflammation  of  the  fauces,  or  ordinary  angina.  A  gar- 
gle made  of  alum,  sage  tea,  and  honey  has  long  been  a  popular  remedy 
for  sore-throat.  The  remedial  impression,  however,  is  due  to  the  alum 
alone ;  the  other  ingredients  simply  serving  to  qualify  the  taste.  Some 
persons  are  very  liable  to  these  anginose  attacks,  which  not  unfrcquently 
subject  them  to  great  inconvenience,  and  sometimes  to  danger,  by  ex- 
tending to  the  larynx,  bronchia,  or  even  pulmonary  tissue.  The  attack 
may  often  be  warded  off  by  proceeding  immediately,  upon  the  occurrence 
of  the  first  symptoms,  to  gargle  the  throat  with  a  strong  solution  of  alum ; 
taking  at  the  same  time  a  dose  of  sulphate  of  magnesia,  and  using  an 
exclusively  vegetable  diet.  But  when  the  inflammation  has  become  firmly 
established,  the  remedy  will  generally  be  useless  or  worse  than  useless, 
until  the  activity  of  the  symptoms  has  subsided ;  when,  if  a  relaxed  state 
of  the  vessels  remain,  keeping  up  a  slight  chronic  congestion,  it  may  be 
again  resorted  to  with  advantage.  The  form  of  lozenge  has  been  sug- 
gested by  M.  Argenti,  of  Venice,  as  sometimes  preferable  to  gargles. 
Held  in  the  mouth,  and  allowed  slowly  to  dissolve,  it  is  kept  in  constant 
contact  with  the  diseased  membrane,  and  may  be  supposed  to  act  more 
effectually  than  when  the  medicine  is  intermittingly  employed.  The 
lozenge  may  be  made  by  incorporating  powdered  alum,  sugar,  and  trag- 
acanth,  by  means  of  some  aromatic  liquid. 

In  the  pseudomembranous  form  of  angina  and  stomatitis,  such 
as  attends  diphtheria,  and  in  the  same  condition  occurring  in  scarlet 
fever,  a  strong  solution  of  alum,  or  the  salt  in  powder,  is  some- 
times very  effectual.  The  powder  may  be  applied  by  means  of  the 
finger,  or  more  conveniently  by  introducing  it  into  a  tube,  and  through 
this  blowing  it  into  the  fauces.  This  application  of  alum  in  modern 
times  we  owe  to  Bretonneau.  It  is  generally  made  in  cases  of  in- 
fants, who  are  most  subject  to  the  diphtheritic  affection.  It  is  usually 
followed  by  a  copious  salivation,  and  by  efforts  to  vomit;  but  these 


142  GENERAL    STIMULANTS.  [PART  II. 

cease  after  a  few  minutes.  The  remedy  is  equally  effectual  when 
applied  to  the  false  membrane,  which,  during  the  prevalence  of  an  epi- 
demic of  the  disease,  is  apt  to  form  on  other  parts,  as  the  nipple,  mucous 
membrane  of  the  generative  organs,  and  ulcerated  surfaces  in  any  por- 
tion of  the  body.  It  may  be  used  also  in  obstinate  aphthous  incrusta- 
tions of  the  mouth.  The  alternate  application  of  powdered  alum  and 
tannic  acid,  one  or  the  other  being  used  every  hour,  has  also  been  recom- 
mended in  pseudomembrarious  angina.  (Ann.  de  Therap.,  1859,  p.  114.) 

Painful  caries  of  the  teeth  may  sometimes  be  relieved  by  filling  the 
cavity  with  a  paste  made  of  alum,  ether,  and  a  little  mucilage,  which 
may  be  repeated  twice  a  day  while  the  pain  lasts.  (  Trousseau  et  Pidoux, 
4e  ed.,  i.  137.) 

In  commencing  ophthalmia,  alum  sometimes  arrests  the  disease ;  but 
in  this  affection,  the  solution  should  be  much  weaker  than  when  used 
for  the  throat,  or  to  arrest  hemorrhage.  When  the  inflammation  is 
fixed,  the  remedy  is  no  longer  applicable ;  but  it  sometimes  comes  again 
into  play  when,  in  the  advanced  stage,  the  eye  remains  red,  and  per- 
haps blood-shot,  from  a  passive  distension  of  the  vessels.  Another 
mode  of  using  alum  in  ophthalmia  is  in  the  form  of  alum-curd,  which 
may  be  applied  as  a  poultice  over  the  closed  eyelids,  between  pieces  of 
soft  linen  or  gauze.  Reference  has  already  been  made  to  its  peculiar 
efficacy  in  the  purulent  ophthalmia  of  infants.  (See  page  140  and  note,} 

Other  forms  of  inflammation,  in  which  alum-curd  may  be  employed, 
are  chilblain  before  the  cuticle  is  broken,  and  the  erythematous  redness 
which  results  from  pressure,  as  in  the  cases  of  patients  long  confined  to 
bed  with  diseases  of  debility. 

Administration.  The  dose  of  alum  for  ordinary  purposes  varies  from 
five  to  fifteen  grains,  which  in  chronic  cases  may  be  given  three  or  four 
times  a  day,  and  in  those  more  acute,  every  two  or  three  hours.  It  may 
be  taken  either  in  powder  or  solution.  In  either  case,  it  will  often  be 
desirable  to  make  some  aromatic  addition,  to  obviate  nausea.  Five 
grains  of  pulverized  nutmeg  are  often  added  to  each  dose  of  the  powder; 
and  an  equal  weight  of  white  sugar  may  be  mixed  with  it,  in  order  to 
qualify  the  taste. 

Another  form  of  administration  is  that  of  alum-whey.  This  is  made 
by  boiling  two  drachms  of  the  powdered  salt  with  a  pint  of  milk,  and 
straining  after  coagulation.  The  dose  is  from  one  to  three  tablespoonfuls. 

For  external  use,  the  curd  remaining  after  straining  the  milk,  in  the 
preparation  of  the  whey,  may  be  employed  in  the  form  of  cataplasm. 
Another  mode  of  making  an  alum  cataplasm  is  to  rub  the  white  of  egg 
with  a  piece  of  alum,  in  a  saucer,  until  the  albumen  coagulates ;  or  a 
drachm  of  powdered  alum  may  be  well  shaken  or  beaten  with  the  whites 
of  two  eggs.  The  curd  thus  prepared  may  be  applied  between  folds  of 
soft  linen. 


CHAP.  I.]  ASTRINGENTS. — LEAD.  143 

The  solution  of  alum  for  external  use  is  of  various  strengths,  accord- 
ing to  the  purpose  for  which  it  is  employed.  In  commencing  ophthalmia 
its  strength  should  not  at  first  exceed  four  or  five  grains  to  a  fluidounce 
of  water;  for  application  to  the  urethra  from  five  to  ten  grains.  A  much 
stronger  solution,  containing  fifteen  or  twenty  grains  in  the  fluidounce, 
has  been  above  recommended  for  various  purposes. 

Alum  is  among  the  substances  most  used  by  means  of  the  atomizer. 
Its  solution,  containing  from  ten  to  twenty  grains  to  the  fluidounce,  is 
inhaled  in  the  state  of  spray,  in  chronic  bronchitis  and  laryngitis,  espe- 
cially when  attended  with  excessive  secretion ;  and,  containing  forty 
grains,  has  been  found  useful  in  pulmonary  hemorrhage. 

The  uses  of  Dried  Alum  (ALUMEN  EXSICCATUM,  U.  <S.)  will  be  treated 
of  under  Escharotics. 


XII.  LEAD. 
PLUMBUM. 

The  preparations  of  lead  are  here  considered,  because  one  of  their 
most  prominent  properties,  and  that  for  which  probably  they  are  most 
employed,  is  their  astringency ;  though,  in  other  respects,  they  are  quite 
peculiar,  and  different  in  their  mode  of  action  from  all  other  medicines. 
In  the  metallic  state,  lead  is  believed  to  have  no  effect  on  the  system. 
It  is  true  that  its  introduction  into  the  stomach  has  been  followed  by 
symptoms  ascribable  to  its  presence ;  but  there  can  be  little  doubt  that 
it  underwent  chemical  change,  under  the  influence  of  the  gastric  liquids, 
before  these  symptoms  were  experienced,  at  least  any  other  than  such 
as  could  be  referred  to  a  mere  mechanical  agency.  The  vapour  arising 
from  melted  lead  is  capable  of  affecting  the  system  through  the  lungs; 
but  it  is  probably  an  oxide,  and  not  the  metal  itself,  which  acts  in  this 
case.  According  to  Mialhe,  all  the  salts  of  lead,  however  insoluble  in 
pure  water,  are  in  a  greater  or  less  degree  soluble  in  the  liquids  of  the 
alimentary  canal,  through  the  agency  of  the  chloride  of  sodium  or  potas- 
sium there  present.  All  of  them,  therefore,  are  capable  of  being  ab- 
sorbed, and  of  operating  on  the  system.  He  does  not  except  even  the  sul- 
phate, which  has  usually  been  considered  inert  in  consequence  of  its  great 
insolubility.  It  is  now  generally  believed  that  none  of  the  known  com- 
binations of  lead  are  without  some  effect,  excepting  only  the  sulphuret.* 

*  Sulphate  of  lead  is  soluble,  to  a  certain  extent,  in  solution  of  hyposulphite  of 
soda,  and  of  course  might  act  on  the  system  if  it  should  encounter  this  salt.  (Journ. 
de  Pharm.  et  de  Chim.,  Janv.  1859,  p.  77.)  Even  the  sulphuret  of  lead  is  said,  when 
applied  as  a  dressing  :o  an  ulcerated  surface,  to  have  caused  lead-poisoning;  so  that 
the  metal  can  hardly  be  considered  safe  in  any  state.  (Dr.  N.  J.  Pittman,  Trans,  of 
Med.  Soe.  of  N.  C.,  1856,  p.  39.) 


144  GENERAL   STIMULANTS.  [PART  II. 

1.  Effects  upon  the  System. 

The  preparations  of  lead  may  act  in  two  ways;  first,  by  simply  irri- 
tating the  part  with  which  they  may  come  into  contact;  and  secondly, 
by  exercising  their  peculiar  influence,  through  absorption,  either  on  the 
part  itself,  or  the  system.  To  a  certain  extent,  these  influences  are  in- 
consistent with  each  other;  for  irritation  in  a  part  is  well  known  to 
impede  absorption ;  and,  in  .proportion  as  the  irritating  substance  is 
t;ik<>n  up,  and  removed  from  the  point  of  application,  is  its  power  of 
irritating,  in  any  given  quantity,  diminished.  This  fact  has  an  important 
practical  bearing.  If  the  peculiar  effect  of  lead  is  wanted,  care  must  be 
taken  that  the  preparation  be  as  little  irritant  as  possible.  Thus,  a 
quantity  of  acetate  of  lead,  large  enough  to  irritate  the  stomach,  will  be 
much  more  likely  to  operate  on  the  system,  when  administered  in  small 
doses  frequently  repeated,  than  when  the  whole  is  taken  at  once.  In  the 
latter  case,  not  only  is  absorption  impeded  by  the  fulness  of  the  irritated 
vessels,  but  the  agent  is  apt  to  be  removed  by  vomiting  or  purgation. 

1.  Irritant  Influence.  In  relation  to  the  irritant  effect  of  the  prepara- 
tions of  lead,  there  is  nothing  peculiar.     They  are  apt  to  operate  in  this 
way  when  applied  largely,  and  to  delicate  surfaces;  and  the  important 
point  for  the  physician  is  to  be  able  to  regulate  the  dose  of  each  prepara- 
tion, according  to  the  susceptibility  of  the  several  parts  with  which  it  is 
brought  into  contact.     The  skin  will  bear  more  than  the  gastric  mucous 
membrane,  and  the  latter  more  than  the  delicate  conjunctiva.     Some  of 
the  preparations  act  as  irritant  poisons  when  swallowed  in  over-doses. 
Too  highly  concentrated,  they  may  indeed  occasion  the  death  of  a  part, 
either  by  excess  of  irritation  beyond  its  vital  capacity,  or  by  chemical 
combination  with  one  or  more  of  its  organic  constituents. 

2.  Peculiar  Influence.  This,  so  far  as  it  can  be  generalized,  is  the  in- 
fluence conjointly  of  an  astringent  and  sedative.   The  sedative  influence, 
though  felt  in  some  degree  in  the  circulation,  is  more  especially  directed 
to  the  nervous  system,  and  appears  to  affect  the  nerve  tissue  directly, 
rather  than  through  the  nervous  centres,  though  these  may  also  be 
involved.     When  the  preparations  of  lead  are  given  in  such  doses  as 
gradually  to  bring  the  system  under  their  influence,  no  observable  effects 
may  be  experienced  for  some  time,  in  a  state  of  health ;  but,  after  a 
shorter  or  longer  period,  which  varies  much  in  different  cases,  the  secre- 
tions are  generally  somewhat  diminished,  and  the  pulse  often  lessened 
in  frequency  and  fulness.     These  may  be  considered  as  their  legitimate 
effects,  when  they  are  used  therapeutic-ally;  and  they  will  sometimes 
prove  useful  in  restraining  morbid  discharges,  even  before  any  change  is 
noticed  in  the  healthy  functions.    If  longer  continued,  whether  accident- 
ally, or  for  medical  purposes,  they  are  capable  of  inducing  a  poisonous 
condition,  which  presents  very  peculiar  phenomena,  and  not  unfrequently 


CHAP.  I.]  ASTRINGENTS. — LEAD.  145 

ends  in  death  if  neglected.  Practically,  this  poisonous  condition  results 
much  more  frequently  from  exposure  to  the  influence  of  the  metal  acci- 
dentally, or  in  the  pursuit  of  business,  than  from  its  use  as  a  remedy ;  no 
doubt  because,  in  the  latter  case,  its  operation  is  carefully  watched,  and 
its  employment  suspended  upon  the  occurrence  of  unpleasant  symptoms. 
The  toxicological  influence  of  lead  was  investigated,  with  peculiar  care, 
by  M.  Tanquerel  des  Planches;  and,  though  much  was  known  before 
the  publication  of  his  treatise,  and  many  observations  have  since  been 
made,  yet  his  account  of  the  symptoms  has  served  as  the  basis  of  most 
subsequent  descriptions. 

Poisonous  Effects.  Among  the  earlier  symptoms  of  lead-poisoning 
are  dryness  of  the  mouth  and  nostrils,  diminished  urine,  and  a  tendency 
to  costiveness,  with  small,  dry,  and  sometimes  light-coloured  stools, 
evincing  diminished  biliary  and  intestinal  secretion.  There  are  often 
also  uneasy  epigastric  sensations,  impaired  appetite,  colicky  pains,  and 
sometimes  nausea  and  vomiting.  If  the  gums  are  now  examined,  they 
will  generally  present  a  bluish  or  slate-coloured  line  along  their  margin, 
of  greater  or  less  extent;  and  the  same  discoloration  will  be  found  to 
affect  the  teeth  themselves,  where  joined  by  the  gums.  This  appear- 
ance is  ascribed  to  the  formation  of  sulphuret  of  lead,  probably  through 
the  agency  of  the  saliva  acting  upon  the  metallic  combination  in  the 
tissue.  It  has  also  been  noticed  in  the  mucous  membrane  of  the  lips 
and  cheeks.  It  is  said  that  the  habit  of  cleaning  the  teeth  or  gums 
daily  with  a  brush  has  some  effect  in  preventing  this  blue  discoloration, 
the  absence  of  which,  therefore,  in  persons  who  thus  use  the  tooth-brush 
is  no  proof  that  they  may  not  be  labouring  under  the  effects  of  lead. 
(Dr.  Alexander  Smith,  Ed.  Hed.  Journ.,  July,  1856,  p.  10.)  Except  in 
such  cases,  the  blue  line  almost  always  occurs,  sooner  or  later,  under 
the  continued  use  of  lead,  even  when  no  poisonous  symptoms  are  ob- 
served. A  sweetish,  astringent  taste,  and  a  peculiar  offensive  odour  of 
the  breath,  are  said  to  accompany  the  poisonous  action  of  lead,  which 
is  also  characterized  by  emaciation,  especially  of  the  face,  and  by  a 
dirty  yellowish  hue  of  the  conjunctiva  and  the  skin.  The  circulation 
is  usually  somewhat  depressed,  as  evinced  by  the  slow  and  contracted 
pulse;  and  the  mind  is  often  dejected.  This  cachectic  condition  may 
exist,  for  a  long  time,  without  any  other  very  striking  phenomena ;  but 
much  more  frequently  it  is  attended  either  with  violent  abdominal  symp- 
toms, constituting  a  variety  of  colic,  with  external  nervous  disorder  in 
the  form  of  neuralgia  or  paralysis,  or  with  serious  cerebral  affections. 
These  different  complications  may  exist  in  the  same  or  in  different  per- 
sons, and,  in  the  former  case,  may  occur  successively,  or  in  a  greater  or 
less  degree  conjointly.  The  most  frequent  of  them,  and  usually  the 
first  in  the  order  of  time,  is  the  affection  called  variously,  colica  pic- 
VOL.  i. — 10 


146  GENERAL    STIMULANTS.  [PART  II. 

tonum,  painters'  colic,  or  lead  colic,  which  is  ordinarily  described  as  a 
distinct  disease. 

Lead  colic  is  characterized  by  severe  pains  about  the  umbilicus,  occur- 
rinir  more  or  less  paroxysmally,  in  general  not  increased  but  rather  re- 
lieved by  pressure,  with  sensations  of  twisting-,  and  a  feeling  of  wretched- 
ness, often  strongly  expressed  upon  the  countenance.  The  walls  of  the 
abdomen  are  usually  hard  and  somewhat  retracted,  and  the  muscles  not 
unfrequently  gathered  into  knots.  The  bowels  are  obstinately  consti- 
pated, though  there  may  be  frequent  desire  to  go  to  stool,  with  straining 
and  tenesmus.  Bilious  vomiting  is  not  uncommon.  The  patient  loses 
sleep,  and  is  extremely  restless,  often  changing  his  position,  and  some- 
times rising  and  walking  about  the  chamber,  with  his  body  stooping, 
and  both  hands  pressed  upon  the  abdomen.  If  the  cause  lie  withdrawn, 
these  symptoms  will  generally  subside  in  a  few  days,  especially  under 
appropriate  treatment;  but  they  sometimes  assume  a  protracted  form. 
and,  more  or  less  moderated  in  violence,  may  run  on  for  weeks  or 
months. 

Lead  palsy  may  occur  among  the  earlier  phenomena,  but  is  generally 
a  sequela  of  the  colic.  It  may  affect  sensation  and  the  power  of  motion 
severally  or  conjointly,  and,  when  it  affects  both,  may  do  so  in  different 
degrees.  It  is  frequently  accompanied  with  neuralgic  pains  in  the  mus- 
cles, joints,  etc.,  counterfeiting  rheumatism,  which  are  usually  continuous, 
though  liable  to  exacerbations,  and  are  increased  by  motion,  but  relieved 
by  pressure.  Sometimes  there  is  spasmodic  rigidity  of  certain  muscles. 
The  part  first  attacked  with  palsy  is  generally  the  hand  and  forearm ; 
and  the  extensor  muscles  are  chiefly  affected,  so  as  to  cause  the  hand, 
when  the  arm  is  held  up,  to  fall  as  if  strongly  flexed.  The  falling  hand 
is  among  the  most  striking  diagnostic  symptoms  of  lead-poisoning.  The 
lower  extremities  are  also  attacked  in  some  cases ;  and  there  is,  particu- 
larly in  the  advanced  stages,  a  general  defect  of  muscular  power,  evinced 
by  tremulous  movements,  and  especially  by  trembling  of  the  tongue 
when  protruded.  The  involuntary  muscles  participate  in  some  degree 
in  the  palsy,  and  the  power  of  the  heart  becomes  at  length  very  sensibly 
diminished.  The  external  paralytic  and  neuralgic  complications  are 
generally  more  difficult  to  cure  than  the  colic. 

By  far  the  most  serious  effects  of  lead  are  those  upon  the  brain. 
They  usually  occur  at  the  close  of  protracted  cases;  but  sometimes  early, 
either  by  themselves,  or  associated  with  colic  or  palsy.  Among  the 
most  prominent  are  convulsive  attacks  similar  to  those  of  epilepsy, 
which  are  generally  fatal.  Sometimes  the  muscles  become  cataleptic; 
and  sudden  comatose  seizures  imitating  apoplexy  now  and  then  occur. 
Impaired  sight  and  hearing,  complete  amaurosis,  diminished  general 
sensibility,  delirium,  stupor,  and  coma,  are  usually  the  last  effects  of  the 
poison. 


CHAP.  I.]  ASTRINGENTS. — LEAD.  147 

Albuminuria  has  in  several  instances  been  noticed  as  one  of  the 
results  of  poisoning  by  lead.  It  is  apt  to  accompany  the  cases  compli- 
cated with  cerebral  disease  and  amaurosis,  and  may  serve  to  account  in 
part  for  these  affections,  through  the  uremic  poisoning  of  the  blood. 

Lead-poisoning  may  end  fatally  in  an  acute  attack,  or  may  last  for 
years,  with  alternations  of  exacerbation  and  remission,  of  seeming  recov- 
ery and  relapse,  or  with  a  more  or  less  continuous  course  of  deteriora- 
tion of  health,  under  an  intermittent  or  steady  exposure  to  the  cause.* 

Local  Effects.  Applied  locally,  and  in  a  quantity  insufficient  to  irritate, 
the  preparations  of  lead  produce  contraction  with  some  diminution  of 
f.'iisibility  in  the  surface,  and,  if  continued,  generally  occasion  a  bluish 
colour,  probably  by  penetrating  into  the  tissue,  and  forming  there  somt 
new  chemical  combination. 

Anatomical  Changes.  The  blood  is  deficient  in  red  corpuscles.  In  one 
case  examined  by  Andral,  they  had  been  reduced  to  83'8  parts  in  1000. 
the  mean  normal  proportion  being  about  1 25.  The  serum  has  a  yellow- 
ish hue,  as  also  have  the  viscera.  In  some  cases,  no  alteration  is  observ- 
able in  the  bowels;  in  others,  one  portion  has  been  found  contracted,  and 
another  dilated  in  the  same  subject.  In  cases  attended  with  albuminu- 
ria,  there  is  produced  in  the  kidneys,  according  to  M.  Lancereaux,  a  new 
formation  of  connective  material,  which  causes  the  retrogression  or  ab- 
sorption of  the  epithelial  cells.  (Ann.  de  Therap.,  1864,  p.  215.)  No 
characteristic  lesion  has  been  noticed  in  the  brain  or  spinal  marrow;  but 
the  muscles  long  affected  with  paralysis  are  usually  pale  and  atrophied, 
and  the  heart  and  blood-vessels  are  said  sometimes  to  be  contracted. 
Lead  has  been  discovered  in  the  tissue  of  all  the  organs  which  have 
evinced  signs  of  its  poisonous  influence  during  life. 

2.  Mode  of  Operation. 

There  can  be  little  doubt  that  the  preparations  of  lead  operate  by 
direct  contact  with  the  parts  affected,  being  in  the  first  place  absorbed 

*  Tbe  influence  of  the  poison,  in  cases  of  pregnancy,  besides  causing  abortion, 
is  said  either  directly  or  indirectly  to  extend  to  the  foetus,  leading  to  arrest  of  devel- 
opment and  even  death,  and,  when  these  results  are  avoided,  causing  various  mor- 
bid conditions  in  the  infant.  Thus,  of  six  cases  of  pregnancy  accompanied  with 
lead-poisoning,  observed  by  M.  Constantin  Paul,  three  of  the  offspring  perished  in 
the  first  six  months,  and  of  the  three  which  remained,  one  was  epileptic,  one  scrofu- 
lous, and  the  third  only  two  months  old,  so  that  time  had  not  been  allowed  for  the 
development  of  morbid  tendencies.  (Arch.  Gen.  de  Med.,  Mai,  I860.  p.  530.)  In  123 
cases  of  pregnancy,  there  were  04  abortions,  4  premature  deliveries,  5  still-born, 
20  infants  who  died  in  the  first  year,  8  in  the  second,  7  in  the  third,  1  later,  and  14 
living,  of  whom  only  10  were  more  than  three  years  old.  (Ibid.,  p.  532.)  M.  Paul 
also  states,  as  the  result  of  his  observation,  that  lead-disease  in  the  father,  as  well 
a^  in  the  mother,  serves  as  the  cause  of  the  death  of  the  foetus,  and  the  premature 
death  of  the  infant.  (Ibid.,  p.  516.)—  Note  to  the  third  edition. 


148  GENERAL    STIMULANTS.  [PART  II. 

into  the  Mood,  and  then  distributed  over  the  system.  By  Tiedemann 
and  Ginelin,  Orfila,  and  other  chemMs,  the  metal  has  been  detected  in 
tin-  blood,  the  urine  and  milk,  the  brain  and  spinal  marrow,  the  mus- 
cles, the  bones,  tin*  liver,  spleen,  and  kidneys,  and  in  the  coats  of  the 
stomach,  bowels,  and  gall-bladder.  As  it  exists  in  the  tissues,  it  is 
sometimes  not  discoverable  by  the  ordinary  tests;  incineration  being 
necessary  to  break  up  the  combination  in  which  it  is  probably  held  with 
organic  matter.  The  precise  character  of  this  combination,  whether  in 
the  blood  or  the  solid  tissues,  is  unknown.  The  system  has  in  general 
the  power  of  throwing  off  the  poison  sooner  or  later,  unless  in  quantities 
sufficient  to  destroy  life.  It  is  eliminated  by  the  kidneys,  skin,  mamma?, 
and  probably  by  the  various  secretory  organs  which  empty  into  the  ali- 
mentary canal.  How  long  it  may  remain  in  the  sy-teni  is  not  certainly 
known;  but  it  was  found  by  Orfila  in  the  liver,  intestinal  coats,  and 
bones  of  an  animal,  eight  months  after  it  was  administered.  (Med. 
Times  and  Gaz.,  iv.  279.)  It  may  operate  through  the  susceptibilities 
of  the  parts  with  which  it  is  brought  into  contact;  but  there  is  reason  to 
think  that  it  sometimes  at  least  enters  into  elementary  combination  with 
the  tissues,  and  thus  necessarily  modifies  their  action.  (See  Arch.  Gen., 
4e  ser.,  xxvii.  75.)  It  is  probably  through  its  presence  in  the  <ubstance 
of  the  nerves  themselves  that  it  occasions  neuralgic  pains,  and  at  length 
loss  of  power,  both  sensory  and  motive.  Colica  pictonum  is  a  combina- 
tion of  neuralgia  and  partial  palsy  of  the  bowels;  and  thus  the  internal 
correspond  exactly  with  the  external  effects  of  the  poison. 

The  chief  avenues  through  which  lead  enters  the  system  are  the  ali- 
mentary canal  and  the  lungs.  TBe  skin,  and  the  mucous  membranes  of 
the  eyes,  mouth,  and  nostrils,  may  possibly  admit  its  pas^a.uv  in  small 
proportion;  but,  with  the  epidermis  sound,  it  is  doubtful  whether  it  ever 
enters  through  the  skin  in  quantities  sufficient  to  produce  poisonous 
effects.  It  is  very  often  applied  to  the  surface  of  the  body  largely,  and 
for  a  long  time  consecutively,  even  in  its  most  soluble  forms,  without 
any  observable  general  effect,  When  applied  to  excoriated  surfaces  and 
•ulcers,  it  is  said  sometimes  to  have  occasioned  serious  lead-poisoning; 
though  I  have  never  witnessed  a  case  of  the  kind.  The  particular  part 
upon  which  it  may  first  display  its  effects,  and  the  rapidity  of  its  opera- 
tion, depend  in  some  measure  upon  the  surface  of  application.  Thus, 
when  taken  into  the  alimentary  canal,  it  may  be  inferred  to  be  more 
likely  to  occasion  colica  pictonum  than  through  any  other  avenue;  but 
it  must  he  allowed  that  positive  proof  to  this  effect  is  wanting.  It  prob- 
ably acts  must  readily  and  rapidly  through  the  respiratory  organs.  The 
late  J.  Price  Wetherill,  who  was  long  and  largely  engaged  in  the  manu- 
facture of  white  lead,  informed  me  that  the  workmen  in  his  employ,  most 
liable  to  be  poisoned,  were  those  engaged  in  preparing  the  thin  sheets  o'' 
lead  used  in  the  process.  The  operation  exposed  them  constantly  to  the 


CHAP.  I.]  ASTRINGENTS. — LEAD.  149 

fumes  of  the  melted  metal.  It  is,  moreover,  well  known  that  painters 
are  more  apt  to  be  attacked  when  they  use  oil  of  turpentine  in  mixing 
the  white  lead,  than  when  they  employ  fixed  oil  alone;  the  terebinthinate 
vapours,  in  the  former  case,  carrying  a  portion  of  the  lead  with  them 
into  the  lungs.* 

The  persons  most  exposed  to  the  poisonous  influence  of  lead,  are  those 
engaged  in  the  different  manufactures  and  arts  in  which  the  metal  is  con- 
cerned Miners  and  smelters  of  lead,  manufacturers  of  white  lead  and 
other  preparations  of  the  metal,  painters,  plumbers,  etc.,  are  apt  to  be 
affected. f  The  poison  is  frequently  taken  in  with  food  or  drink;  and  in 
many  instances  its  ill  effects  are  allowed  to  continue  long,  and  are  per- 
haps misinterpreted,  because  the  source  of  impregnation  is  hidden.  The 
practitioner  should  be  careful  to  guard  against  mistakes  of  this  kind,  and, 
whenever  symptoms  analogous  to  those  of  lead -poisoning  come  under 
his  observation,  should  diligently  search  for  the  cause  in  the  occupations, 
habits,  diet,  and  various  exposures  of  the  patient.  The  blue  discolora- 
tion of  the  gums  is  an  invaluable  sign  in  such  instances.  It  is  not  only 
those  cngaped  in  the  processes  in  which  lead  is  used  who  are  liable  to  be 
affected,  but  also  all  who  may  be  exposed,  from  residence  or  accidental 
vicinity,  to  the  same  influence.  In  relation  to  food,  independently  of 
the  occasional  presence  of  the  preparations  of  lead  from  pure  accident, 
carelessness,  or  malicious  intention,  the  poisonous  impregnation  may 
proceed  from  the  use  of  lead  glazing  for  earthen-ware,  or  of  soldering  in 
metallic  vessels,  especially  when  acid  substances  are  introduced  into 
them,  as  in  the  instance  of  pickles  or  preserves.  But  drinks  are  much 
more  liable  to  this  impurity.  Water,  through  the  agency  of  the  absorbed 
oxygen  and  carbonic  acid,  always  contained  in  it  when  exposed  to  the 
air,  is  capable  of  acting  on  metallic  lead,  forming  an  oxide  or  carbonate, 
which  may  be  held  in  solution  in  minute  proportion.  Of  course  the  same 

*  A  case  is  recorded  in  which  the  disease  originated  from  inhaling  the  fumes  of 
old  painted  wood  undergoing  combustion ;  the  poison  arising  no  doubt  from  the 
carbonate  of  lead  in  the  paint.  (Journ.  dePharm.  et  Chim.,  Mai,  1866,  p.  384.) — Nota 
to  the  third  edition. 

•j-  In  many  instances,  the  source  of  the  poisoning  is  very  obscure,  and  requires  a 
close  investigation  for  its  discovery;  but  the  symptoms  are  so  peculiar  that  they 
must  always  lead  to  suspicion,  however  little  apparent  cause  there  may  be  even  to 
imagine  the  presence  of  lead.  Thus,  the  working  people  in  a  factory  in  France,  whose 
business  was  to  give  a  certain  vitreous  coating  to  iron,  were  attacked  with  the  symp- 
toms of  lead-poisoning,  which,  on  investigation,  were  found  to  be  owing  to  the  use 
of  a  kind  of  crystalline  matter,  containing  a  small  proportion  of  oxide  of  lead.  In 
the  process  of  manufacture,  this  material  was  reduced  to  a  fine  powder,  which  was 
more  or  less  agitated,  causing  the  suspension  of  some  particles  in  the  air,  which,  be- 
ing inhaled,  were  the  source  of  the  mischief.  (Dr.  Archambault,  Arch.  Gen.  dt 
Med ,  Avril,  1861,  p.  129.)  The  same  result  would  probably  follow  exposure  to  the 
dust  of  powdered  flint  glass,  or  any  other  containing  lead.  (Note  to  the  third  edition.) 


150  GENERAL   STIMULANTS.  [PART  II. 

result  must  happen  from  contact  with  the  carbonate  already  formed. 
Hence,  lead-poisoning  has  often  proceeded  from  the  use  of  water  as 
drink,  which  had  stood  long  in  leaden  reservoirs,  or  passed  through 
leaden  pipes ;  and  the  similar  use  of  rain-water  falling  from  a  painted 
roof  has  produced  the  same  effect.  Certain  natural  waters,  in  conse- 
quence of  the  protective  agency  of  the  salts  which  they  contain,  are  less 
liable  to  be  thus  rendered  noxious  than  pure  water.  This  is  particu- 
larly true  of  those  containing  carbonates  and  sulphates.  It  has  been 
supposed  that  these  act  by  forming  carbonate  and  sulphate  of  lead,  which. 
being  insoluble,  are  precipitated  as  rapidly  as  they  are  formed,  and,  giv- 
ing a  coating  to  the  surface,  prevent  the  contact  of  the  water  with  the 
metal.  This  may  be  partially  true ;  but  such  a  coating  must  be  an  un- 
certain protection,  and  in  fact  has  often  proved  insufficient.  A  better 
explanation  of  the  effect  of  these  salts  is,  I  think,  the  following.  The 
carbonates  and  sulphates  referred  to  are  usually  those  of  lime.  In  the 
instance  of  carbonate  of  lime,  which  is  in  fact  a  bicarbonate,  the  proper 
carbonate  being  insoluble,  one  equivalent  of  the  carbonic  acid  seizes  the 
oxide  of  lead,  as  fast  as  formed,  and  the  reproduced  carbonate  then  appro- 
priates the  free  carbonic  acid  in  the  water,  which  is  thus  rendered  inca- 
pable of  acting  as  a  solvent  to  the  carbonate  of  lead  produced ;  for  this 
carbonate  is  quite  insoluble  in  pure  water.  A  little  carbonate  of  lime  in 
the  water  may  thus  serve  as  a  carrier  of  the  carbonic  acid  from  the  water 
to  the  oxide  of  lead,  and  keep  the  liquid  free  from  both.  In  the  instance 
of  the  sulphate  of  lime,  the  sulphuric  acid  combines  with  the  oxide  of 
lead  as  rapidly  as  it  is  generated,  or  decomposes  any  carbonate  of  lead 
that  may  have  been  produced,  in  either  case  forming  a  totally  insoluble 
sulphate  of  lead,  while  the  liberated  lime  would  neutralize  any  free  car- 
bonic acid  in  the  water.  It  is  thus  seen  that  these  salts  preserve  the 
purity  of  the  water,  not  simply  by  forming  a  mechanical  impediment  to 
its  contact  with  the  lead,  but  by  separating  the  impurity  at  the  moment 
of  its  generation.  It  is  in  this  way  probably  that  the  Schuylkill  water, 
with  which  the  city  of  Philadelphia  is  supplied,  is  kept  free  from  lead, 
though  constantly  flowing  through  leaden  pipes.  Water  containing 
chlorides  is  not  similarly  protected.  I  have  known  colica  pictonum  to 
prevail  in  a  neighbourhood  where  the  pump-water  is  brackish,  simply 
from  the  introduction,  as  a  substitute  for  the  common  pump,  of  an  appa- 
ratus containing  a  small  portion  of  leaden  pipe. 

Carbonic  acid  water  is  capable  of  dissolving  a  small  proportion  of 
lead.  I  have  known  of  two  cases  of  colica  pictonum  produced  by  drink- 
ing, every  morning,  the  first  draught  from  a  soda-water  fountain ;  in  the 
leaden  pipe  proceeding  from  which,  the  liquid  had  been  allowed  to  stand 
over  night 

The  use  of  fermented  and  spirituous  liquors  containing  lead  has  been 
a  fruitful  source  of  poisoning.  Cider  has  sometimes  been  kept  in  leaden 


CHAP.  I.]  ASTRINGENTS. LEAD.  151 

vats,  or  vessels  having  lead  in  or  about  them,  and  thus  become  impreg- 
nated with  malate  or  acetate  of  lead  with  the  most  fatal  effects.  I  have 
been  informed  of  cases  of  lead  colic,  produced  by  drinking  cider  which 
had  been  allowed  to  run  from  the  press  through  a  spout  of  that  metal. 
Wines  have  become  poisonous  in  a  similar  manner;  and  sometimes  also 
by  the  purposed  addition  of  metallic  lead,  or  acetate  of  lead,  to  improve 
their  flavour.  I  have  seen  an  account  of  large  numbers  of  a  regiment 
in  the  East  Indies  having  been  poisoned  by  drinking  arrack  containing 
lead. 

Even  the  metal  itself,  in  the  ordinary  state  in  which  it  exists  of  par- 
tial oxidation  upon  the  surface,  is  not  without  effect.  Lead-poisoning 
has  been  produced  by  the  habitual  chewing  of  sheet-lead,  such  as  lines 
the  tea-chests  from  China.* 

I  have  given  the  above  particulars  by  no  means  as  illustrating  all  the 
sources  of  lead-poisoning,  but  as  examples,  which  may  serve  to  direct 
the  inquiries  of  the  inexperienced  practitioner,  in  any  suspected  case  of 
the  kind.f 

3.  Treatment  of  the  Effects  of  Lead. 

When  a  quantity  of  any  one  of  the  preparations  has  been  swallowed, 
sufficient  to  produce  severe  irritation  or  inflammation  of  the  stomach,  an 
emetic  of  ipecacuanha  should  be  immediately  administered,  along  with 
sulphate  of  magnesia,  or  other  harmless  sulphate,  as  an  antidote,  and 
with  free  dilution.  The  salt  acts  by  forming  with  the  preparation  of 
lead  the  insoluble  and  comparatively  innocent  sulphate  of  that  metal. 
After  the  stomach  has  been  thoroughly  evacuated,  a  cathartic  dose  of 


*  A  very  interesting  account  has  been  published  of  extensive  lead-poisoning, 
affecting  upwards  of  200  persons  in  a  limited  community  in  Orange  Co.,  N.  York, 
which  was  found  to  be  owing  to  the  use  of  flour  obtained  from  a  certain  mill,  in 
which  defects  in  the  surfaces  of  an  old  pair  of  stones  had  been  obviated  by  filling 
the  cavities  with  melted  lead,  whereby  particles  of  the  metal,  separated  in  the  attri- 
tion, had  become  mingled  with  the  flour.  (Am.  Journ.  of  Pharm.,  July,  1866,  p.  366, 
from  N.  Y.  Tribune,  June  2.)  Even  the  use  of  cosmetics  containing  lead  is  believed 
to  have  been  a  source  of  the  disease;  and  a  case  of  the  kind  was  observed  by  Dr.  W. 
Couzins,  of  London.  (Med.  T.  and  Gaz.,  Sept.  1864.) — Note  to  the  third  edition. 

f  A  very  slight  degree  of  impregnation  with  lead  is  sufficient  to  render  water 
poisonous,  when  used  as  an  habitual  drink.  In  one  instance  where  a  whole  village 
suffered  from  this  cause,  Mr.  Herapath  found  the  proportion  of  lead  not  to  exceed 
half  a  millionth  of  the  weight  of  the  water.  Indeed,  the  proportion  is  so  small  as, 
in  the  dilute  state,  to  be  insensible  to  the  test  of  hydrosulphuric  acid.  Under  such 
circumstances,  Mr.  Herapath  evaporates  a  portion  of  the  water  to  dryness,  treats  the 
residue  with  nitric  acid,  and,  dissolving  the  product  in  a  small  proportion  of  water, 
passes  hydrosulphuric  acid  through  the  solution.  The  smallest  proportion  is  thus 
detected  by  the  dark  colour  produced  ;  the  nitrate  being  more  sensible  to  the  test 
than  the  bicarbonate,  in  which  state  the  lead  is  usually  held  in  the  water.  (Pharm. 
Journ.  and  Trans.,  xviii.  618.) 


152  GENERAL   STIMULANTS.  [PART  II. 

the  sulphate  of  magnesia  or  of  soda  should  be  given,  to  decompose  and 
carry  out  of  the  bowels  any  of  the  poison  which  may  have  enter*'  i 
them.  The  remaining  treatment  must  consist  of  measures  calculated 
to  remove  any  irritation  or  inflammation  that  may  have  been  produced; 
as  the  use  of  opiates,  demulcent  drinks,  counter- irritation  to  the  epigas- 
trium, and,  if  necessary,  leeching-. 

The  peculiar  poisonous  effects  of  lead  require  a  different  treatment. 
In  such  cases  the  metal  has  entered  the  blood,  and  is  probably  lodged  in 
the  various  tissues.  The  indications  are  to  obviate  the  pathological  con- 
ditions produced,  and  to  eliminate  the  poison  from  the  system.  Sul- 
phuric acid  and  the  different  sulphates  have  been  recommended  as 
antidotes;  but  it  is  obvious  that  they  are  not  calculated  to  correct  the 
action  of  the  absorbed  poison  in  this  way ;  for,  if  absorbed  themselves, 
they  could  act  only  by  converting  the  combination  of  lead,  existing  in 
(he  blood  or  the  tissues,  into  a  sulphate,  which,  from  its  comparative 
insolubility,  would  resist  elimination,  and  might  continue  to  exercise  a 
noxious  influence,  if  fixed  in  the  solids.  It  is  only  by  operating  on  any 
portion  of  the  poison  existing  in  the  alimentary  canal,  that  they  could 
do  good  in  this  way ;  and  when  there  is  reason  to  suppose  that  such  a 
condition  of  things  exists,  they  should  be  employed.  The  sulphurets 
have  a  similar  antidotal  power;  but,  from  their  more  irritant  properties, 
they  are  seldom  given  internally.  Used  externally  in  the  form  of  bath, 
they  prove  advantageous  by  converting  into  the  inert  sulphuret  any 
preparation  of  lead  that  may  adhere  to  the  surface ;  and  probably  still 
more  so,  by  disposing,  through  their  chemical  agency,  to  an  elimination, 
upon  the  surface  of  the  body,  of  the  lead  which  may  be  circulating  in 
the  blood.  It  is  asserted  that,  in  cases  of  saturnine  impregnation  of  the 
system,  the  use  of  these  baths  is  followed  by  the  production,  upon  the 
skin,  of  a  dark  matter,  which  is  the  sulphuret  of  lead.  The  result  may, 
it  is  true,  be  ascribed  to  the  excretion  of  the  lead  by  the  skin,  through 
the  unaided  powers  of  the  system ;  and  the  antidote  may  act  simply  by 
forming  a  sulphuret  with  the  excreted  metal.  Even  in  this  case,  it  might 
prove  useful  by  putting  the  poison  into  a  condition  unfitting  it  for  reab- 
sorption ;  but  the  probability,  I  think,  is,  that  it  has  a  positive  power  of 
elimination  through  its  affinity  for  the  lead  in  the  blood-vessels,  acting 
through  the  epidermis  and  the  capillary  walls;  and  that  thus  the  poison 
is  withdrawn  much  more  rapidly  than  it  would  be  by  the  excretory 
power  of  the  skin  alone.  The  bath  may  be  made  by  dissolving  four 
ounces  of  sulphuret  of  potassium  in  thirty  gallons  of  warm  water,  in  a 
wooden  tub.  After  immersion,  the  dark  coating  formed  should  be  re- 
moved from  the  surface  by  scrubbing  with  a  stiff  flesh- brush,  witli  soap 
and  water;  after  which  the  patient  should  be  again  immersed,  and  the 
process  repeated  so  long  as  any  obvious  discoloration  of  the  skin  is  pro- 
duced. In  a  short  time,  a  renewal  of  the  bath  will  be  found  again  to 


CHAP.  I.]  ASTRINGENTS. — LEAD.  153 

discolour  the  skin.  The  measure,  therefore,  should  be  repeated  twice  a 
week,  and  not  abandoned  until  this  effect  ceases  to  be  produced,  which 
may  not  happen  for  many  Avceks. 

Another  method  by  which  lead  may  be  eliminated  from  the  system,  is 
through  the  agency  of  some  body,  which,  received  into  the  blood,  and 
circulating  with  it,  may  be  brought  into  contact  with  the  insoluble  com- 
pound of  lead  in  the  tissues,  and,  rendering  it  soluble  in  the  blood,  may 
enable  that  fluid  to  take  it  up,  and  discharge  it  through  the  different 
emunctories.  Iodide  of  potassium,  which,  in  an  alkaline  solution,  has 
the  property  of  dissolving  lead,  was  recommended  for  this  purpose  by 
M.  Mclsens,  and  was  found  by  him  to  be  one  of  the  most  efficacious 
remedies  in  lead-poisoning.  According  to  this  theory  of  its  action,  evi- 
dences should  be  presented  of  the  absence  of  lead  in  the  urine  or  other 
excretions  before  the  use  of  the  iodide,  and  its  presence  afterwards.  This 
evidence  M.  Melsens  did  not  produce ;  but,  subsequently  to  the  publica- 
tion of  his  memoir,  Dr.  E.  A.  Parkes,  of  London,  found  the  requisite 
proof  in  a  case  which  came  under  his  notice  (Brit,  and  For.  Medico- 
chirurg.  Rev.,  Am.  ed.,  xi.  411)  ;  and  Dr.  H.  S.  Swift,  of  New  York,  has 
given  an  account  of  no  less  than  twenty-three  cases,  in  which  the  iodide 
was  used  very  advantageously  in  obstinate  lead-poisoning,  and  in  many 
of  which  lead  was  detected  in  the  urine  after  the  use  of  the  remedy, 
though  in  no  instance  could  it  be  discovered  previously.  (N.  Y  Me.d. 
Times,  Hi.  145.)  M.  Melsens  found,  in  his  experiments  on  animals,  that 
the  poisonous  effects  of  the  lead  were  increased  when  the  iodide  was 
early  employed,  probably  in  consequence  of  its  rendering  the  poison  in 
the  alimentary  canal  more  soluble,  and  consequently  more  readily  ab- 
sorbed ;  and  it  is  not  impossible  that  the  liberation  of  the  lead  from 
certain  tissues,  and  its  reintroduction  into  the  blood,  may  occasionally, 
for  a  time,  aggravate  the  symptoms.  Dr.  Swift  noticed  this  in  two  out 
of  twenty-three  cases ;  but  the  aggravation  was  slight,  and  improve- 
ment was  soon  evinced.  From  five  to  twenty  grains  of  the  iodide  may 
be  given  three  times  a  day,  and  continued  until  the  symptoms  of  poison- 
ing cease.  One  evidence  of  improvement  is  the  disappearance  of  the 
blue  discoloration  of  the  gums  produced  by  the  lead. 

The  above  remarks  are  applicable  to  lead-poisoning  in  general.  Par- 
ticular forms  of  it  require  special  modifications  of  treatment.  In  the 
form  of  colic,  it  is  necessary  to  relieve  the  pain,  and  overcome  the  obsti- 
t  nate  constipation.  For  this  purpose,  the  preparations  of  opium  are  to 
be  employed  in  connection  with  purgatives,  of  which  calomel,  croton  oil, 
castor  oil,  and  sulphate  of  magnesia  are  perhaps  the  best.  The  last- 
mentioned  remedy  has  the  additional  advantage  of  converting  the  poi- 
sonous preparation  of  lead  in  the  bowels  into  the  sulphate.  The  pur- 
gatives may  be  aided  by  cathartic  enemata.  Tobacco  cataplasms,  and 
chloroform  over  the  abdomen,  have  been  recommended  for  the  purpose 


1,04  GENERAL    STIMULANTS.  [PART  II. 

of  relieving  pain  and  relaxing  spasm ;  and  the  latter  remedy  has  been 
used  internally  with  the  same  view.  The  mercurial  impression  has  been 
considered  as  antidotal  to  the  saturnine,  and  calomel  with  a  view  to 
salivation  has  been  considerably  used ;  but  it  is  seldom  necessary. 
Alum  often  acts  most  happily  in  the  disease,  sometimes  speedily  reliev- 
ing all  the  symptoms,  when  the  opiate  and  purgative  plans  have  failed. 
It  may  be  employed  conjointly  with  them  from  the  beginning  of  the 
treatment.  It  has  been  supposed  to  operate  chemically,  either  upon  the 
poison  remaining  in  the  bowels,  or  on  that  contained  in  the  tissue  of 
their  coats,  by  converting  the  compound  of  lead  into  a  sulphate ;  but, 
were  this  its  mode  of  action,  the  same  effects  should  be  obtained  from 
diluted  sulphuric  acid  or  Epsom  salt,  which  have  not  been  found  to 
answer  as  well  in  practice.  As  the  insensibility  of  the  bowels  to  purga- 
tive influence  is  probably  owing  to  a  partial  condition  of  paralysis,  the 
use  of  strychnia  is  indicated  in  obstinate  cases. 

In  the  paralytic  cases,  besides  the  use  of  the  antidotal  measures  above 
referred  to,  and  especially  iodide  of  potassium  and  sulphuretted  baths, 
recourse  may  be  had  to  strychnia,  electricity,  and  the  application  of 
blisters;  and  the  mercurial  impression  may  be  tried,  should  other  meas- 
ures fail.  When  neuralgic  pains  complicate  the  palsy,  opiates  or  other 
anodynes  may  be  conjoined  with  the  antidote. 

In  the  cerebral  cases,  whether  convulsive,  comatose,  or  delirious,  gen- 
eral and  local  bleeding,  cold  to  the  head,  sinapisms  or  blisters  to  the 
extremities,  and  purgation  have  been  generally  deemed  advisable ;  and, 
should  the  state  of  the  circulation  call  for  these  remedies,  they  should 
undoubtedly  be  employed.  But  there  is  reason  to  believe  that  these 
phenomena,  sometimes  at  least,  depend  upon  a  direct  impression  made 
by  the  lead  upon  the  cerebral  centres,  analogous  to  that  upon  the 
bowels  and  the  external  muscles;  and,  as  this  is  rather  of  a  depressing 
than  excitant  character,  it  may  be  a  question,  whether  opiates  and  other 
cerebral  stimulants  may  not  prove  more  effectual  than  depletory  meas- 
ures. In  a  fatal  case,  with  violent  delirium,  spasmodic  rigidity  of  the 
muscles,  and  convulsions,  ending  in  coma,  in  which  the  depletory  and 
revulsive  measures  were  employed  with  no  effect,  no  sign  could  be  dis- 
covered after  death  of  inflammation  or  active  congestion  of  the  brain  or 
its  membranes.  (Arch.  Gen.,  4e  ser.,  xxvii.  71.)  In  such  a  case,  if  at- 
tended with  an  unexcited  state  of  the  pulse,  and  palene.-^  of  the  face,  I 
should  be  disposed  to  try  the  plan  referred  to,  of  course  in  conjunction 
with  the  proper  antidotal  measures. 

Prevention.  In  relation  to  preventive  measures,  the  best  rule  is  to 
guard,  by  extreme  care,  against  the  introduction  of  the  poison  into  the 
system.  For  this  purpose,  the  cautions  should  be  observed  to  keep  the 
hands  and  surface  of  the  body  clean,  and,  as  far  as  possible,  to  avoid 
swallowing  any  of  the  poison  whether  in  food,  drink,  or  mixed  with  the 


CHAP.  I.]       ASTRINGENTS. — ACETATE  OF  LEAD.  155 

saliva.  It  cannot  be  kept  from  the  lungs  when  the  air  inspired  is 
impregnated  with  it;  but  much  may  be  done  for  self-protection  by 
preventing  this  impregnation,  and  by  avoiding  the  inhalation  of  the 
poisoned  atmosphere.  Thus,  in  the  manufacture  of  white  lead,  it  has 
been  found  that  the  disease  is  less  prevalent  since  the  introduction  of 
grinding  the  salt  under  water,  than  when  it  was  powdered  dry,  and 
thus  caused  to  fill  the  air  with  its  fine  particles.  The  habitual  use  of 
sulphuric  acid,  diluted  so  as  to  form  an  agreeable  drink,  has  been  re- 
commended as  a  preventive  to  those  who  are  necessarily  exposed.  But 
it  is  evident  that  the  acid  can  act  only  on  the  portion  of  the  poison 
swallowed;  and,  as  the  sulphate  has  been  shown  not  to  be  altogether 
innocuous,  it  cannot  be  a  complete  safeguard  even  against  this;  while 
the  steady  use  of  a  substance  so  active  as  sulphuric  acid  cannot  itself  be 
without  its  inconveniences.* 

4.  Therapeutic  Application. 

The  therapeutic  indications  to  be  fulfilled  by  the  preparations  of  lead, 
based  upon  their  astringent  and  sedative  properties,  are  mainly  to  arrest 
hemorrhage  and  morbibly  increased  secretions,  and  to  reduce  inflamma- 
tion. But  it  will  be  most  convenient  to  consider  the  remedial  uses  of  the 
metal,  under  the  head  of  its  several  preparations,  and  especially  under 
that  of  the  acetate,  which  is  the  only  one  much  employed  internally. 

5.  Preparations  of  Lead. 

I.  ACETATE  OF  LEAD.— PLUMBI  ACETAS.  U.  S.,  Br. — Sib- 
gar  of  Lead. — Saccharum  Saturni. 

Acetate  of  lead  is  prepared  by  the  action  of  vinegar,  or  other  form  of 
dilute  acetic  acid,  either  upon  plates  of  metallic  lead  oxidized  by  ex- 
posure to  the  air,  or  directly  upon  the  protoxide  of  lead  with  the  aid  of 
heat.  It  is  the  neutral  acetate  of  the  protoxide  of  lead,  consisting  of 
one  equivalent  of  acetic  acid,  one  of  protoxide  of  lead,  and  three  equiva- 
lents of  water. 

Sensible  and  Chemical  Properties  This  salt  is  in  the  form  of  shining, 
white,  acicular  crystals,  isolated  or  in  masses,  efflorescent,  of  a  sweet  and 
astringent  taste,  and  often,  when  long  kept,  of  an  acetous  odour,  owing 
probably  to  the  action  of  the  carbonic  acid  of  the  air,  and  the  slow 
escape  of  acetic  acid.  It  is  readily  dissolved  by  water;  and  the  solution 

*  In  the  instances,  in  the  arts,  in  which  water  has  to  pass  through  leaden  pipes, 
it  is  recommended  by  M.  Schwartz,  of  Breslau,  that  the  pipes,  before  being  used, 
should  be  filled  with  a  concentrated  solution  of  an  alkaline  sulphuret,  whereby 
their  internal  surface  receives  an  insoluble  and  impermeable  varnish  of  sulphuret 
of  lead,  perfectly  protecting  the  water  from  contact  with  the  metal.  (Repertoire  dt 
Pharmacie,  Nov.  1863.) — Xole  to  the  third  edition. 


156  GENERAL    STIMULANTS.  [PART  II. 

has  a  white  turbid  appearance,  which,  when  the  water  is  free  from  saline 
impurities,  is  removed  by  the  addition  of  vinegar  or  acetic  acid.  The 
whiteness  is  owing  to  the  carbonate  of  lead,  formed  by  the  combination 
of  the  carbonic  acid,  which  is  contained  in  all  natural  waters,  with  a  por- 
tion of  the  protoxide  of  lead,  liberating  the  acetic  acid,  and  thereby  giving 
the  solution  an  acetous  smell.  In  hard  waters,  the  white  precipitate  is 
usuallv  a  sulphate  or  chloride  of  lead,  and  not  redissolved.  Distilled 
water,  recently  boiled,  forms  a  perfectly  clear  solution  with  the  acetate, 
if  quite  pure;  but,  as  found  in  the  shops,  the  salt  often  contains  a  por- 
tion of  carbonate,  in  which  case  the  solution  will  be  more  or  less  opaque. 

Incompatibles.  Acetate  of  lead  yields  precipitates  with  sulphuric, 
phosphoric,  citric,  tartaric,  meconic,  and  carbonic  acids,*  and  all  the  solu- 
ble salts  of  these  acids ;  with  hydrochloric  and  hydriodic  acids,  and  all  the 
soluble  chlorides  and  iodides;  with  hydrosulphuric  acid,  and  the  soluble 
sulphurets ;  with  tannic  acid,  and  consequently  all  the  vegetable  astrin- 
gents; with  certain  mucilages,  and  especially  that  of  slippery  elm  bark, 
but  not  with  pure  gum;  with  chondrin  and  albumen;  and  with  lime- 
water,  and  solutions  of  ammonia,  potassa,  and  soda,  the  last  t\vo  redis- 
solving  the  precipitate  if  added  in  excess.  The  precipitate  formed  with 
the  sulphurets  is  black,  with  the  iodides  yellow,  and  with  the  other 
reagents  mentioned  white  or  whitish.  But,  though  the  above  substances 
are  chemically  incompatible,  it  does  not  follow  that  they  are  medicinally 
so.  On  the  contrary,  many  of  the  precipitates  are  probably  not  less 
efficient  than  the  acetate;  and,  in  fact,  this  salt  is  often  exhibited  in  con- 
nection with  substances  which  decompose  it.  What  it  is  necessary  for 
the  practitioner  to  guard  against  is  the  addition  of  the  incompatible  sub- 
stances in  solution.  In  the  form  of  pill  or  powder,  they  may  frequently 
be  added  with  advantage,  when  rcmedially  indicated.  The  only  sub- 
stances which  should  always  be  avoided  are  sulphuric  or  hydrosulphuric 
acid,  and  the  soluble  sulphates  or  sulphurets;  as  the  precipitates  formed 
with  these  are  feeble,  if  not  inert.  It  is  probable  that  acetate  of  lead  is 
always  decomposed  in  the  alimentary  canal,  either  by  the  hydrochloric 
acid  or  the  chlorides  in  the  stomach,  or  hydrosulphuric  acid  in  the  bowels. 

Effects  upon  the  System.  Acetate  of  lead  has  all  the  effects  upon  the 
system  which  have  already  been  described  as  characterizing  the  prepa- 
rations of  lead  in  general.  In  large  doses,  or  unsuitably  applied,  it  is 
irritant;  but,  when  so  employed  as  to  obtain  its  peculiar  influence,  it  is 
astringent  and  sedative. 

1.  Its  irritant  effects  are  shown  when  it  is  applied  in  strong  solution 
to  delicate  surfaces,  as  to  the  conjunctiva,  the  urethra,  or  the  skin  denuded 

*  I  have  verified  by  experiment  the  decomposition  of  perfectly  neutral  and  pure 
acetate  of  lead  by  carbonic  ncid.  The  whole  of  the  salt,  however,  is  not  decomposed ; 
as,  when  the  acetic  acid  has  attained  a  certain  degree  of  excess,  it  appears  to  pre- 
vent the  further  action  of  the  carbonic  acid. 


CHAP.  I.]        ASTRINGENTS. — ACETATE  OP  LEAD.  157 

of  the  cuticle,  or  when  taken  too  largely  into  the  stomach.  Orfila  found 
it,  when  introduced  in  large  quantity  into  the  stomach  of  dogs,  to  occa- 
sion fatal  inflammation;  and  the  gastric  and  intestinal  mucous  membrane 
was  observed  to  be  whitened  by  its  chemical  action.  In  man,  when 
taken  in  excessive  doses,  it  generally  produces  vomiting,  burning  pain 
in  the  oesophagus  and  stomach,  and  tenderness  in  the  epigastrium, 
usually  followed  by  severe  griping  in  the  bowels,  and  sometimes  by  con- 
vulsions, coma,  and  local  palsy,  especially  if  the  bowels  arc  not  acted  on. 
Its  dangers,  however,  as  an  irritant  poison,  were  formerly  much  over- 
rated ;  for,  though  often  taken  accidentally  in  quantities  varying  from  a 
drachm  to  an  ounce,  no  fatal  case  is,  I  believe,  on  record  from  its  imme- 
diate effects.  Being  frequently  prescribed  for  external  use,  at  the  same 
time  that  Epsom  salt  is  directed  as  a  cathartic,  it  has  occasionally  been 
swallowed  instead  of  the  latter,  which,  in  its  turn,  has  been  applied 
locally;  and  this  accident  should  be  carefully  guarded  against  by  the 
practitioner.  I  was  once  called  to  a  case  of  the  kind,  in  which  two 
drachms  of  the  acetate  had  been  swallowed,  with  the  effect  of  producing 
severe  gastric  pain  ;  but,  before  I  reached  the  patient,  a  dose  of  sulphate 
of  zinc  had  been  taken,  which  caused  vomiting,  and  no  injury  ensued. 
What  quantity,  therefore,  may  be  considered  as  poisonous,  in  reference 
to  the  irritant  action,  it  is  impossible  to  say;  but  this  much  may  be 
inferred,  that  there  is  less  danger  to  life  from  its  temporaiy  influence  in 
an  excessive  dose,  than  from  the  same  amount  given  in  minute  doses 
frequently  repeated,  and  spread  over  a  considerable  length  of  time.  The 
mode  of  treating  its  poisonous  effects,  as  an  irritant,  has  been  given  under 
the  general  head  of  the  preparations  of  lead.  The  best  antidote  is  sul- 
phate of  magnesia,  or  sulphate  of  soda. 

2.  It  has  been  doubted  whether  acetate  of  lead  is  capable  of  producing 
the  poisonous  constitutional  effects  of  the  metal,  especially  if  protected 
against  conversion  into  the  carbonate  by  an  excess  of  acetic  acid.  Cer- 
tainly, considerable  doses  have  been  given  daily,  and  continued  long, 
without  any  observable  influence  on  the  general  system  ;  and  the  extreme 
fear  formerly  entertained  by  many,  as  to  the  danger  of  its  internal  use  as 
a  medicine,  has  been  shown  to  have  had  little  foundation  in  fact.  Never- 
theless, that  it  is  capable  of  producing,  when  incautiously  or  recklessly 
employed,  all  the  dangerous  constitutional  effects  of  lead,  has  been  abund- 
antly proved  by  experience.  Dr.  Mulford,  of  Camden,  N.  J.,  many 
years  ago,  assured  me  that  he  had  witnessed  two  cases  of  colica  picto- 
num  resulting  from  its  medicinal  use;  and  many  instances  to  the  same 
effect  have  since  been  placed  on  record.  Death  has  occurred  in  one 
instance  from  colic  and  paralysis,  in  a  boy  of  fifteen,  to  whom  from  one 
to  eight  grains,  in  divided  portions,  were  given  daily  until  the  whole 
amounted  to  somewhat  more  than  two  drachms.  In  the  Provincial 
Medical  and  Surgical  Journal  (June  27th,  1849),  Dr.  William  Norris, 


GENERAL   STIMULANTS.  [PART  II. 

of  Stourbridge,  relates  an  occurrence  in  which  nearly  a  thousand  persons 
were  more  or  less  poisoned,  in  consequence  of  a  mistake  made  by  a  baker, 
who  mixed  thirty  pounds  of  acetate  of  lead,  instead  of  the  same  quan- 
tity of  alum,  with  sixty  or  eighty  sacks  of  flour.  It  may  be  said  that,  in 
this  case,  the  acetate  was  decomposed  before  being  taken.  It  probably 
was  so ;  but  not  more  certainly  than  it  is  decomposed  in  the  stomach, 
after  having  been  swallowed.  Dr.  L.  S.  Jones,  of  Accomack,  Ya.,  has 
related  a  case  of  obstinate  colica  pictonum,  which  resulted  from  thirty 
grains  of  the  acetate,  given  in  four  days,  though  care  was  taken  to  ac- 
company the  use  of  the  medicine  with  vinegar.  (Stethoscope,  i.  6G4.)  It 
is  proper,  therefore,  to  observe  some  caution  in  the  use  of  this  medicine. 
With  such  caution,  I  believe  it  may  always  be  given  safely.  I  have  been 
in  the  habit  of  using  acetate  of  lead  for  forty  years,  have  given  it  in  a 
vast  number  of  cases,  and  though,  after  a  certain  continuance  of  the 
medicine,  griping  pains  in  the  bowels  have  generally  occurred,  often 
with  nausea  and  general  malaise,  I  have  never  witnessed  more  than  one 
instance  in  my  practice,  in  which  anything  that  could  properly  be  de- 
nominated colica  pictonum  has  resulted.  I  have  not  unfrequently  pre- 
scribed two  grains  every  two  hours  through  the  day,  and  continued  it 
for  several  days,  sometimes  even  for  weeks,  before  any  sign  of  its  consti- 
tutional effects  were  evinced.  I  have,  however,  always  been  careful  to 
suspend  the  medicine  as  soon  as  the  effects  on  the  stomach  and  bowels 
just  referred  to,  or  a  blue  discoloration  of  the  gums,  have  been  noticed. 

Therapeutic  Application.  This  medicine  is  much  used  for  the  general 
purposes  of  the  astringents.  In  consequence  of  its  combination  of  seda- 
tive with  astringent  properties,  it  will  frequently  act  very  efficiently  in 
the  relief  of  inflammation,  when  brought  directly  into  contact  with  the 
surface  affected;  and  it  is  to  this  agency  that  much  of  its  therapeutic 
value  is  to  be  ascribed  I  shall  first  treat  of  its  internal,  and  subse- 
quently of  its  external  or  local  use. 

1.  Internal  Use.  The  hemorrhages  are  among  the  complaints  in  which 
it  is  most  useful.  Its  sedative  property  gives  it  a  great  advantage  in 
these  affections,  especially  when  of  the  active  kind,  over  other  astrin- 
gents, which,  being  somewhat,  however  slightly,  stimulant,  cannot 
always  be  employed  with  propriety  in  the  early  stage.  Acetate  of  lead 
may  always  be  given  when  the  indication  exists  to  suppress  the  dis- 
charge. But,  from  the  facility  with  which  lead  is  absorbed,  the  medi- 
cine is  peculiarly  adapted  to  those  cases  in  which  the  affected  part  can 
be  reached  only  by  the  medium  of  absorption  and  circulation.  When 
the  seat  of  the  hemorrhage  is  such  that  the  astringent  can  be  directly 
applied  to  it,  alum  is  probably  more  efficient  as  a  mere  hemostatic. 
Such  are  the  cases  of  hemorrhage  from  different  parts  of  the  alimentary 
canal.  But  in  hemorrhage  from  the  lungs,  acetate  of  lead  is  preferable 
to  all  other  astringents,  and  is  very  much  used.  In  hemorrhage  from 


CHAP.  I.]  ASTRINGENTS. ACETATE    OF    LEAD.  159 

the  kidneys,  and  from  the  uterus,  it  is  also  one  of  the  best  remedies.  In 
the  former,  I  have  seen  it  promptly  effectual,  and  would  strongly  recom- 
mend it.  In  all  these  cases,  but  especially  in  haemoptysis,  it  should 
generally  be  combined  with  a  little  opium  to  prevent  irritation  of  stom- 
ach, and  with  ipecacuanha  if  there  is  febrile  excitement,  without  nausea 
or  a  tendency  to  it.  The  opiate  is  peculiarly  indicated  in  the  pulmonary 
affection,  from  its  effect  in  quieting  the  cough.  About  one-sixth  of  a 
grain  of  opium,  and  an  equal  or  double  quantity  of  ipecacuanha,  may 
be  combined  with  each  dose  of  the  acetate.  Though,  as  above  stated, 
alum  is  probably  more  effectual  in  hsematemesis  and  intestinal  hemor- 
rhage, yet  the  salt  of  lead  is  frequently  employed  in  these  affections, 
and  not  without  advantage.  It  should  in  these  also  be  combined  with 
opium. 

In  certain  conditions  of  diarrhoea,  this  medicine  is  very  useful.  I  do 
not  think  it  adapted  to  the  acute  form  of  the  disease,  attended  with  in- 
flammatory excitement;  but  rather  to  chronic  cases  with  copious  and 
exhausting  discharges,  with  or  without  ulceration  of  the  small  intes- 
tines; and  I  have  also  found  it  extremely  useful  in  certain  cases, 
whether  recent  or  of  long  standing,  in  which,  without  evidences  of  in- 
flammation, the  evacuations  are  very  copious,  and  of  a  whitish  gruel- 
like  appearance  from  the  absence  of  bile.  In  these  latter  cases,  it  should 
be  given  in  combination  with  small  doses  of  calomel  and  opium,  and 
frequently  repeated.* 

In  epidemic  cholera,  with  exhausting  rice-water  discharges,  the 
above-mentioned  combination  is,  I  think,  the  most  efficacious  which 
can  be  employed ;  but  the  urgency  of  the  danger  in  this  case  demands 
larger  doses  than  simple  diarrhoea ;  as  it  is  of  the  utmost  importance  to 
produce  a  prompt  impression. 

The  advanced  stages  of  cholera  infantum  may  sometimes  be  treated 
advantageously  with  this  astringent.  It  may  be  tried  in  all  obstinate 
cases  of  the  disease,  in  connection  with  opiates,  and  with  a  little  calomel 
or  blue  mass  when  bile  is  wanting  in  the  passages.  Occasionally  it  has 
been  found  efficient,  not  only  in  arresting  the  diarrhrea,  but  also  in  cor- 
recting the  irritable  stomach  of  this  disorder,  probably  by  an  antiphlo- 
gistic influence  on  the  gastric  mucous  membrane. 

It  is  the  same  antiphlogistic  action  which  has  recommended  it  in 
dysentery,  in  the  treatment  of  which  it  is  highly  esteemed  by  some.  Its 
use  in  acute  dysentery  originated  with  the  late  Dr.  Richard  Harlan,  of 
Philadelphia ;  and  has  found  many  advocates.  I  confess,  however,  that 

*The  following  formula  may  be  used.  R.  Pluinbi  acetat.,  gr.  vj  ;  Hydrarg 
chlorid.  mil.,  Opii  pulv.,  aa  gr.  j ;  Acacise  pulv.,  Syrup,  aa  q.  s.  Mix,  so  as  to 
form  a  mass,  to  be  divided  into  six  pills,  of  which  one  may  be  taken  every  half 
hour,  hour,  or  t^  i>  hours,  according  to  the  urgency  of  the  case. 


160  GENERAL   STIMULANTS.  [PART  II. 

my  experience  with  it,  in  the  ordinary  forms  of  this  affection,  does  not 
accord  with  theirs.  It  no  doubt  appears  to  act  favourably  in  some 
ca>i's;  but  I  have  often  met  with  others,  in  which,  after  an  employment 
of  several  days,  it  has  increased  the  griping  and  uneasiness  of  the 
patient,  without  any  beneficial  influence  over  the  disease,  and  in  which 
the  symptoms  have  speedily  subsided,  under  proper  treatment,  after  its 
omission.  But  in  chronic  cases,  with  rather  copious  discharges,  it  is 
often  useful.  I  shall  have  occasion  directly  to  refer  to  a  condition  of 
dysentery,  in  which  it  may  be  employed  as  an  injection  writh  the  greatest 
advantage.  As  in  other  bowel  affections,  it  should  in  this  also  be  asso- 
ciated with  opium. 

In  reference  to  its  antiphlogistic  effects,  acetate  of  lead  has  been  used 
with  great  supposed  advantage  in  pneumonia,  especially  in  the  old,  and 
in  other  cases  in  which  bleeding  has  been  sufficiently  employed,  or  may 
be  contraindicated.  (L' Union  Medicate,  No.  82.)  But  pneumonia  so 
often  ends  in  recovery  under  any  treatment,  that  reports  of  the  efficacy 
of  one  or  another  remedy  must  be  received  with  great  hesitation. 

Excessive  sweating,  exhausting  diuresis,  copious  mucous  or  purulent 
discharges  from  the  respiratory  and  urinary  passages,  and  abundant 
suppuration,  from  whatever  source,  have  been  considered  as  offering  in- 
dications for  the  astringent  influence  of  acetate  of  lead.  In  phthisis  it 
has  been  recommended  for  the  night-sweats,  the  muco-purulent  expecto- 
ration, which  is  sometimes  exhaustingly  copious,  and  the  diarrhoea,  either 
severally  or  conjointly.  As  to  the  night-sweats,  I  think  they  are,  in 
general,  more  effectually  and  more  safely  controlled  by  other  means,  less 
calculated  than  acetate  of  lead  to  disturb  the  digestive  process,  which  it 
is  all-important  to  sustain.  The  same  remark  is  applicable  to  the  expec- 
toration. In  these  affections,  therefore,  separutrly,  I  would  not  advise 
the  remedy;  but,  when  they  exist  in  combination  with  obstinate  diar- 
rhoea, and  a  chronic  sub-inflammatory  condition  of  the  gastric  mucous 
membrane,  the  indication  for  its  use,  in  reference  to  the  latter  conditions, 
is  perhaps  strengthened  by  the  possible  benefit  which  may  be  hoped  for 
from  it,  in  reference  to  the  former. 

Obstinate  mercurial  salivation  is  said  to  have  yielded  to  the  internal 
use  of  this  remedy;  but  its  local  application  is  preferable. 

In  yellow  fever,  acetate  of  lead  was  strongly  recommended  by  the 
late  Dr.  Irvine,  of  Charleston,  S.  C.  It  is  only  in  the  second  stage,  after 
the  subsidence  of  the  first  long  febrile  paroxysm,  that  the  remedy  should 
be  employed.  At  this  period,  with  greatly  reduced  powers  of  system, 
and  probable  depravation  of  the  blood,  there  is  usually  phlogosis  of  the 
gastric  mucous  membrane,  with  a  tendency  to  prostrating  hemorrhage, 
in  the  form  either  of  unaltered  blood  or  black  vomit.  Should  the  blood 
be  fatally  depraved,  no  medicine  could  save  the  patient;  but  in  doubtful 
cases,  where  a  slight  impression  might  turn  the  scale  in  the  favourable 


CHAP.  I.]        ASTRINGENTS. ACETATE  OF  LEAD.  161 

direction,  it  seems  reasonable  to  expect  benefit  from  a  medicine,  calcu- 
lated, by  contracting  the  vessels,  and  exercising  a  sedative  influence  on 
the  nerves,  at  once  to  correct  the  inflammation  and  obviate  the  hemor- 
rhage. I  have,  myself,  used  the  acetate  of  lead  under  these  circum- 
stances, in  a  few  instances,  and  in  all  with  favourable  results.  In  one 
case,  there  was  an  appearance,  in  the  evacuations  from  the  stomach,  of 
commencing  black  vomit.  Two  grains  should  be  given,  with  a  little 
opium,  every  two  hours,  and  continued  until  thirty-six  or  forty-eight 
grains  have  been  taken,  or  until  the  dangerous  period  is  past,  unless 
some  unpleasant  effect  of  the  medicine  should  be  previously  experienced. 
I  would  repeat,  that  the  acetate  is  not  to  be  used  until  the  first  febrile 
symptoms  have  begun  to  subside,  which  is  usually  on  the  second  or 
third  day. 

In  enteric  or  typhoid  fever,  acetate  of  lead  would  seem  to  be  indi- 
cated as  an  alterative  and  antiphlogistic  remedy  for  the  diseased  state  of 
the  mucous  membrane  of  the  ileum.  Hence,  it  has  been  recommended 
in  this  affection  by  the  German  practitioners.  In  this  country,  it  has 
been  employed  very  successfully  by  Dr.  John  L.  Atlee,  of  Lancaster,  Pa., 
who  gives  it  in  doses  of  from  one  to  three  grains  every  two,  three,  or 
four  hours,  commencing,  after  having  first  evacuated  the  bowels  by  a 
mild  cathartic,  and  persevering  so  long  as  the  enteric  symptoms  con- 
tinue. I  cannot  speak  of  the  remedy  from  experience,  having  never 
used  it  in  this  complaint. 

In  the  irritable  stomach  of  bilious  fever,  and  in  other  cases  of  06- 
stinale  vomiting,  the  medicine  has  been  employed  with  supposed  advant- 
age ;  though  it  might  be  difficult  to  say,  in  many  instances  of  this  kind, 
how  much  was  due  to  the  acetate,  and  how  much  to  the  opium  usually 
given  along  with  it. 

Aneurisms  of  the  aorta  and  of  other  large  internal  vessels  have 
been  treated  with  some  advantage  by  acetate  of  lead.  Introduced  into 
use  originally  in  Germany,  the  practice  was  imitated  by  Dupuytren  and 
others  in  France;  and  I  have  myself  tested  its  efficacy  in  some  degree  in 
this  country.  The  astringent  and  sedative  influence  of  the  preparations 
of  lead  would  seem  to  be  indicated  in  this  affection ;  and  several  in- 
stances are  on  record  in  which  the  tumour  has  very  much  diminished  in 
size  under  the  use  of  the  acetate.  (Arch.  Gen.,  3e  ser.,  v.  443.)  In  one 
of  several  cases  in  which  I  employed  it  in  the  Pennsylvania  Hospital,  an 
aneurismal  tumour,  which  showed  itself  projecting  from  the  thorax  near 
the  left  sterno-clavicular  junction,  underwent  a  marked  diminution,  and 
became  at  length  scarcely  perceptible  ;  but  the  patient  left  the  house 
before  any  definitive  result  was  obtained.  I  am  not  aware  that  any 
satisfactory  case  of  a  complete  cure  by  this  remedy  has  been  reported. 
Indeed,  considering  the  condition  of  the  coats  of  the  vessels  in  internal 
aneurism,  altered  as  they  generally  are  by  atheromatous  deposit,  car- 
VOL.  i. — 11 


162  GENERAL   STIMULANTS.  [PART  II. 

tilaginous  or  bony  degeneration,  or  other  organic  affection,  a  cure  by 
this  measure  would  be  in  most  cases  impossible;  and,  even  when  no 
insurmountable  difficulty  of  this  kind  might  be  in  the  way,  few  constitu- 
tions would  probably  be  found  to  tolerate,  and  few  patients  to  submit  to 
the  long-continued  and  persevering  use  of  the  medicine  which  would  be 
necessary  to  success.  The  plan  is  to  give  six  or  eight  grains  of  the 
acetate  daily,  in  doses  of  one  or  two  grains,  at  equal  intervals,  and  to 
continue  until  nausea  or  griping  pains  in  the  bowels,  or  other  symptoms 
of  lead-poisoning  are  exhibited ;  then  to  suspend  the  remedy  until  these 
symptoms  have  subsided ;  after  which  it  is  to  be  resumed ;  and  thus  altern- 
ately, until  the  end  aimed  at  is  effected,  or  found  to  be  unattainable. 

Simple  enlargement  of  the  heart,  independent  of  disease  of  the  valves, 
would  seem  to  offer  quite  as  good  a  chance  of  success,  under  this  treat- 
ment, as  internal  aneurism.  I  have  employed  it  in  cases  of  this  kind; 
and,  in  one  of  great  cardiac  dilatation  in  a  boy,  found  the  dimensions  of 
the  heart,  as  indicated  by  percussion,  to  diminish  considerably.  What 
finally  became  of  the  case  I  do  not  know ;  as  the  patient  passed  from 
under  my  care  in  the  midst  of  the  treatment. 

Acetate  of  lead  has  been  used  in  various  nervous  diseases,  as  epilepsy, 
hysteria,  hooping-cough,  and  even  tetanus;  but  few  would  at  present 
expect  from  it  any  very  material  benefit  in  these  affections.  I  remember 
to  have  seen  somewhere  an  account  of  a  case  of  hydrophobia  which  had 
ended  favourably  under  its  use;  but  there  can  be  little  doubt  that  the 
disease  was  mistaken. 

2.  Local  or  External  Use.  Under  this  head,  it  is  intended  to  embrace 
all  those  modes  of  using  the  remedy,  in  which  it  is  brought  into  direct 
contact  with  the  seat  of  its  intended  operation  through  extraneous 
agency,  including  injection  into  the  various  passages  opening  extern- 
ally, as  well  as  application  to  the  surface  of  the  body.  In  these  it  acts 
upon  the  same  principles  as  when  used  internally.  But  it  is  more  especi- 
ally for  its  antiphlogistic  effects  that  it  is  employed.  As  a  mere  styptic, 
either  for  arresting  hemorrhage,  or  controlling  increased  secretion  un- 
connected with  inflammation,  as  excessive  sweating  for  example,  it  is 
less  efficient  than  alum,  or  probably  the  vegetable  astringents.  In  refer- 
ence to  the  mucous  surfaces,  it  is,  as  a  general  rule,  better  adapted  to 
the  earliest  stage  of  inflammation,  or  the  very  advanced  stage  when  sup- 
puration has  taken  place,  or  to  the  chronic  forms  of  the  affection,  than  to 
the  condition  of  acute  inflammation  in  full  vigour.  But  this  remark  does 
not  apply  to  affections  of  the  skin,  protected  by  the  cuticle. 

As  an  eye-wash  in  ophthalmia,  from  one  to  two  grains  of  the  acetate 
may  be  dissolved  in  a  fluidounce  of  rose-water,  or  simple  distilled  water. 

In  chronic  inflammation  of  the  nasal  passages,  with  purulent  dis- 
charge, a  solution  containing  from  ten  to  twenty  grains  to  the  fluid- 
ounce  of  water,  may  be  injected  or  otherwise  introduced  into  the  nostrils, 


CHAP.  I.]       ASTRINGENTS. — ACETATE  OF  LEAD.  163 

once  or  twice  daily,  with  hope  of  benefit.  Care,  however,  should  be 
taken,  in  such  cases,  that  none  of  the  solution  is  swallowed. 

Chronic  suppuration  of  the  auditory  meatus  may  be  treated  in  a 
similar  manner ;  though  it  would  be  prudent  to  commence  with  a  weaker 
solution,  say  from  two  to  five  grains  to  the  fluidounce,  and  to  increase  if 
found  necessary. 

As  a  mouth- wash  or  gargle,  acetate  of  lead  is  chiefly  employed  in 
cases  of  mercurial  salivation,  in  which  it  is  one  of  the  best  applications. 
For  this  purpose,  the  solution  may  have  the  strength  of  two  or  three 
grains  to  the  fluidounce  to  begin  with.  It  often  blackens  the  teeth  and 
tongue,  in  consequence  of  the  formation  of  sulphuret  of  lead,  through 
reaction  with  the  sulphur  contained  in  the  salivary  liquids.  But  this 
discoloration  is  of  no  serious  importance,  and  gradually  disappears.  In 
ordinary  ulccration,  or  pseudomembranous  affections  of  the  mouth  and 
fauces,  sulphate  of  zinc,  or  nitrate  of  silver,  in  solution,  is  more  effectual 
than  tlie  salts  of  lead. 

In  certain  cases  of  dysentery  affecting  the  rectum  especially,  and  at- 
tended with  little  general  disturbance  of  the  system,  a  solution  of  acetate 
of  lead,  injected  into  the  rectum,  often  serves  an  excellent  purpose.  It 
will  sometimes  put  an  almost  immediate  end  to  cases,  which  have  proved 
tedious  under  other  treatment.  From  four  to  six  fluidounces  of  a  solu- 
tion, containing  two  or  three  grains  of  the  acetate  in  each. fluidounce, 
with  thirty  or  forty  drops  of  laudanum  in  the  whole  quantity,  should  be 
injected  three  times  a  day.  The  laudanum  is  useful  by  facilitating  the 
retention  of  the  liquid,  as  well  as  by  directly  calming  irritation.  It  ie 
true  that  the  meconate  of  morphia  is  converted  into  the  acetate,  while  a 
little  insoluble  meconate  of  lead  is  formed;  but  this  result  is  of  no  prac- 
tical importance.  It  may  be  obviated,  however,  by  substituting  for  the 
laudanum  one-quarter  or  one-third  of  a  grain  of  acetate  of  morphia. 

Encmata  composed  of  ten  grains  of  acetate  of  lead,  dissolved  in  six 
fluidounces  of  warm  water,  and  administered  every  two  hours,  are  said 
to  have  been  used,  with  remarkable  success,  in  strangulated  hernia. 

In  gonorrlicea  and  leucorrhoea,  injections  of  the  salt  are  often  very 
useful.  For  the  effectual  treatment,  however,  of  these  affections,  the 
solution  should  be  very  frequently  repeated,  so  that  the  impression  may 
be  steadily  maintained.  In  gonorrhoea,  the  injection  should  be  admin- 
istered not  less  than  six  times  a  day,  at  equal  intervals.  It  should  be 
at  first  of  the  strength  of  two  or  three  grains  to  the  fluidounce,  which 
may  be  increased  if  necessary. 

Perhaps  for  no  purpose  is  this  salt  more  employed  than  for  the  relief 
of  inflammatory  affections  of  the  skin  and  the  subcutaneous  tissue.  In 
erysipelas,  when  the  inflammation  is  very  high  ;  in  the  more  inflam- 
matory forms  of  erythema,  as  E.  nodosum ;  in  certain  cases  of  herpes, 
eczema,  and  other  cutaneous  eruptions  attended  with  much  heat,  pain, 


164  GENERAL   STIMDLANTP.  [PART  II. 

and  redness;  in  inflammation  of  the  subcutaneous  areolar  tissue,  either 
arising  spontaneously,  as  in  phlegmon,  or  resulting  from  sprains,  bruises, 
etc.,  and  in  acute  swelling  of  the  external  lymphatic  glands,  a  solution 
of  acetate  of  lead  is  often  highly  useful  in  the  alleviation  or  cure  of  the 
inflammation.  For  these  purposes,  two  drachms  of  the  acetate  may  be 
dissolved  in  a  pint  of  soft  water;  the  turbidness  being  corrected  by  a 
fluidrachm  of  vinegar  or  diluted  acetic  acid.  In  some  cases,  laudanum 
or  acetate  of  morphia  may  be  usefully  added.  The  solution  may  be  ap- 
plied by  means  of  folded  linen  wet  with  it,  or  in  the  form  of  the  cold 
poultice,  made  by  mixing  the  solution  with  crumb  of  bread,  and  en- 
closing the  soft  mass  in  linen  or  gauze. 

It  is  customary,  in  cases  of  superficial  inflammation,  particularly  the 
erysipelatous,  to  apply  mucilaginous  solutions  with  a  view  to  their  anti- 
phlogistic effect.  This  may  be  increased  by  the  addition  of  acetate  of 
lead  to  the  solution  ;  but  it  should  be  remembered  that  this  salt  is  in- 
compatible with  certain  mucilages,  particularly  with  those  of  slippery 
elm  and  quince-seeds,  with  which  it  forms  precipitates,  and  thus  deprives 
the  liquid  of  its  mucilaginous  property.  But  with  the  mucilages  of  flax- 
seed  and  the  pith  of  sassafras  it  reacts  but  slightly,  not  sufficiently  to 
impair  materially  their  demulcent  properties,  or  to  interfere  with  its  own 
efficiency.  These  latter  mucilages,  therefore,  should  always  be  selected, 
preferably  to  those  first  mentioned,  for  external  use  in  connection  with 
acetate  of  lead.  Thus,  we  may  add  this  salt  with  propriety  to  an  eye- 
wash of  mucilage  of  sassafras  pith,  often  used  in  ophthalmia,  while  it 
would  be  incompatible  with  mucilage  of  quince-seeds,  also  used  for  the 
same  purpose. 

In  irritable  or  inflamed  ulcers,  and  those  attended  with  very  pro- 
fuse discharges,  and  in  inflamed  blistered  surfaces,  a  solution  of  acetate 
of  lead  may  also  be  used,  but  of  not  more  than  half  the  strength  of  that 
employed  where  the  cuticle  is  entire.  In  these  cases,  the  acetate  often 
reacts  with  the  albumen  and  salts  of  the  secreted  liquid,  producing  a 
white  insoluble  compound.  This  is  ordinarily  of  no  inconvenience;  but, 
in  ulcers  of  the  cornea,  there  is  danger  that  this  compound  may  become 
permanently  incorporated  with  the  tissue,  forming  an  opaque  spot,  which 
cannot  be  removed.  In  this  aflection,  therefore,  the  salt  should  not  be 
used. 

Administration.  Acetate  of  lead  may  be  given  in  pill  or  solution. 
The  pill  is  best  made  with  mucilage  of  gum  arabic  and  syrup,  as  these 
are  not  incompatible  with  the  salt.  It  should  be  prepared  as  wanted 
for  use.  Opium  is  often  combined  with  the  salt;  and,  though  mutual 
decomposition  may  take  place  between  the  meconate  of  morphia  and 
acetate  of  lead,  no  practical  disadvantage  results.  Nor  is  the  addition  of 
the  vegetable  astringents  improper,  as  the  resulting  tannate  of  lead  is 
officient.  When  the  salt  is  given  in  solutiou,  the  preparation  is  rendered 


CHAP.  I.]  ASTRINGENTS. — SUBACETATE   OP   LEAD.  165 

more  elegant  by  the  addition  of  a  few  drops  of  acetic  acid,  or  a  little 
distilled  vinegar;  but  Dr.  Thomson  was  mistaken  in  thinking  that  the 
poisonous  effects  of  the  lead  could  in  this  way  be  prevented.  Colica 
pictonum  has  followed  the  use  of  the  acetate  thus  protected.  Indeed,  it 
may  be  considered  nearly  certain  that  the  salt  is  always  decomposed  in 
the  stomach,  whether  given  with  or  without  a  little  acetic  acid.  Lauda- 
num renders  the  solution  turbid  by  the  formation  of  meconate  of  lead; 
but  its  efficiency  is  not  impaired.  The  other  incompatibles  before  re- 
ferred to  (see  page  156)  should  be  avoided  in  connection  with  the  salt 
in  solution,  though  many  of  them  may  be  given  with  it  in  the  pilular 
form. 

The  dose  of  acetate  of  lead  is  from  one  to  three  grains,  which,  in  acute 
cases,  may  be  repeated  every  hour,  two,  or  three  hours,  and  in  chronic 
cases,  three  or  four  times  daily. 

In  the  form  of  ointment  or  cerate,  the  acetate  of  lead  may  be  employed 
as  a  dressing  for  irritable  or  inflamed  ulcers,  excoriated  surfaces,  and 
blisters,  and  may  be  prepared  by  thoroughly  rubbing  together  half  a 
drachm  of  the  salt  very  finely  powdered,  and  an  ounce  of  simple  oint- 
ment ;  but  the  cerate  of  the  subacetate  is  preferable,  for  the  purposes 
mentioned. 

II.  SOLUTION  OF  SUBACETATE  OF  LEAD. — LlQUOR 
PLUMBI  SUBACETATIS.  U.S.,Br. —  Goulard's  Extract. 

This  is  made  by  boiling  litharge  or  protoxide  of  lead  with  solution 
of  acetate  of  lead,  and  filtering. 

It  is  a  solution  of  diacetate  of  lead,  consisting  of  one  equivalent  of 
acetic  acid  and  two  of  protoxide  of  lead. 

Sensible  and  Chemical  Properties.  The  solution  is  a  colourless  liquid, 
of  a  sweetish  and  astringent  taste,  of  the  sp.  gr.  1.267  as  prepared  by  the 
U.  S.  process,  and  of  an  alkaline  reaction.  Exposed  to  the  air,  it  absorbs 
carbonic  acid,  forming  the  carbonate  of  lead,  which  is  deposited  at  the 
bottom  and  on  the  sides  of  the  vessel.  Its  constituents  are  known  by 
the  same  tests  as  those  of  the  neutral  acetate,  from  which  it  is  distin- 
guished by  forming  a  heavy  white  precipitate  with  solution  of  gum 
arable,  which  is  not  affected  by  that  salt,  and  by  being  more  copiously 
precipitated  by  carbonic  acid. 

Incompatibles.  These  are  the  same  as  those  of  the  neutral  acetate, 
with  the  addition  of  pure  gum  arabic,  and  certain  mucilages,  as  those 
of  sassafras  pith  and  flaxseed,  which  are  strongly  precipitated  by  the 
diacetate,  while,  though  in  some  degree  affected  by  the  neutral  salt,  they 
are  scarcely  sufficiently  so  to  be  incompatible  with  it.  Gum  mezquite, 
brought  into  notice  some  years  since  by  Dr.  Shumard,  as  a  product  of 
New  Mexico,  though  strongly  resembling  gum  arabic  in  many  of  its 
properties,  does  not,  according  to  Professor  Procter,  yield  a  precipitate 
with  the  solution  of  subacetate  of  lead. 


166  GENERAL    STIMULANTS.  [PART  II. 

Medical  Properties  and  Uses.  This  solution  has  all  the  effects  on  the 
system  of  the  other  preparations  of  lead,  but  in  this  country  and  Great 
Britain  is  seldom  if  ever  given  internally.  In  France,  it  has  been  pre- 
scribed by  M.  Boudin,  with  some  success,  in  the  vomiting  of  epidemic 
cholera. 

Its  local  effects  are  the  same  as  those  of  the  acetate,  but  probably 
somewhat  more  intense.  In  France,  it  is  much  employed  for  all  the 
purposes  for  which  the  acetate  is  used  locally  with  us;  for  example,  as 
a  collyrium  in  ophthalmia;  as  an  injection  in  morbid  discharges  from 
the  nostrils  and  ear;  as  a  mouth- wash  and  gargle  in  different  forms  of 
angina  and  stomatitis;  as  an  enema  in  chronic  mucoid  or  purulent  dis- 
charges from  the  rectum,  with  or  without  ulceration ;  and  as  a  topical 
remedy  in  Ieucorrho3a  and  gonorrhoea.  I  have  long  been  in  the  habit  of 
using  acetate  of  lead,  by  injection,  in  cases  of  acute  dysentery  affecting 
especially  the  rectum.  M.  Barthcz  has  successfully  used  the  solution  of 
the  subacetate  in  the  same  way;  and  the  practice  has  been  extended  to 
acute  diarrhoea  and  epidemic  cholera,  with  satisfactory  results.  Vast 
quantities  were  injected,  largely  diluted  with  warm  water,  without  any 
unpleasant  constitutional  effect;  the  liquid  producing  its  local  impression 
upon  the  mucous  membrane,  but  not  being  retained  long  enough  to  be 
largely  absorbed.  M.  Barthez  administered  at  first  somewhat  more  than 
a  drachm  in  100  times  its  weight  of  water;  but  afterwards  increased  the 
quantity  to  one,  two,  and  even  three  ounces  in  one  injection,  without 
poisonous  effects.*  (Trousseau  et  Pidoux.) 

In  this  country,  the  use  of  the  solution  of  subacetate  of  lead  is  con- 
fined chiefly  to  superficial  inflammations,  either  of  the  skin,  the  subcu- 
taneous cellular  tissue,  the  lymphatic  glands,  the  tendons  and  aponeu- 
roses,  or  the  more  superficial  vessels,  whether  absorbents  or  veins.  In  the 
inflammation  of  sprains,  bruises,  wounds,  etc.;  in  the  more  inflammatory 
states  of  certain  cutaneous  eruptions,  as  erythema,  erysipelas,  eczema, 
herpes,  and  impetigo;  in  burns,  blisters,  and  excoriations;  and  in  various 
ulccrative  affections  attended  with  irritation,  inflammation,  excessive 
secretory  discharge,  or  hemorrhage;  it  may  be  used  as  an  antiphlo- 
gistic, astringent,  anodyne,  or  haemostatic.  For  the  purposes  above 
mentioned,  the  preparation  is  usually  employed  very  much  diluted,  as 
in  the  form  of  the  officinal  diluted  solution. 

In  France,  it  has  recently  been  recommended,  in  very  strong  solution, 
in  mercurial  salivation;  not  less  than  a  sixth,  or  an  eighth  part  being 
used  in  the  mouth-water  or  gargle  employed;  and  a  preparation  of  equal 
strength  is  recommended  in  leucorrboeal  discharges,  especially  connected 
with  superficial  ulceration  of  the  neck  of  the  uterus,  being  applied  by 
means  of  a  sponge  or  roll  of  linen  saturated  with  the  liquid. 


*  The  up.  gr.  of  the  present  French  preparation  is  1.32,  while  that  of  the  U.  S. 
Pharm.  is  1.2G7;  so  that  the  former  is  considerably  stronger  than  the  latter. 


CHAP.  I.]  ASTRINGENTS. — SUBACETATE   OF    LEAD.  167 

Great  success  has  been  claimed,  in  the  treatment  of  the  inflammation 
and  fungous  growth  connected  with  inverted  nail,  for  the  solution  of 
subacctate  of  lead,  applied  by  separating  the  nail  from  the  flesh,  and 
every  hour,  two,  or  three  hours,  dropping  into  the  vacant  space  two  or 
three  drops  of  the  liquid;  the  parts  in  the  mean  time  being  covered  with 
a  pledget  of  raw  cotton  wet  with  the  same  liquid,  and  the  cotton  changed 
every  day. 

The  following  are  preparations  of  the  solution  now  under  consider- 
ation. 

1.  DILUTED   SOLUTION   OP   SUBACETATE   OP    LEAD.— 
LIQUOR  PLUMBI  SUBACETATIS  DILUTUS.  U.S.,  Br. — Lead  Water. 

This  dilute  solution,  usually  called  lead  water,  is  at  present  made  by 
adding  three  fluidrachms  of  the  strong  solution  to  a  pint  of  water.  The 
carbonic  acid  in  the  water  causes  some  turbidness  in  the  diluted  prepa- 
ration, which  does  not,  however,  interfere  with  its  virtues.  The  strength 
of  the  diluted  solution  may  often  be  much  increased  with  advantage;  and 
from  half  a  fluidounce  to  a  fluidounce  may  be  employed  to  each  pint, 
with  perfect  impunity,  when  the  cuticle  is  unbroken.  Local  paralysis  is 
stated  in  the  books  to  have  resulted  from  its  use;  and,  though  this  must 
be  extremely  rare,  as  I  have  never  witnessed  nor  heard  of  a  well-authen- 
ticated case  of  it,  still  some  caution  should  be  exercised  in  applying  the 
solution  to  abraded  surfaces.  It  may  be  applied  by  means  of  linen  cloths, 
or  in  the  form  of  the  cold  poultice,  as  the  solution  of  acetate  of  lead. 

2.  CERATE  OP  SUBACETATE  OP  LEAD. — CERATUM  PLUMBI 
SUBACETATIS.  U.S. — UNGUENTUM  PLUMBI  SUBACETATIS.  Br.  —  Gou- 
lard's Cerate. 

This  consists  of  the  solution  of  subacetate  of  lead,  incorporated  with 
wax,  olive  oil,  and  a  very  little  camphor.  It  is  an  excellent  preparation, 
admirably  calculated  to  produce  the  local  effects  of  lead,  in  cases  in  which 
the  cuticle  is  wanting.  Irritable,  inflamed,  and  painful  ulcers  are  often 
relieved  by  it;  while  by  its  astringeiicy  it  favours  desiccation  in  those 
which  are  copiously  suppurating,  and  disposes  the  loose  and  flabby  to 
take  on  the  healing  process.  In  blisters,  burns  or  scalds,  chilblains,  inter- 
trigo  and  other  forms  of  superficial  abrasion  or  excoriation,  herpetic,  ecze- 
matous,  and  impetiginous  eruptions  with  serous  or  puruloid  discharge, 
and  a  similar  condition  in  lichen  agrius  and  other  cutaneous  affections, 
it  is  one  of  the  best  applications  that  can  be  made.  I  know  nothing 
equal  to  it  as  a  dressing  for  blisters  indisposed  to  heal.  In  many  in- 
stances, and  particularly  in  the  one  last  mentioned,  it  may  be  combined 
at  first  with  an  equal  weight  of  simple  cerate.  The  caution  should 
always  be  observed  not  to  employ  it  in  a  rancid  state,  in  which  it  be- 
comes irritant.  Hence  it  should  be  made  with  perfectly  sweet  oil,  and 
used  as  fresh  as  possible.  It  is  sometimes  combined  with  opium,  or 
calomel,  or  both,  as  an  application  in  skin  diseases  of  a  local  character. 


168  OENKRAL    STIMULANTS.  [PART  IT. 

3.  SOAP  CERATE.— CERATUM  SAPONIS.  U.S. 

This  was  made,  according  to  the  Pharmacopoeia  of  1850,  by  boiling 
the  solution  of  subacetate  of  lead  with  soap,  and,  after  due  evaporation, 
addinir  wax  and  olive  oil.  The  process  yielded  a  fine  white  cerate,  ca- 
pable of  being  spread  by  a  knife  upon  linen  or  muslin.  The  present 
Pharmacopoeia  prepares  it  by  melting  lead  plaster  with  wax,  and  adding 
olive  oil  to  the  mixture.  Soap  cerate  is  a  mild  sedative  and  desiccant 
preparation,  applicable  to  similar  purposes  with  the  preceding,  and 
employed  in  scrofulous  swellings,  and  other  external  inflammations. 

III.  CARBONATE  OF  LEAD.—  PLUMBI  CARBONAS.  U.  S.,  Br. 
—  Cerusse. —  Cerussa. — White  Lead. 

White  lead  is  made  either,  1.  by  the  reaction  of  the  vapour  of  vinegar, 
and  exhalations  from  decomposing  stable  manure,  upon  coiled  plates  of 
lead,  or  2.  by  passing  carbonic  acid  through  a  solution  of  subacetate 
of  lead.  Its  composition  is  somewhat  different  according  to  the  mode 
of  preparation.  The  neutral  carbonate,  made  by  double  decomposition 
between  a  soluble  salt  of  lead  and  an  alkaline  carbonate,  consists  of  one 
eq.  of  acetic  acid,  and  one  of  protoxide  of  lead ;  the  white  lead  of  com- 
merce is  generally  believed  to  be  a  compound  of  this  neutral  carbonate 
with  variable  proportions  of  hydrated  oxide  of  lead. 

Sensible  and  Chemical  Properties.  Carbonate  of  lead  is  in  the  form 
of  a  white  powder  or  pulverulent  lumps,  heavy,  inodorous,  and  nearly 
tasteless,  insoluble  in  pure  water,  very  slightly  soluble  in  water  contain- 
ing carbonic  acid,*  dissolved  with  effervescence  by  nitric  acid,  blackened 
by  sulphuretted  hydrogen,  reduced  by  heat  to  the  yellow  protoxide,  and 
by  heat  with  charcoal  to  the  metallic  state. 

Impurities.  The  commercial  carbonate  of  lead  is  very  often  adulter- 
ated ;  the  most  common  impurities  being  sulphates  of  lime,  baryta,  and 
lead,  and  carbonate  of  lime. 

Effects  on  the  System.  This  salt,  in  consequence  of  its  insolubility,  is 

i 

*  To  test  the  solubility  of  carbonate  of  lead,  the  following  experiment  was  per- 
formed at  my  request  by  Professor  Procter.  A  solution  of  neutral  acetate  of  lead 
was  precipitated  by  carbonate  of  potassa,  and  the  carbonate  of  lead  thus  obtained 
WHS  thoroughly  washed.  This  was  introduced  into  a  bottle  containing  carbonic 
ucid  water,  which  was  instantly  corked.  After  standing  for  twelve  hours,  with 
occasional  agitation,  the  liquid  was  filtered,  exposed  to  the  air  so  as  to  allow  that 
portion  of  the  carbonic  acid  to  escape  which  had  been  retained  by  pressure,  and 
subsequently  boiled  so  as  to  drive  off  the  remainder.  No  appreciable  deposition 
took  place,  nor  was  the  liquid  att'ccted  by  iodide  of  potassium;  but  when  a  current 
of  sulphuretted  hydrogen  was  passed  through  it,  the  liquid  was  perceptibly  dark- 
ened, and  upon  standing  deposited  a  minute  quantity  of  sulpliuret  of  lead.  Thin 
experiment  proves  that  carbonate  of  lead  is  appreciably  dissolved  by  water  impreg- 
nated with  carbonic  acid,  and  is  retained  by  the  water  after  the  carbonic  acid  has 
been  driven  off  by  heat. 


CHAP.  I.]        ASTRINGENTS. — NITRATE  OF  LEAD.  189 

less  apt  than  the  acetates  to  irritate  or  inflame  the  alimentary  mucous 
membrane;  but  it  more  readily  affects  Ihe  system  at  large,  and  is  sup- 
posed by  some  to  be  the  most  noxious  of  all  the  preparations  of  lead. 
This  proneness  to  act  on  the  system  may  possibly,  as  suggested  by  Dr. 
Christison,  be  owing  to  the  disposition  which,  from  its  weight  and  insol- 
ubility, the  carbonate  of  lead  has  to  adhere  to  the  membrane,  so  that  it 
is  not  carried  off  with  the  contents  of  the  bowels,  and  is  more  exposed 
to  absorption. 

Medical  Uses.  Carbonate  of  lead  is  never  given  internally.  Exter- 
nally, it  is  employed  as  a  desiccant  and  antiphlogistic  application.  Some 
recommend  it  to  be  sprinkled  in  the  state  of  powder  upon  excoriated 
surfaces;  but  it  should  be  used  in  this  way  with  caution.  I  have  known 
it,  sprinkled  thickly  upon  an  abraded  surface  on  the  leg,  to  produce 
severe  inflammation,  with  much  pain  and  swelling,  and  a  superficial 
slough.  There  is  some  danger,  too,  from  its  absorption;  for  a  case  is 
on  record  in  which  death  in  a  child  resulted  from  the  external  use  of  the 
medicine.  The  best  method  of  application  is  in  the  form  of  an  ointment 
(UNGTJENTUM  PujMBi  CARBONATES,  U.S.,  Br.),  which  is  made  by  rub- 
bing up  eighty  grains  of  very  finely  powdered  carbonate  thoroughly 
with  a  troyounce  of  simple  ointment,  previously  softened  by  a  gentle 
heat.  In  this  way  it  may  be  used  in  ulcers,  burns  and  scalds,  excoria- 
tions of  different  kinds,  and  irritating  cutaneous  eruptions.  A  liniment, 
formed  by  mixing  it  with  flaxseed  oil  to  the  consistence  of  cream,  has 
been  particularly  recommended  in  burns.  A  case  is  reported  by  Dr. 
Kunkler,  of  Madison,  Indiana,  in  which  colica  pictonum  occurred  in 
consequence  of  the  application  of  carbonate  of  lead,  in  the  form  of  com- 
mon white  paint,  to  an  extensive  scald  of  the  arm ;  but  this  effect  is 
very  rare.  (N.  Am.  3Tedico-chirurg.  Rev.,  i.  605.) 

IV.  NITRATE  OF  LEAD.— PLUMBI  NlTRAS.  U.  S. 

This  is  made  by  direct  combination  of  litharge  and  nitric  acid.  It 
consists  of  one  equivalent  of  protoxide  of  lead  and  one  of  nitric  acid, 
without  water. 

Sensible  and  Chemical  Properties.  Nitrate  of  lead  is  in  white,  nearly 
opaque,  four  or  eight-sided  crystals,  inodorous,  sweet  and  astringent  to 
the  taste,  permanent  in  the  air,  soluble  in  water  and  alcohol,  and  char- 
acterized by  evolving  nitrous  vapour  when  heated,  and  by  yielding  a 
white  precipitate  with  fcrrocyanide  of  potassium,  a  yellow  one  with 
iodide  of  potassium,  and  a  black  one  with  hydrosulphate  of  ammonia. 

Effects  on  the  System.  So  far  as  known,  these  are  the  same  as  those 
of  the  other  soluble  salts  of  lead. 

Therapeutic  Application.  Nitrate  of  lead  was  long  since  employed 
as  an  internal  remedy  in  asthma,  epilepsy,  and  the  hemorrhages;  but  it 
is  now  almost  entirely  out  of  use,  having  been  superseded  by  the 
acetate. 


170  GENERAL    STIMULANTS.  [PART  II. 

As  it  possesses  the  property  of  decomposing  hydrosulplmric  acid  and 
the  hydrosulphates,  it  corrects  fctid  odours  dependent  upon  these  sub- 
stances, and  may  be  employed  with  that  object.  Hence  it  is  occasionally 
sprinkled  in  the  chambers  of  the  sick,  and  added  to  offensive  discharges 
to  obviate  their  smell.  For  this  purpose,  a  solution  may  be  employed 
containing  a  drachm  in  every  fluidounce  of  water.  Ledoyen'x  disinfect- 
ing liquid  is  of  this  nature.  But,  though  it  will  correct  offensive  odours, 
there  is  no  proof  that  it  will  prevent  putrefaction,  or  decompose  and 
render  innoxious  contagious  effluvia,  or  the  malaria  of  marshes.  It 
should,  therefore,  never  be  depended  on  as  an  antidote  to  these  noxious 
agents. 

Having,  with  the  corrective  property  above  referred  to,  the  desiccant 
and  sedative  powers  of  the  saturnine  preparations  generally,  it  may  be 
employed,  with  reference  to  both,  as  an  external  application,  in  offensive 
ulcers,  and  fetid  discharges  from  the  nostrils,  ears,  vagina,  and  uterus. 
To  these  purposes  it  has  been  applied  by  Dr.  Ogicr  Ward,  who  uses  it 
also  in  gleety  discharges  from  the  urethra,  and  in  chronic  impetiginous 
affections.  He  employs,  however,  an  extemporaneous  preparation,  made 
by  dissolving  one  scruple  of  carbonate  of  lead  in  as  much  diluted  nitric 
acid  as  may  be  necessary  for  the  purpose,  and  adding  this  to  a  pint  of 
distilled  water.  It  may  be  applied  two  or  three  times  daily.  In  the 
more  obstinate  cases,  a  much  stronger  solution  may  be  used  with  im- 
punity. On  the  continent  of  Europe,  a  solution,  containing  ten  grains 
of  the  nitrate  in  a  fluidounce  of  water,  has  been  advantageously  em- 
ployed in  sore  nipples,  chapped  hands,  cracked  lips,  and  various  ex- 
coriations. 

The  dose  of  the  nitrate,  for  internal  use,  would  be  from  one-quarter  of 
a  grain  to  a  grain,  to  be  repeated,  in  acute  cases,  every  two  or  three 
hours ;  in  chronic,  two  or  three  times  a  day. 

V.  IODIDE  OF  LEAD. — PLUMBI  lODIDUM.  U.S. 

This  is  made  by  mutual  decomposition  between  iodide  of  potassium, 
and  nitrate  or  acetate  of  lead  in  solution ;  the  resulting  precipitate  being 
washed  with  distilled  water.  It  consists  of  one  equivalent  of  lead  and 
one  of  iodine. 

Sensible  and  Chemical  Properties.  It  is  a  yellow,  heavy,  inodorous, 
and  nearly  tasteless  powder,  soluble  in  somewhat  more  than  1000  parts 
of  cold  water,  arid  about  200  of  boiling  water,  soluble  also  in  alcohol, 
fusible  and  volatilizable  by  heat,  yielding  vapours  at  first  yellow,  but 
ultimately  violet  from  the  disengagement  of  iodine.  It  should  be  kept 
excluded  from  the  light. 

Medical  Effects  and  Uses.  Its  effects  are  probably  identical  with  those 
produced  by  the  other  preparations  of  lead.  The  preparation  has  been 
supposed  to  produce  also  the  effects  of  iodine,  and,  under  this  impression, 
has  been  given  in  tuberculous  affections,  but  with  little  advantage.  In 


CIIAP.   I.]         ASTRINGENTS. — SEMIVITRIFIED    OXIDE    OF    LEAD.          171 

scrofulous  and  syphilitic  swelling's  of  the  absorbent  glands,  both  external 
and  internal,  and  in  obstinate  ulcers,  it  is  said  to  have  proved  useful, 
given  internally,  and  applied  locally,  at  the  same  time.  The  dose  is 
from  one  to  four  grains  three  times  daily.  Dr.  O'Shaughnessy  gave  ten 
grains  without  inconvenience,  and  even  thirty  grains  have  been  pre- 
scribed. Externally  it  is  used  in  the  form  of  an  ointment,  made  by  rub- 
bing one  drachm  with  an  ounce  of  lard. 

VI.  SEMIVITRIFIED  OXIDE  OF  LEAD.— OXIDE  OF  LEAD. 
— PLUMBI  OXIDUM.  U  S. — LITHARGYRUM.  Br. — Litharge. 

Litharge  is  prepared  by  exposing  melted  lead,  at  a  high  temperature, 
to  a  current  of  air  from  a  pair  of  blast-bellows,  which  blows  off  the  oxide 
formed  on  the  surface  of  the  metal  into  a  recipient,  where  it  solidifies  in 
minute  scales.  It  is  a  protoxide  of  lead,  containing  one  equivalent  of 
lead  and  one  of  oxygen. 

Sensible  and  Chemical  Properties.  This  oxide  is  in  small,  shining 
scales,  of  a  yellowish  colour  usually  tinged  with  red,  inodorous  and 
tasteless,  fusible  and  at  a  high  temperature  volatilizable,  and  reducible 
by  heat  with  charcoal  to  the  metallic  state.  For  practical  purposes  it 
may  be  considered  insoluble,  though  it  is  said  that  one  part  is  dissolved 
by  7000  parts  of  water.  It  is  wholly  dissolved  by  dilute  nitric  acid, 
and  is  blackened  by  hydrosulphuric  acid.  On  exposure  to  the  air,  it 
slowly  absorbs  carbonic  acid,  and  therefore  usually  contains  a  little 
carbonate  of  lead. 

Effects  on  the  System.  Litharge  is  capable  of  producing  the  peculiar 
effects  of  lead  upon  the  system,  whether  taken  into  the  stomach,  or 
inhaled,  in  the  state  of  vapour  or  of  powder,  into  the  lungs.  But  it  is 
never  used  internally.  Locally  it  has  the  ordinary  sedative  properties  of 
the  metal. 

Medical  Uses.  It  has  sometimes  been  used,  sprinkled,  in  fine  powder, 
on  the  surface  of  ulcers ;  but  its  almost  exclusive  employment  at  present 
is  as  an  ingredient  in  various  officinal  preparations,  for  which  it  is  very 
important.  I  shall  notice  here  those  which  are  considered  under  no 
other  head. 

1.  LEAD  PLASTER. — EMPLASTRUM  PLUMBI.  U.  S. — EMPLASTUUM 
LITHARGYRI.  Br. — Litharge  Plaster. — Diachylon. 

This  is  made  by  boiling  litharge,  olive  oil,  and  water  together,  over 
a  slow  fire,  until  they  concrete  into  a  plaster.  According  to  the  views 
now  generally  received,  olive  oil  consists  of  two  fatty  acids,  the  oleic  and 
margaric,  combined  with  the  oxide  of  a  hypothetical  radical  denominated 
glyceryle.  During  the  process,  the  oxide  of  lead  unites  with  these  acids, 
and  the  oxide  of  glyceryle  takes  an  equivalent  of  water  to  form  glycerin, 
which  is  in  great  measure  separated  by  kneading  under  water.  The 
plaster  is,  therefore,  oleate  and  niargarate  of  lead,  probably  with  a  little 


172  GEXERAL   STIMULANTS.  [PART  II. 

unseparated  glycerin,  which  is  useful  by  giving  it  more  plasticity.  As 
kept  in  the  shops,  it  is  in  cylindrical  rolls,  of  a  grayish  or  yellowish- 
white  colour  deepening  on  exposure,  brittle  when  cold,  but  softening  and 
becoming  adhesive  by  a  very  moderate  heat. 

This  preparation  is  much  employed  as  the  basis  of  other  plasters,  but 
is  also  itself  highly  useful  as  a  direct  application  to  the  skin.  In  exco- 
riations and  slight  superficial  wounds  and  sores,  it  promotes  healing  by 
its  sedative  property,  and  by  protecting  them  from  the  air.  To  guard 
surfaces  against  friction  and  pressure,  and  thus  to  prevent  bed-sores,  it 
is  one  of  the  best  applications  that  can  be  made.  Surgeons  sometimes 
employ  it  to  keep  the  edges  of  wounds  in  contact,  and  for  strapping  the 
leg  in  ulcers  of  that  part,  when  bandaging  is  employed  in  their  treatment. 
For  these  purposes  its  freedom  from  all  irritant  properties  peculiarly 
adapts  it;  but  it  is  not  sufficiently  adhesive  without  some  resinous  addi- 
tion, and  should,  therefore,  be  used  only  when  the  skin  is  peculiarly  del- 
icate. It  may  be  spread  on  leather,  linen,  or  muslin. 

2.  RESIN  PLASTER. — EMPLASTRUM  RESINJE.  U.S.,  Br.  —  Adhe- 
sive Plaster. 

This  is  made  by  melting  lead  plaster  and  resin  together.  The  British 
Pharmacopeia  adds  a  little  soap,  which  renders  the  plaster  more  pliable, 
and  less  apt  to  crack  in  cold  weather.  It  is  the  common  adhesive  plas- 
ter of  the  shops,  much  used  for  keeping  the  surfaces  of  wounds  together, 
and  as  a  dressing  for  ulcers  by  gently  compressing  them,  and  gradually 
approximating  their  edges.  It  is  usually  kept  in  the  shops,  already 
spread,  by  means  of  a  machine,  upon  muslin  cloths.  As  it  becomes  less 
adhesive  by  exposure,  the  fresher  it  is  when  used,  the  better. 

3.  SOAP  PLASTER. — EMPLASTRUM  SAPONIS.  U.  S.,  Br. 

This  is  made  by  incorporating  soap  with  the  lead  plaster.  It  is  a 
very  mild  preparation,  sedative,  and  supposed  to  be  discutient,  and  hence 
employed  in  chronic  swellings  and  indurations,  spread  usually  upon 
leather. 


A  few  other  preparations  of  lead  are  noticed  by  authors ;  but  they  are 
little  employed,  and  probably  capable  of  producing  no  effect,  which  could 
not  be  as  well  or  better  obtained  from  some  one  of  those  already  referred 
to.  Among  them  may  be  mentioned  the  chloride,  saccharale,  and  lan- 
nate  of  lead,  of  which  an  account  may  be  seen  in  Pereira's  Materia 
Medica;  and  of  the  last  in  the  twelfth  edition  of  the  U.  S.  Dispensatory. 
Tannate  of  lead  may  be  made  with  great  facility  by  adding  a  solu- 
tion of  acetate  of  lead  to  infusion  of  galls  or  oak  bark.  It  is  used  exclu- 
sively as  a  local  application,  and  for  this  purpose  may  be  incorporated 
with  glycerin.  It  may  be  used  in  excoriations,  as  a  resolvent  in  stru- 


CHAP.  I.]  ASTRINGENTS.  173 

mous  swellings,  and,  in  the  form  of  ointment,  as  a  dressing  for  bed-sores, 
and  gangrenous  ulcers. 


Besides  Alum  and  the  Preparations  of  Lead,  there  are  several  other 
mineral  substances  which  are  decidedly  astringent;  but  all  of  them  have 
other  properties,  more  important,  and  for  which  they  are  more  employed; 
and  it  is  deemed  best,  in  order  to  give  due  prominence  to  these  proper- 
ties, and  at  the  same  time  to  avoid  repetition,  to  classify  them  with  those 
medicines  with  which  they  agree  in  their  greatest  efficiency,  and  to  treat 
of  their  astringent  qualities  incidentally.  Such  are  especially  the  sul- 
phates of  iron,  zinc,  and  copper,  and,  in  a  less  degree,  other  prepara- 
tions of  the  same  metals,  nitrate  of  silver,  corrosive  chloride  of  mer- 
cury, sulphuric  acid,  and  lime.  (See  Tonics,  Alteratives,  and  Antacids,) 


174  GENERAL   STIMULANTS.  [PART  II. 


II. 
TONICS. 

TONICS  arc  medicines  which  moderately  and  somewhat  durably  exalt 
the  vital  actions.  They  promote  the  appetite,  invigorate  digestion, 
render  the  pulse  fuller,  stronger,  and  sometimes  more  frequent,  raise  the 
temperature  of  the  body,  augment  in  some  degree  the  various  secretions, 
give  increased  firmness  to  the  muscles,  and  probably  operate  also  on  the 
nervous  centres,  especially  those  of  organic  life,  somewhat  elevating, 
though  not  always  observably,  the  various  functions  over  which  they 
preside.  It  is  not  pretended  that  all  these  effects  are  produced  by  every 
tonic  medicine,  or  by  any  one  of  them  at  all  times,  and  under  all  circum- 
stances. It  will,  however,  I  think,  be  generally  admitted  that,  as  a 
class,  they  operate  as  above  stated  upon  the  system  in  health. 

They  differ  from  astringents  in  the  universality  of  thoir  action.  The 
latter  affect  the  single  vital  property  of  organic  contractility;  and  what- 
ever other  effects  they  may  produce  result  from  their  influence  upon  this. 
Tonics  operate  not  only  on  the  vital  contractility,  but  upon  all  the  other 
vital  properties,  and  may  be  said  to  be  universal  excitants  to  the  func- 
tions. But  this  very  diffusiveness  of  action  prevents  a  concentration  of 
their  influence  on  anyone  function;  and  consequently  their  power  of 
producing  contraction  of  the  tissues  is  much  less  obvious  than  that  of 
the  astringents. 

A  notion  formerly  prevailed  that  strength  depended  on  a  certain 
rigidity,  tension,  or  tone,  as  it  was  called,  of  the  living  fibres,  and  espe- 
cially of  the  muscular;  and  medicines  calculated  to  increase  the  strength 
were  supposed  to  do  so  by  increasing  this  tension  or  tone  of  the  fibres, 
and  hence  were  denominated  tonics.  But  views  so  mechanical  as  this 
are  now  no  longer  tenable.  There  may  be  a  certain  physical  tension  of 
the  muscles,  tendons,  and  ligaments,  resulting  from  mere  position;  but 
this  has  nothing  to  do  with  vital  force,  and  an  increase  of  it  will  not  in- 
crease the  general  strength.  The  arteries  have  an  elasticity  which, 
under  the  pressure  of  the  heart's  action,  permits  a  tensive  expansion  of 
their  coats;  and  a  diminution  of  this  property  might  lead  to  a  defective 
condition  of  the  circulation.  We  may  even  conceive  that,  in  case  of 
diminished  elasticity,  tonics  might  have  some  effect  in  restoring  it  by 
improving  the  nutrition  of  the  tissue;  but  the  remedy  would  not  in  this 
case  act  immediately  upon  the  physical  property,  but  only  secondarily 
through  the  vital  functions. 


CHAP.  I.]  TONICS.  175 

It  is  true  that  there  is  a  certain  vital  cohesion  of  the  living  molecules, 
in  every  highly  organized  tissue,  which  is  essential  to  the  due  perform- 
ance of  its  office ;  and  a  moderate  augmentation  of  this  vital  cohesion 
may  give  increased  energy  to  the  function;  but  this  is  very  different 
from  the  physical  property  of  tension.  The  muscles  possess  this  kind 
of  cohesion  in  common  with  the  living  tissues  generally;  but  the 
strength  of  the  system  is  not  more  dependent  upon  its  due  state  in 
these  than  in  other  structures,  and  probably  much  less  than  in  some 
others,  as  the  nervous  centres,  and  the  mucous  coat  of  the  stomach.  If, 
therefore,  we  admit  the  existence  of  tension  or  tone  in  this  modified 
sense,  and  that  tonics  may  act  by  increasing  it,  still,  it  does  not  follow 
that  this  class  of  medicines  operates  exclusively,  or  even  mainly,  on  the 
muscles. 

In  the  present  state  of  our  knowledge,  it  is  best  to  throw  out  of  view 
the  origin  of  the  terms  tone  and  tonic,  and  to  consider  that,  by  the 
former,  is  expressed  simply  the  vital  power  by  which  the  several  con- 
stituents of  the  body  arc  enabled,  under  the  influence  of  the  proper 
excitants,  to  perform  their  function  duly;  and,  by  the  latter,  the  means 
calculated  moderately  to  elevate  the  several  functions,  by  causing  an 
increase  of  this  power,  or  an  increased  exertion  of  it. 

In  order  to  estimate  properly  the  operation  of  this  class  of  medicines, 
it  is  necessary  to  discriminate  between  strength  and  action.  The  former 
is  obviously  the  capacity  to  act,  the  latter  the  exercise  of  that  capacity. 
By  increasing  the  latter,  we  do  not  necessarily  increase  the  former. 
Tonics  do  not,  therefore,  essentially  augment  strength,  and  the  name  of 
roborantia  or  corroborants,  by  which  it  has  been  proposed  to  designate 
them,  is  not  appropriate.  In  a  state  of  perfect  health,  they  cannot  be 
said,  in  any  degree,  to  increase  the  vital  force  or  strength.  I  conceive 
that  the  greatest  strengtl^of  system  is  that  which  enables  it  to  perform 
all  its  functions  in  the  best  manner,  and  to  offer  the  firmest  resistance  to 
all  disturbing  agencies,  of  whatever  kind,  whether  excitant,  depressing, 
or  perverting.  It  is  in  perfect  health  that  this  condition  is  presented. 
If  any  function,  or  any  number  of  functions  are  exalted,  either  from  a 
peculiar  state  of  the  power,  or  a  peculiar  application  of  excitant  agency, 
beyond  the  healthy  medium,  the  system  generally,  instead  of  being 
stronger,  that  is,  better  able  to  perform  all  its  offices  justly,  and  to  resist 
noxious  influences,  is,  in  fact,  upon  the  verge  of  disease,  and  may  be 
brought  into  that  state  by  causes,  which,  in  its  healthy  condition,  would 
not  affect  it  injuriously.  In  health,  therefore,  tonics  are  not  strength- 
ening. 

They  may  be,  indeed,  and  not  unfrequently  are  indirectly  debilitating. 
They  are  ranked  among  the  permanent  stimulants;  but  this  epithet  is 
only  relative.  No  stimulant  is  or  can  be  permanent.  The  excitability 
of  living  parts,  in  other  words,  their  susceptibility  to  excitant  impres- 


17C  GENERAL   STIMULANTS.  [PART  II. 

sions,  is  limited.  If  called  into  excessive  action,  it  is  proportionally 
exhausted;  and,  in  this  state  of  exhaustion,  the  ordinary  healthful  exci- 
tants have  less  than  their  normal  effect.  Depression,  therefore,  necessa- 
rily follows  stimulation.  This  is  obvious  in  the  use  of  powerful  stimu- 
lants; but  it  is  no  less  true  of  tonics;  though,  in  the  use  of  these,  as  the 
excitation  is  more  moderate  and  more  slowly  induced,  the  subsequent 
depression  is  less  in  degree  and  longer  delayed.  By  a  constant  repeti- 
tion of  the  stimulant,  we  may  sustain  the  excess  of  action  longer;  but 
the  result  is  obtained  at  the  expense  of  the  excitability,  which  is  sooner 
or  later  still  more  exhausted,  and  may  at  length  be  so  much  reduced  that 
the  stimulus  ceases  to  be  felt,  and  depression  occurs  even  under  its  con- 
tinued use.  This  depression  can  be  counteracted  only  by  increasing  the 
amount  of  the  stimulus;  but  the  same  penalty  is  inevitably  exacted  ;  and 
in  the  end  excitability  is  worn  out  altogether,  and  function  ceases.  It 
may  be  said,  however,  that  excitability  is  not  strength,  and,  consequently, 
that  the  latter  does  not  necessarily  diminish  with  the  former.  This  is 
to  a  certain  extent  true.  But  the  strength  of  an  organ,  or  its  power  to 
act,  depends  on  its  due  nutrition,  on  the  steady  repair  of  its  losses  by  the 
assimilation  of  new  material,  on  the  maintenance  in  fine  of  its  normal 
state  of  organization.  Now,  if  its  excitability  is  permanently  impaired, 
it  cannot  feel  duly  the  influence  of  the  materials  essential  to  its  repair, 
and  they  cannot,  therefore,  be  suitably  appropriated.  Its  nourishment 
fails,  its  structure  is  impaired,  and  consequently  its  ability  to  perform  its 
function  is  diminished.  This  is  debility.  It  follows  that  a  constant  use 
of  tonics  not  only  exhausts  excitability,  and  secondarily  depresses  func- 
tion, but  positively  debilitates  the  system. 

Other  evils  arise  irom  the  abuse  of  these  medicines.  Allowing  that 
they  act  equally  on  the  whole  system,  and  equally  elevate  all  the  func- 
tions, they  of  course  promote  digestion,  increase  the  quantity  and  stimu- 
lant quality  of  the  blood,  augment  the  nutrition  of  all  the  organs,  and 
thus  put  the  system  into  a  state  in  which,  from  its  universal  exaltation, 
a  slight  irregularity  may  cause  the  excess  of  excitement  to  fall,  with  an 
overwhelming  force,  on  some  important  organ,  and  thus  seriously  en- 
danger health,  if  not  life,  before  the  compensating  provision  of  impaired 
excitability  has  had  time  to  come  into  play.  But  supposing,  as  gener- 
ally happens,  that  the  tonic  operates  with  especial  force  on  some  one 
organ,  or  series  of  organs,  the  constant  excitement  sustained  in  it  attracts 
an  excess  of  blood  and  of  nervous  influence,  which  may  in  the  end  occa- 
sion inflammation.  When  the  stimulation  is  powerful,  the  resulting  in- 
flammation may  be  acute;  but,  as  resulting  from  tonics,  it  is  generally 
chronic. 

Thus,  the  abuse  of  the  medicine  may  lead  in  the  end  to  general  debil- 
ity, and  at  the  same  time  chronic  inflammation  of  particular  organs;  a 
complication  which  it  is  difficult  to  treat,  and  which  can,  in  fact,  be 


CHAP.  I.]  TONICS.  177 

treated  successfully  only  by  withdrawing  the  cause,  either  abruptly  or 
gradually,  and  trusting  to  the  recuperative  powers  of  the  system. 

The  principles  above  stated  are  strongly  illustrated  by  the  results  of 
the  abuse  of  the  Portland  powder,  formerly  much  employed  in  the  treat- 
ment of  gout.  This  powder  consisted  of  a  combination  of  vegetable 
bitters  and  aromatics,  and  was  to  be  taken  continuously  for  two  years, 
at  the  end  of  which  time  a  permanent  cure  might  be  expected.  Dr. 
Cullen  states  that  the  cases  of  nine  or  ten  persons  had  come  under  his 
knowledge,  who  took  the  remedy  the  required  length  of  time,  having 
previously  been  subject  to  regular  attacks  of  inflammatory  gout  yearly, 
or  twice  a  year.  After  a  longer  or  shorter  continuance  of  the  remedy, 
they  had  missed  the  paroxysms,  and,  at  the  end  of  the  two  years,  were 
entirely  free  from  them,  and  had  no  attack  afterwards  for  the  remainder 
of  their  lives.  But  in  every  instance  their  health  was  impaired ;  they 
were  much  troubled  with  dyspeptic  and  nervous  disorder,  and  low- 
ness  of  spirits;  and,  in  less  than  a  year  from  the  completion  of  the 
course,  without  exception,  they  began  to  exhibit  dropsical  symptoms, 
which  gradually  increased,  in  the  form  of  hydrothorax  or  ascites  with 
anasarca,  and  in  two  or  at  most  three  years  proved  fatal.  (Culleri's  Mat. 
Med.)  It  is  not  difficult  to  explain  the  result  in  these  cases.  The  con- 
stant use  of  the  stimulant  impaired  and  finally  exhausted  the  excitability 
of  the  system ;  debility  with  anaemia  ensued ;  and  with  these  were  prob- 
ably combined  chronic  visceral  inflammation,  especially  of  the  stomach, 
liver,  and  heart,  resulting  from  the  sustained  irritation  of  the  medicine, 
and  the  superadded  irritation  of  the  gout,  invited  from  an  external  to  an 
internal  seat. 

It  is  inferrible  from  the  above  course  of  reasoning,  the  correctness  of 
which  has  been  abundantly  confirmed  by  experience,  that  tonics  should 
never  be  given  in  a  state  of  sound  health  with  the  hope  of  increasing 
strength,  nor  for  too  great  a  length  of  time  even  in  diseased  conditions, 
in  which  they  may  have  been  originally  indicated,  for  fear  of  inducing 
secondary  debility  and  perhaps  chronic  inflammation. 

But,  nevertheless,  these  remedies  are  of  great  value  in  various  con- 
ditions of  depressed  and  forpid  function  and  debility.  It  may  be  said 
that  here  also,  as  well  as  in  health,  the  principles  above  developed  are 
applicable  ;  and  that  the  ultimate  effect  ought  to  be,  by  an  impairment 
of  the  excitability,  still  further  to  depress  and  weaken  the  system.  It 
can,  however,  be  shown  that  this  is  not  a  legitimate  deduction. 

1.  It  has  been  stated  that  the  characteristic  office  of  tonics  is  moder- 
ately and  somewhat  durably  to  increase  the  vital  actions.  Their  first 
direct  effect,  therefore,  in  depressed  function,  is  to  obviate  this  condition. 
As  strength  consists  in  the  normal  state  of  the  ultimate  organic  constitu- 
ents of  the  tissues,  which  can  be  sustained  only  by  a  due  degree  of  all 
the  vital  processes  which  contribute  to  the  nutrition  or  maintenance  of 
VOL.  i.— 12 


178  GENERAL   STIMULANTS.  [PART  II. 

parts,  and  tonics  have  the  property  of  stimulating  these  processes,  it  fol- 
lows that,  when  they  are  deficient,  and  debility  has  ensued  as  a  result, 
tonics  may  prove  not  only  stimulant  but  positively  strengthening,  pro- 
vided the  depressing  causes  do  not  outlast  the  excitability  of  the  part  or 
parts  affected.  Let  us  apply  this  principle. 

In  numerous  diseases,  there  is  a  depressed  condition  of  function,  with 
or  without  positive  debility,  which  depends  upon  a  cause  either  essen- 
tially temporary  or  removable.  Such  a  condition  exists,  for  example, 
in  low  states  of  fever  of  a  typhoid  character,  in  which  a  depressing  poison 
is  probably  acting  upon  the  system,  and  in  the  suppurative  stage  of  in- 
flammation, and  in  gangrene,  in  which  the  strength  is  exhausted  by 
copious  discharge,  or  prostrated  by  the  sedative  influence  of  the  mortifi- 
cation. In  either  of  these  cases,  life  may  be  in  imminent  danger;  but, 
as  the  operation  of  the  cause  is  temporary,  if  the  vital  functions  can  be 
sustained  until  this  ceases  or  is  removed,  the  patient  may  be  saved. 
Tonics  may  afford  the  support  requisite  for  this  purpose.  They  excite 
the  depressed  functions,  and  strengthen  by  due  nutrition  the  debilitated 
structures;  and,  long  before  the  excitability,  through  which  they  operate, 
has  had  time  to  suffer  materially  from  the  stimulus,  the  cause-  ceases,  and 
the  system  is  left  in  a  condition  in  which  it  can  repair  itself. 

2.  We  not  unfrequently  meet  with  cases  of  depression  and  debility, 
continuing  after  the  cause  has  ceased.     The  system,  or  a  part  of  it  is,  as 
it  were,  left  paralyzed.    It  seems  as  though  a  habit  of  insufficient  action 
had  been  established,  which  the  inherent  force  of  the  system  could  not 
throw  off.     Living,  like  dead  matter,  has  a  sort  of  vis  inertise,  which  dis- 
poses it  to  continue  in  any  condition  in  which  it  may  have  compulsorily 
continued  for  a  considerable  time.     Under  these  circumstances,  a  little 
gentle  stimulus  serves  to  rouse  it  out  of  its  torpor;  and  once  again  fairly 
in  action,  it  will  go  on  without  further  aid.     As  a  watch  stopped  in  the 
winding,  and  continuing  quiescent,  will  resume  its  accustomed  motions 
with  a  little  shaking ;  so  the  system,  reduced  by  disease,  and  remaining 
torpid  after  the  disease  has  ceased,  will  react  with  a  slight  excitation, 
and  enter  again  into  its  ordinary  round  of  action.     Tonics  are  often  suf- 
ficient to  give  the  requisite  impulse.     Hence,  in  part  at  least,  their  use 
in  the  torpor  of  system,  or  that  of  a  particular  organ,  so  common  in  con- 
valescence from  acute  disease. 

3.  General  drpn-.-.-inn  or  debility  may  result  from  the  torpidity  of  a 
particular  function  or  organ,  upon  which,  in  turn,  the  general  deficiency 
may  react,  so  as  to  sustain  and  even  increase  its  inertness.     Thus,  tin- 
stomach,  or  the  function  of  digestion,  may  have  been  di'pn-.-M-d  by  some 
cause  acting  upon  it  alone.    The  food,  of  course,  is  not  properly  digested, 
the  quality  of  tin-  blood  is  impaired,  the  general  function  of  nutrition  suf- 
fers, and  consequently  the  stomach  with  other  organs.    The  disease  thus 
runs  on  in  a  vicious  circle,  at  each  round  increasing  the  local  condition 


CHAP.  I.]  TONICS.  171* 

in  which  the  whole  originated,  and  deepening  the  general  debility.  By 
moderately  stimulating  the  digestion,  we  restore  the  due  qualities  to  the 
blood  and  the  due  energy  to  nutrition,  the  stomach  recovers  its  powers 
when  properly  nourished,  and  the  whole  evil  is  corrected.  A  like  train 
of  consequences,  and  a  similar  mode  of  repair,  may  occur  in  reference  to 
any  one  of  the  great  organs  or  functions.  Tonics  often  operate  in  this 
method  in  the  cure  of  disease. 

It  is  seen,  therefore,  that  numerous  cases  of  depression  and  debility 
occur  in  which  tonics  may  be  useful.  But  they  are  not  applicable  to  all 
affections  of  this  kind  indiscriminately. 

1.  That  tonics  may  be  serviceable  in  debility,  there  must  be  a  certain 
amount  of  excitability  remaining.    Otherwise  they  may  be  useless,  or  even 
worse  than  useless.     Depression  and  debility,  resulting  from  exhausted 
excitability,  cannot  be  repaired  by  tonics.    In  the  debility  of  drunkards,  for 
example,  which  is  the  result  of  over-stimulation,  tonics,  if  felt  at  all,  could 
produce  only  a  slight  excitement,  to  be  followed  by  still  greater  depression : 
and  their  habitual  use  would  only  hasten  the  fatal  issue.    The  only  hope 
in  these  cases  is  in  the  cessation  of  the  cause.     The  habit  of  stimulation 
must  be  abandoned,  or  there  can  be  no  remedy.    With  future  abstinence, 
if  the  excitability  of  the  organs  has  not  been  fatally  impaired,  and  no  de- 
structive disorganization  has  taken  place,  a  gradual  amendment  and  ulti- 
mate restoration  may  be  hoped  for,  under  the  recuperative  powers  of  the 
system.    The  only  principle  upon  which  tonics,  under  such  circumstances, 
could  be  used  with  propriety,  rests  on  the  occasional  necessity  of  not  too 
hastily  withdrawing  all  support  from  the  system,  lest  fatal  prostration 
should  ensue.    They  may  sometimes  be  resorted  to,  as  a  feebler  stimulus 
than  the  accustomed  one,  in  order  that  the  transition  may  not  be  too 
abrupt. 

2.  Tonics  cannot  be  relied  on  when  the  debility  results  from  a  con- 
stantly operating  and  irremovable  cause.     They  would,  in  such  cases, 
generally  prove  injurious  by  their  secondarily  debilitating  influence,  and 
would  probably  lead  to  a  more  rapid  exhaustion  of  the  patient.     Tht 
debility,  for  example,  resulting  from  cancer  cannot  be  repaired  by  tonics. 
They  may  occasionally  be  useful  in  counteracting  accidental  debility  of 
some  one  organ,  or  association  of  organs,  which  may  be  interfering  with 
the  proper  exercise  of  the  others ;  but  the  general  rule  holds  true. 

3.  Depression,  amounting  even  to  apparent  prostration  of  the  system, 
sometimes  depends  upon  an  active  and  overwhelming  congestion,  or 
extensive  inflammation  of  some  important  organ  or  tissue,  as  the  brain, 
heart,  lungs,  stomach,  peritoneum,  etc.,  which   either  concentrates  so 
much  of  the  blood  and  nervous  force  in  one  part  that  there  is  insufficient 
elsewhere  to  support  the  systemic  actions  generally,  or  immediately 
cramps  the  organ  affected  so  as  to  arrest  its  function,  and  thus  prostrate 
all  dependent  functions.     In  either  of  these  cases,  tonic  medicines  could 


180  GENERAL   STIMULANTS.  [PART  II. 

be  of  no  service ;  the  indication  being  by  depletory  measures  to  unload 
the  congested  organ. 

4.  In  cases  of  great  or  sudden  and  transient  depression,  tonics  are  of 
little  or  no  service ;  their  action  being  too  slow  and  moderate  to  meet 
the  indication  presented.  When  stimulation  is  required,  under  such  cir- 
cumstances, it  is  necessary  to  have  recourse  to  the  diffusible  stimulants 
for  internal  use,  and  the  rubefacients  externally. 

The  general  rule,  then,  in  relation  to  the  use  of  tonics,  is  that  they 
are  indicated  in  all  cases  of  depression  and  debility,  in  which  tho  excita- 
bility has  not  been  exhausted  by  previous  stimulation,  which  do  not 
proceed  from  a  permanent  and  irremovable  cause,  and  in  which  the 
depression  is  neither  the  result  of  active  congestion  or  irritation,  nor  so 
sudden  and  transient  as  to  call  for  stimulation  more  prompt  and  fugitive 
than  that  which  characterizes  this  class  of  medicines. 

Of  the  particular  diseases  in  which  tonics  may  be  used,  all  that  can 
be  advantageously  said  will  come  better  under  the  heading  of  the  several 
individual  medicines;  as  the  peculiar  character  of  each  medicine  very 
much  influences  its  application.  It  remains  here  only  to  treat  of  their 
precise  mode  of  action,  so  far  as  that  is  known. 

Mode  of  Operation.  Most  of  the  tonics  probably  act  directly  on  the 
mucous  coat  of  the  stomach  and  bowels,  thus  stimulating  immediately 
the  digestive  function ;  and  there  is  reason  to  believe  that  some  act 
chiefly,  if  not  exclusively,  in  this  way.  It  was  formerly  thought,  and 
some  still  think,  that  the  impression  made  on  this  surface  is  propagated, 
to  a  greater  or  less  extent,  over  the  system  by  means  of  sympathy,  or 
the  intervention  of  the  nervous  centres;  and  it  is  not  possible  to  prove 
that  the  tonic  impression  is  never  diffused  in  this  way.  But.  when  it  is 
considered  how  slowly  the  tonics  act,  and  that  many  of  them,  particu- 
larly those  of  mineral  origin,  have  been  detected  by  chemical  reagents 
in  the  blood  or  secretions,  it  seems  most  reasonable  to  suppose  that 
those,  the  direct  influence  of  which  extends  beyond  the  digestive  organs, 
operate  through  the  route  of  the  circulation.  The  different  modes  of 
action  of  the  different  tonics  may  be  included  under  the  following  heads. 

1.  I  have  stated  that  some  appear  to  act  chiefly,  if  not  exclusively,  so 
far  as  their  immediate  tonic  influence  is  concerned,  on  the  digestive 
organs.  By  promoting  the  appetite  and  invigorating  digestion,  they 
cause  more  food  to  be  taken,  and  that  which  is  taken  to  be  more  thor- 
oughly prepared  for  absorption  and  assimilation.  They  thus  enrich  the 
blood,  rendering  it  at  once  more  stimulating  to  the  functions,  and  nutri- 
tive to  the  tissues,  and  produce  indirectly  the  general  tonic  effects  upon 
the  system  at  large.  Such  are  the  mineral  acids,  and  to  a  certain  extent 
the  simple  or  pure  bitters,  which,  though  they  may  possibly  operate 
directly  on  the  system  through  absorption,  display  their  effects  much 
more  obviously  upon  the  stomach  and  bowels. 


CHAP.  I.]  TONICS.  181 

2.  Other  medicines  of  the  class  operate  directly  and  mainly  on  the 
blood  itself;  not  through  the  agency  of  the  digestive  process,  but  by 
intimate  admixture  with  that  fluid,  into  which  they  find  admission, 
either  by  venous  absorption,  or  through  the  lacteals  or  intestinal  lym- 
phatics.     They  may  act  either  1.  by  entering  immediately  into  the 
composition  of  some  one  of  the  proximate  principles  of  the  blood,  2.  by 
modifying  the  vital  condition   of  its  organized  constituents,  or  3.  by 
favouring,  through  a  stimulant  influence  on  its  vital  properties,  the  phy- 
siological actions  which  are  constantly  going  on  within  it,  and  thus 
contributing  to  its  full  development  and  maintenance.     The  blood,  thus 
elevated  in  its  constitution,  performs  its  offices  in  the  economy  with 
more  vigour,  and  operates  with  a  tonic  influence  on  all  the  functions. 
Upon  this  principle  it  probably  is  that  the  preparations  of  iron  chiefly 
act;  and  I  am  disposed  to  ascribe  the  peculiar  influences  of  cod-liver  oil 
in  disease,  in  some  measure,  to  analogous  modifications  produced  by  it 
in  the  blood. 

3.  Most  of  the  class  probably  operate  directly  upon  the  ultimate 
organic  constituents  of  the  tissues,  entering  the  circulation  either  un- 
changed or  more  or  less  modified,  and  being  distributed  everywhere  by 
the  blood  as  a  mere  vehicle ;  though  it  is  not  impossible  that  they  may 
operate  also  upon  the  vital  properties  of  that  fluid,  through  the  same 
power  by  which  they  affect  the  similar  properties  of  solids.     How  it  is 
precisely  that  they  affect  the  ultimate  organic  constituents  of  the  body  is 
conjectural.    They  may  act  merely  by  their  presence,  or  they  may  enter 
into  a  sort  of  chemical  union  with  the  living  matter,  though  I  am  in- 
clined preferably  to  the  former  of  these  views.     At  all  events,  some  of 
them  have  been  found,  on  chemical  investigation,  in  the  midst  of  the 
tissues.     It  is  probable  that  each  distinct  function  is  performed  through 
the  instrumentality  of  a  special  power  in  the  ultimate  organic  cells, 
nuclei,  or  molecules  of  the  organ,  and  tonics  may  operate  simply  by 
stimulating  this  power  into  a  somewhat  increased  activity.    But  we  may 
advance  one  step  further,  and  adopt  the  very  plausible  opinion,  that  in 
all  the  tissues  there  is  a  certain  vital  cohesion  which  is  essential  to  the 
due  performance  of  the  function,  and  that  tonics  are  moderate  stimu- 
lants to  this  cohesion.     To  this  mode  of  action  we  may  ascribe  in  part 
the  greater  firmness  of  the  tissues,  especially  the  muscles  and  blood- 
vessels; and  to  this  perhaps  also  that  condition  of  the  nervous  centres, 
resulting  from  the  use  of  certain  tonics,  by  which  they  are  enabled  to 
exercise  their  proper  functions  more  energetically,  and  have  greater 
power  of  resistance  to  all  kinds  of  disturbing  influences.     Such  an  in- 
fluence is  exhibited  in  the  control  evinced  by  some  of  the  metallic  tonics 
over  various  nervous  diseases,  as  chorea,  epilepsy,  and  neuralgia. 

Before  considering  the  several  tonic  medicines,  with  their  subdivisions. 
I  propose  to  give  a  succinct  account  of  various  influences  of  a  tonic 


182  GENERAL   STIMULANTS.  [PART  II. 

Character,  which,  though  not  strictly  medicinal,  are  often  very  useful  in 
disease,  and  must  therefore  rank  among  remedies. 


1.  TONIC  DIET. 

A  proper  regulation  of  the  diet  is  indispensable  to  the  obtaining  of 
satisfactory  results  from  the  use  of  tonic  medicines.  Experience  has 
established  the  fact,  beyond  controversy,  that  a  mixture  of  vegetable  and 
animal  food  is  best  suited  for  man.  There  can  be  as  little  doubt,  on  the 
score  of  experience,  that  animal  food  is  more  supporting  to  the  system, 
and  more  stimulating  than  vegetable.  Indeed,  the  effects  of  a  relative 
increase  of  the  former  in  the  diet  are  not  dissimilar  to  those  produced  by 
tonic  medicines;  proceeding  at  first  from  a  direct  excitant  impression  on 
the  stomach,  and  subsequently  from  an  augmented  richness  of  the  blood. 
A  long-continued  excess  of  animal  food  leads  also,  like  an  abuse  of  tonics, 
either  to  plethora  with  its  dangers,  or  to  a  complication  of  diminished 
excitability  with  local  inflammation.  We  may,  therefore,  rank  the  use 
of  animal  food,  beyond  the  ordinary  proportion,  among  tonic  influences; 
and,  when  an  indication  exists  for  these  medicines,  there  is  generally  a 
coincident  indication  for  the  kind  of  diet  referred  to. 

As  the  main  object  of  tonics  is  usually  not  merely  to  stimulate  the 
functions,  but  to  obviate  debility  by  sustaining,  through  the  process  of 
nutrition,  a  due  state  of  the  organization,  it  is  obvious  that,  in  order 
to  produce  this  effect,  there  must  be  nutrient  material  for  them  to 
operate  with.  It  does  not,  however,  necessarily  follow,  that  the  quantity 
or  richness  of  the  food  taken  should  be  increased;  for  the  patient  may 
have  been  in  the  habit  of  taking  more  than  his  digestive  powers  could 
manage;  and  the  end  desired  is  attained  by  a  more  thorough  assimila- 
tion, and  less  waste  of  the  nutriment,  through  the  greater  energy  given 
to  digestion  by  the  medicine.  In  judging,  therefore,  as  to  the  propriety 
of  increasing  the  amount  of  food,  the  practitioner  must  take  previous 
habits  into  consideration ;  and,  if  the  diet  should  be  found  to  have  been 
in  excess,  in  reference  to  the  digestive  and  assimilative  powers,  there 
would  be  no  propriety  in  augmenting  it,  at  least  until  the  balance  should 
be  restored. 

The  kind  of  food  previously  used  must  also  be  allowed  to  modify  the 
prescription.  If  the  diet  had  been  exclusively  vegetable,  it  is  obvious 
that  a  relatively  smaller  quantity  of  animal  food  should  be  directed ;  if 
exclusively  animal,  it  would  be  necessary,  in  order  to  obtain  the  same 
end,  to  employ  it  more  freely. 

Reference  must  also  be  had  to  the  habits  of  the  patient  in  relation  to 
exercise.  Food  is  consumed  by  bodily  exertion,  and  the  invator  the 
latter  is,  the  more  will  be  required  of  the  former.  To  produce  a  tonic 


CHAP.  I.]  TONICS. — TONIC    DIET.  183 

effect,  therefore,  a  greater  elevation  of  the  diet  would  be  necessary  in  a 
person  of  active,  than  in  one  of  sedentary  habits. 

The  quality  of  the  animal  food  employed  is  scarcely  less  important 
than  its  quantity.  Some  kinds  are  more  stimulant,  some  more  nutritious, 
and  some  more  digestible  than  others.  The  most  stimulating  may  pro- 
duce an  excitant  effect  greater  than  desired;  but  food  can  scarcely  be  too 
nutritious,  or  too  easily  digested  for  tonic  purposes.  A  few  words,  there- 
fore, on  the  more  common  articles  of  animal  food,  in  reference  to  these 
points,  may  not  be  out  of  place  here. 

One  of  the  lowest  varieties  of  animal  food  in  stimulant  and  nutritive 
properties,  taking  bulk  into  consideration,  is  milk;*  but  it  is  easy  of 

*  Milk  Cure.  Milk  has  been  recently  raised,  in  Russia,  almost  to  the  dignity  of  a 
panacea.  Dr.  Philip  Karell,  "Physician  to  his  Majesty  the  Emperor  of  Russia," 
in  a  communication  to  the  Medical  Society  of  St.  Petersburg,  after  giving  a  history 
of  the  therapeutical  uses  of  milk  by  his  predecessors  in  various  parts  of  Europe, 
some  of  whom  had  most  extraordinary  success,  proceeds  to  offer  his  own  mode  of 
treatment,  in  the  remedial  efficiency  of  which  he  seems  to  have  unbounded  confi- 
dence.  He  generally  commences  the  treatment  by  directing  the  exclusive  use  of  milk 
for  nourishment,  permitting  no  other  food.  He  prescribes  for  the  patient,  three  or 
four  times  a  day,  at  regular  intervals,  from  two  to  six  ounces  of  skimmed  milk  of 
the  best  quality.  The  whole  of  each  dose  should  not  be  swallowed  at  once;  but.  it 
should  be  taken  slowly,  and  in  small  quantities,  so  as  to  be  well  mixed  with  the 
saliva.  If  the  patient  digest  the  milk  well,  which  may  be  inferred  if  the  stools, 
before  liquid,  become  solid,  the  dose  is  to  be  gradually  increased.  For  the  first 
week  the  patient  has  great  difficulty  in  resisting  his  craving;  but  this  is  removed  in 
the  second  week,  during  which  two  quarts  are  given  daily.  If  the  cure  take  its 
regular  course,  the  milk  must  now  be  drank  four  times  a  day;  at  eight  A.M.,  at 
noon,  at  four  P.M.,  and  at  eight  P.M.  If  the  patient  wish  other  hours,  he  may  be 
allowed  to  change;  but  the  same  interval  must  always  be  enjoined;  and  on  no 
account  should  he  be  left  to  his  own  discretion  either  as  to  the  time  or  quantity. 
When  the  bowels  become  constipated,  as  often  happens,  this  may  be  obviated  by 
injections  of  warm  water,  or  by  the  use  of  castor  oil  or  rhubarb.  Should  the  cos- 
tiveness  be  obstinate,  a  little  coffee  may  be  given  every  morning  with  the  milk,  or 
towards  four  o'clock  stewed  preserves  or  a  roasted  apple.  If,  at  the  end  of  the 
second  or  third  week,  there  is  a  craving  for  solid  food,  a  little  stale  bread  with  salt, 
or  a  small  salt  herring,  may  be  allowed;  and  a  little  stale  bread  at  the  dinner-hour. 
Once  a  day,  the  patient  is  permitted  to  take  some  soup  made  of  milk  and  oatmeal. 
After  five  or  six  weeks,  the  milk  may  be  given  only  thrice  daily,  and  once  a  chop 
or  steak.  Dr.  Karell  has  found  raw  meat  to  digest  the  most  easily.  Great  confi- 
dence on  the  part  of  the  patient,  and  a  rigid  adherence  to  the  rules  given,  are  neces- 
sary to  assure  success.  The  affections  to  which  the  milk-cure  is  applicable  are  dropsy 
with  impoverished  blood;  disordered  innervation  in  the  forms  of  hysteria  and  hy- 
pochondriasis;  obstinate  dyspepsia;  catarrhal,  rheumatic,  and  gouty  affections; 
nervous  maladies  dependent  on  defects  in  the  fluids;  chronic  irritation  of  the 
pharynx  and  oesophagus,  ulcers  of  the  stomach,  and  similar  affections  of  the 
bowels.  The  gastric  cases  formed  the  larger  portion  of  those  successfully  treated. 
(Edin.  M(d.  Journ.,  Aug.  1866,  p.  97.) 

Now  I  can  bear  testimony  to  the  great  efficiency  of  an  exclusive  or  almost  ex- 


184  GENERAL   STIMULANTS.  [PART  II. 

digestion,  and  may  be  preferred  in  a  tonic  course  when  the  digestion  is 
feeble,  and  the  previous  habits  of  the  patient  have  been  those  of  absti- 
nence. The  same  may  be  said,  in  less  degree,  of  its  derivative  butter. 
Another  derivative,  cheese,  while  probably  not  more  nutritious,  is  more 
difficult  of  digestion,  and,  in  consequence  of  chemical  changes,  often 
much  more  stimulating.  The  latter,  therefore,  should  not  be  given  when 
the  stomach  is  feeble.  Next  in  the  ascending  scale  of  nutritive  and  exci- 
tant power,  are  oysters,  eggs,  and  the  lighter  kinds  of  fish ;  and  these 
are  generally  easy  of  digestion,  when  properly  prepared.  Haw  oysters, 
particularly  salt  oysters,  are  themselves  stomachic,  often  exciting  the 
appetite,  generally  easy  of  digestion,  and  an  excellent  ingredient  in  a 
tonic  regimen.  The  eggs  should  be  soft  boiled ;  or,  if  hard,  should  be 
grated  very  finely  so  as  to  overcome  their  cohesion,  and  render  them 
more  easily  soluble  in  the  gastric  juice.  Next  come  the  different  kinds 
of  poultry  with  white  flesh,  and  after  these  the  ordinary  meats,  as  777 ul- 
ton  and  beef.  The  dark-fleshed  poultry,  as  ducks  and  geese,  and  all  the 
varieties  of  pork,  are  most  stimulant  and  most  difficult  of  digestion,  and, 
though  highly  nutritious  also,  should  be  used  only  when  the  digestive 
powers  are  strong,  and  exercise  is  taken  abundantly.  Wild  animal  food 
is  preferable  to  the  same  varieties  tame,  as  being  more  easily  digested. 
On  the  same  score,  adult  animal  food  is  preferable  to  the  very  young, 
which  is  too  stringy,  and  less  nutritive,  or  to  the  very  old,  which  is  often 
very  tough.  Beef,  mutton,  and  fowls  arc  preferable  to  veal,  lamb,  and 
chickens.  Very  fat  meats,  though  stimulant  and  nutritious,  are  not  so 
easily  digested,  and  often  unsuitable.  Salt  meats  are  less  nutritious  than 
the  fresh,  and  also  less  digestible,  and,  though  often  admissible,  particu- 
larly in  small  quantities  as  condiments,  should  be  excluded,  as  main  arti- 
cles of  diet,  when  the  digestion  is  feeble.  The  mode  of  cooking,  too,  has 
much  influence  over  the  quality  of  the  food.  Boiling  renders  meats  less 
nutritious,  and  therefore  less  suitable  for  a  tonic  diet.  Frying,  and  other 
modes  of  preparation,  in  which  butter  and  fats  are  heated  with  the  meat 
to  the  point  of  decomposition,  are  unsuitable,  in  consequence  of  the  indi- 
gestible, as  well  as  irritant  character,  often  imparted  to  the  food.  Roast- 
ing, broiling,  baking,  and  slewing  are  more  appropriate  modes  of  treat- 
ment. Soups,  which  contain  the  extractive,  gelatin,  and  other  soluble  parts 

elusive  milk  diet,  particularly  in  morbid  states  of  the  blood,  and  in  cases  of  obsti- 
nate romiting,  and  chronic  diarrhoea;  having 'recommended  and  employed  this  rem- 
edy, under  such  circumstances,  for  more  than  thirty  years.  In  reference  to  the  blood, 
I  have  used  the  remedy  on  the  grounds  of  the  easy  digestibility  of  milk,  and  its 
composition,  as  it  contains  all  the  constituents  necessary  for  making  wholesome 
blood;  and,  in  reference  to  diseases  of  the  stomach  and  bowels,  of  its  perfect  bland- 
ness,  in  addition  to  the  properties  mentioned.  But  I  am,  nevertheless,  indisposed 
to  admit  its  claims  to  a  position  of  special  eminence  as  the  milk-cure.  (Note  to  the 
third  edition. ) 


CHAP.  I.]  TONICS. — EXERCISE.  185 

of  meat,  are  more  stimulant  and  less  nutritious  than  solid  flesh,  and, 
though  they  may  be  employed,  should  never  be  relied  on.  Meat  extracts 
contain  the  soluble  parts  of  meat,  obtained  first  in  a  liquid  form,  and 
then  evaporated  to  a  solid  consistence.  They  arc  in  fact  concentrated 
soups,  and  when  used  are  brought  into  the  liquid  form  by  treating  them 
with  boiling  water.*  The  essences  arc  too  stimulating  for  a  mere  tonic 
course,  f  Whatever  food  is  taken  should  be  thoroughly  masticated. 
Fresh  vegetable  food  of  easy  digestion  should  not  be  excluded;  for, 
though  destitute  of  tonic  properties,  it  imparts  qualities  to  the  blood 
which  are  indispensable,  and  without  which  there  would  be  constant 
danger  of  producing  a  scorbutic  character  of  that  fluid.  Potatoes,  from 
their  highly  nutrient  and  antiscorbutic  properties,  are  very  useful  in  a 
tonic  regimen. 


2.  EXERCISE  AS  A  TONIC. 

This  is  an  invaluable  tonic  measure  in  debility.  There  are  two  kinds 
of  exercise,  which,  though  they  produce  the  same  ultimate  effect,  operate 
in  a  somewhat  different  manner,  and  are  calculated  to  meet  somewhat 
different  indications;  active,  namely,  and  passive.  Active  exercise  is 
that  performed  under  the  influence  of  the  will ;  passive,  that  in  which 
the  will  is  quiescent,  and  extraneous  influences  operate.  Walking,  run- 
ning, leaping,  wrestling,  rowing,  and  the  various  gymnastic  movements 
are  examples  of  the  former;  riding  on  horseback,  driving,  steaming,  sail- 
ing, etc.,  of  the  latter.  The  two  are  frequently  more  or  less  combined. 

*  The  noted  "extractum  carnis"  of  Liebig,  which  has  the  advantage  of  containing 
little  gelatin,  is  prepared  by  digesting  meat,  finely  divided,  and  deprived^a*  far  as 
possible  of  gelatinous  and  fatty  matter,  with  twice  its  weight  of  water,  at  212°,  for 
an  hour,  and  separating  the  liquid  by  strong  pressure;  again,  digesting  and  ex- 
pressing as  before;  then  evaporating  to  about  one-sixth;  and,  after  allowing  the 
residue  to  cool,  removing  the  fat  that  congeals  on  the  surface,  and  finally  evaporat- 
ing to  the  ordinary  consistence  of  extracts.  Ten  pounds  of  meat  should  yield  six 
ounces  of  extract.  (Pharm.  Journ.  and  Trans.,  Oct.  1865,  p.  207.) — Note  to  the  third 
edition. 

f  Raw  meat.  Considerable  attention  has  of  late  been  paid  to  raw  meat  and  alco- 
hol as  a  remedy  for  phthisis  and  other  cacliectic  affections,  introduced  into  use  by 
M.  Fuster,  of  Montpellier,  France,  who  claims  to  have  obtained  great  advantages 
from  it.  For  the  mode  of  administration,  see  my  work  on  the  Practice  of  Medicine 
(6th  ed.,  i.  113).  According  to  M.  Fuster,  the  raw  meat  favours  assimilation  and 
nutriiion,  and  with  alcohol  has  proved  of  great  advantage  in  various  diseases  be- 
sides phthisis,  as  chronic  ancemia,  leucocythemia,  allniminuria,  diabetes,  and  typhus 
and  typhoid  fevers.  How  much  of  the  virtues  of  the  remedy  depends  on  the  rawness 
of  the  meat  is  exceedingly  doubtful;  and  it  is  liable  to  this  great  disadvantage,  that 
the  meat  may  contain  the  germs  of  one  of  the  forms  of  tsenia,  or  even  those  of  the 
Trichina  spiralis,  and  if  taken  uncooked,  may  give  rise  to  those  serious  forms  of 
parasitic  disease.  (Note  to  the  third  edition.) 


186  GENERAL    STIMULANTS.  [PART  II. 

Thus,  in  the  active  exercise  of  rowing,  while  the  muscles  of  the  extrem- 
ities are  operating  under  the  will,  the  whole  frame  is  jarred  by  the  move- 
ments of  the  boat;  and  in  the  passive  exercise  on  horseback,  while  the 
body  is  shaken  by  the  motions  of  the  horse,  the  muscles  are  employed  in 
regulating  the  animal,  and  maintaining  the  position  of  the  rider.  Active 
exercise  is  always  primarily  partial;  passive  is  usually  general,  affect- 
ing every  part  of  the  body,  though  this  is  not  necessarily  the  case  in  all 
instances;  for  a  part  only  of  the  body  may  be  agitated;  as  in  that  kind 
of  exercise  of  the  stomach  recommended  by  Halsted  in  the  treatment  of 
dyspepsia,  in  which,  the  body  being  bent,  and  the  hands  pressed  back- 
ward beneath  the  epigastrium,  gentle  and  quickly  repeated  succussions 
are  given  to  the  organ  by  the  upward  movement  of  the  fingers. 

It  is  not  difficult  to  explain  the  tonic  effects  of  exercise.  In  the  active 
variety,  the  cerebral  centres  are  first  stimulated;  then  the  muscles;  then 
the  heart  through  the  organic  nervous  centres;  and  finally  all  the  func- 
tions indirectly,  in  consequence  of  the  greater  rapidity  of  the  blood  flow- 
ing everywhere  through  the  capillaries,  to  which  these  functions  are 
indebted  for  the  supply  at  once  of  stimulus  and  material.  A  certain 
amount  of  exercise,  varying  according  to  the  state  of  the  individual,  is 
requisite  to  support  the  functions  in  a  condition  corresponding  with  the 
degree  of  general  strength.  A  moderate  excess  beyond  this  amount 
will  produce  only  a  moderate  stimulation,  or  in  other  words  a  tonic 
effect;  a  great  excess  gives  rise  to  proportional  excitement,  and  may 
prove  powerfully  stimulant.  The  general  laws  above  given,  in  reference 
to  tonic  medicines,  are  applicable  to  this  remedial  measure.  In  a  state  of 
debility,  if  the  exercise  be  moderately  increased,  it  will  increase  strength, 
by  supporting  all  the  organic  functions,  and  among  the  rest  digestion, 
sanguification,  and  nutrition.  In  perfect  health,  if  urged  beyond  the 
point  requisite  for  the  sustenance  of  this  condition,  it  leads  to  the  evils 
before  described  as  the  result  of  the  abuse  of  tonics.  In  either  case,  if 
used  in  great  excess,  so  as  to  stimulate  actively,  it  exhausts  the  excita- 
bility, and  may  thus  lead  to  secondary  prostration  and  debility.  It  is 
perceived,  therefore,  that  the  employment  of  active  exercise  as  a  tonic 
requires  the  same  judgment  and  discrimination  as  that  of  the  medicines 
belonging  to  the  class.  The  general  rule  is  to  proportion  the  amount  of 
it  to  the  strength,  and  never  to  push  it  so  far  as  to  occasion  secondary 
exhaustion.  A  slight  feeling  of  fatigue  may  be  considered  as  an  evi- 
dence that  it  has  been  carried  sufficiently  far  for  the  time. 

In  passive  exercise,  as  a  general  rule,  all  parts  of  the  body  are  excited 
by  the  agitation  equably  and  moderately.  The  blood  and  nervous  power 
are,  therefore,  invited  in  a  nearly  equal  degree  to  the  seat  of  every  func- 
tion, and  a  moderate  diffusive  tonic  effect  is  experienced  throughout  the 
system.  It  may  be  said  that,  as  there  is  only  a  certain  quantity  of  blood, 
and  a  certain  amount  of  nervous  power  in  the  body,  you  cannot  increase 


CHAP.  I.]  TONICS. — EXERCISE.  187 

these,  in  the  system  at  large,  through  any  immediate  influence,  and, 
therefore,  that  such  a  diffusive  tonic  effect  as  I  have  referred  to  is  im- 
possible. But  the  whole  nervous  power  is  never  called  into  full  exer- 
cise in  health,  and,  though  it  cannot  be  indefinitely  drawn  upon,  yet  it 
may  be  so  in  a  moderate  degree,  beyond  the  ordinary  wants  of  the  sys- 
tem; and  its  influence,  therefore,  may  be  everywhere  in  the  same  degree 
augmented.  In  reference  to  the  blood,  if  the  whole  quantity  cannot  be 
increased,  yet  the  rapidity  of  its  motion  may ;  so  that  a  greater  amount 
is  present  within  a  given  time  in  all  the  organs.  Besides,  so  far  as  con- 
cerns the  smaller  vessels  or  capillaries,  where  alone  the  blood  is  operative 
in  sustaining  the  functions,  the  quantity  may  certainly  be  increased  at 
the  expense  of  that  in  the  heart  and  great  vessels,  which  serve  mainly 
for  its  conveyance,  or  in  the  spleen,  which  probably  often  acts  as  a  mere 
receptacle.  It  is,  therefore,  quite  possible  that  all  the  organic  functions 
may  be  moderately  excited  at  the  same  time ;  and  this,  I  think,  is  the 
effect  of  passive  exercise.  In  consequence  of  the  equable  and  diffusive 
character  of  its  influence,  it  has  an  advantage  over  active  exercise  in 
cases  of  great  debility.  In  the  latter,  a  slight  excess  of  muscular  action 
may  call  the  heart  into  inordinate  and  even  dangerous  excitement.  Pa- 
tients greatly  debilitated  have  sometimes  fallen  dead,  upon  slight  exer- 
tion, in  consequence  of  the  excessive  action  and  consequent  speedy  ex- 
haustion of  the  heart;  and,  where  there  is  no  danger  of  such  a  result, 
there  may  be  liability  to  serious  congestions,  to  hemorrhage,  and  even 
to  cardiac  hypertrophy.  So  also,  the  encephalon  may  be  inordinately 
stimulated  through  the  influence  sent  up  to  it  by  the  excited  muscles, 
demanding  through  the  nervous  centres  a  supply  of  blood.  Again,  the 
over-excitement  of  particular  organs  leads  to  deficiency  of  action  or  de- 
pression in  others;  as  shown  in  the  result  of  violent  exercise  taken  imme- 
diately after  a  full  meal ;  the  powers  of  the  system  being  concentrated  in 
the  muscular,  and  its  immediately  subsidiary  functions,  and  withdrawn 
from  the  digestive,  so  that  the  food  remains  unacted  on.  In  short,  the 
influence  of  active  exercise  is  necessarily  more  or  less  partial,  and  there- 
fore liable  to  occasion  local  excess  or  deficiency  of  function ;  that  of  pas- 
sive exercise  is  general,  and  more  equable,  and  therefore  safer  when  the 
object  is  to  correct  great  general  debility,  especially  when  associated 
with  morbid  tendencies  of  any  organ,  as  of  the  heart,  which  active  exer- 
tion may  serve  to  aggravate,  or  call  into  operation. 

Yet  passive  exercise  is  alone  insufficient ;  for  there  are  certain  func- 
tions, such  as  that  of  muscular  motion,  which  can  be  performed  only 
through  the  agency  of  the  will,  and  which  will  suffer  if  permitted  to  re- 
main quiescent.  Though  the  instruments  of  these  functions  may  be  in- 
vigorated, so  far  as  their  nutrition  is  concerned,  by  passive  exercise,  yet 
they  will  not  operate  efficiently  for  their  peculiar  purposes  unless  sus- 
tained in  a  due  habit  of  action.  On  the  whole,  therefore,  in  order  to 


188  GENERAL   STIMULANTS.  [PART  II. 

strengthen  a  weakened  system  in  all  points,  it  is  advisable  to  combine 
more  or  less  together  both  kinds  of  exercise. 

Partial  or  local  weakness  may  always  be  treated  with  partial  exercise, 
whether  active  or  passive.  Thus,  a  limb  which  has  become  enfeebled, 
and  incompletely  paralyzed  by  long  rest,  as,  for  example,  an  arm  or  a 
leg  in  which  the  muscles  have  been  restrained  by  bandaging,  may  be 
restored  to  its  original  powers  by  constantly  repeated  efforts  on  the  part 
of  the  patient  to  use  it;  and  attention  has  already  been  called  to  a 
useful  method  of  producing  passive  exercise  of  the  stomach  in  pure 
dyspepsia. 

The  above  remarks  are  applicable  to  the  mental,  or  purely  cerebral 
functions  as  well  as  to  the  others.  These  may  also  be  divided  into  the 
active  and  passive,  the  former  being  voluntary,  as  the  intellectual  func- 
tions, the  latter  involuntary,  as  the  emotional.  In  debility  of  the  active 
functions,  it  is  necessary,  in  order  to  restore  due  vigour,  to  exercise  them 
actively  through  the  will  of  the  patient;  in'that  of  the  passive,  to  exer- 
cise them  passively,  by  so  regulating  extraneous  influences  as  to  excite 
them  into  operation. 

It  may  be  proper,  before  leaving  the  subject,  to  say  a  few  words  on 
the  several  varieties  of  exercise  most  resorted  to  in  the  treatment  of 
disease. 

Modes  of  Active  Exercise.  Upon  the  whole,  walking  is  probably  the 
safest  and  most  efficient  mode  of  active  exercise,  in  cases  of  simple  gen- 
eral debility.  It  should  be  continued  at  one  time  no  longer  than  may  be 
sufficient  to  cause  a  slight  sense  of  fatigue,  and  should  be  frequently  re- 
peated. The  amount  must,  of  course,  be  regulated  by  the  strength  of 
the  patient.  It  should  never,  in  debility,  be  so  rapid  as  to  induce  much 
palpitation  of  the  heart.  When  the  weather  is  such  as  to  forbid  the 
invalid  to  walk  in  the  open  air,  he  should  take  the  exercise  withindoors, 
throwing  up  the  windows,  so  as  to  admit  the  fresh  air,  and  maintaining 
a  temperature  in  the  apartment,  somewhat  below  that  which  is  com- 
fortable to  him  when  seated. 

Other  and  more  energetic  modes  of  active  exercise  are  running,  leap- 
ing, wrestling;  the  various  kinds  of  bodily  labour;  athletic  games,  as 
those  of  quoits,  ball-playing,  bullet-rolling,  bar-pitching,  etc.;  and  within 
doors,  dancing,  billiards,  nine-pins,  the  use  of  dumb-bells,  baltledore 
and  shuttlecock,  gymnastics,  calisthenics,  etc.  It  is  often  necessary,  in 
order  that  the  invalid  may  be  duly  amused  or  interested,  to  vary  the 
modes  of  exercise  to  suit  his  taste  or  caprices;  and  hence  the  propriety 
of  having  a  considerable  list  out  of  which  to  choose.  To  those  already 
mentioned,  as  suitable  for  patients  confined  to  their  housi-s,  may  be  added, 
sawing  and  aplilling  wood,  rubbing  furniture,  and  various  other  house- 
hold operations,  which,  by  amusing  the  patient  with  the  idea  of  useful- 
ness, may  lessen  the  irksomeness  of  the  measure,  considered  merely  hi 


CRAP.  I.]  TONICS. — EXERCISE.  189 

a  therapeutic  point  of  view.  Indeed,  this  idea  should  be  carried  out  in 
all  plans  of  exercise.  There  should  be  some  other  ostensible  object  than 
that  merely  of  improving  health.  The  patient  should,  if  possible,  become 
interested  in  the  act,  occupation,  or  pursuit  for  itself  alone.  Other  ad- 
vantages of  this  diversity  of  plans  are  that,  by  a  proper  choice  among 
them,  we  may  duly  proportion  the  activity  of  the  exercise  to  the  strength 
of  the  patient,  and  that,  in  consequence  of  the  various  muscles  brought 
into  play  in  the  different  methods,  we  may  by  successive  changes  operate 
on  the  whole-  system  of  voluntary  muscles,  or  bring  some  particular  method 
to  bear  upon  special  muscles  or  organs,  which  may  stand  peculiarly  in 
need  of  invigoration.  But  in  all  the  methods  referred  to,  care  must  bo 
taken  to  avoid  excess;  and  this  is  particularly  necessary  of  those  which 
have  in  themselves  something  fascinating  or  seductive.  Serious  evils, 
for  example,  have  sometimes  arisen  from  the  abuse  of  dancing,  and  gym- 
nastic exercises. 

The  modes  of  exercise  above  referred  to  are  often  useful,  not  only  by 
their  tonic  influence  on  the  muscular  system  directly,  and  other  systems 
indirectly,  but  also  by  a  derivative  influence,  tending  to  draw  away  an 
excess  of  blood  and  nervous  action  from  internal  organs,  congested  or 
chronically  inflamed  Every  one  of  sedentary  and  studious  habits  must 
have  been  sensible  of  the  great  relief,  in  instances  of  visceral  uneasiness, 
or  oppressed  and  clouded  thought,  afforded  by  rising  and  walking 
briskly  for  some  time,  or  otherwise  actively  employing  the  voluntary 
muscles;  and  chronic  inflammation  of  the  liver,  stomach,  brain,  etc., 
may  often  be  greatly  benefited  by  a  systematic  external  derivation  of 
the  same  kind. 

Modes  of  Passive  Exercise.  Horseback  exercise  is  probably  the 
most  effective,  and  generally  applicable,  of  all  the  different  passive 
methods.  It  is,  however,  too  fatiguing  for  great  debility.  Moderate 
at  first,  it  should  be  gradually  increased  with  the  increasing  strength 
and  tolerance;  and  a  patient  who  has  commenced  with  less  than  a 
mile,  may  often  extend  his  rides  to  fifteen  or  twenty  miles  daily  with 
propriety.  It  is  more  especially  applicable  to  cases  in  which  the  ab- 
dominal or  thoracic  viscera  are  enfeebled.  No  remedy,  probably,  is 
more  effectual  in  pure  dyspepsia;  and,  since  the  times  of  Sydenham,  it 
has  been  considered  a  most  valuable  prophylactic  in  phthisis.  Indeed, 
there  is  reason  to  think  that  it  often  proves  useful,  and  sometimes  even 
curative,  after  the  disease  has  actually  commenced.  Hepatic  torpor 
without  inflammation,  habitual  constipation  from  enfeebled  function, 
and  hemorrhoidal  affections  arising  from  one  or  both  of  the  preceding 
conditions,  are  often  benefited  by  this  mode  of  exercise.  The  same  may 
be  said  of  headaches  and  other  cerebral  affections,  purely  functional, 
and  connected  with  debility.  In  relation  to  riding  on  horseback,  the 
remark  before  made  as  to  the  importance  of  combining  other  objects 


190  GENERAL    STIMULANTS.  [PART  II. 

with  the  pursuit  of  health,  is  peculiarly  applicable.  I  have  been  told 
that  the  late  Professor  Wistar,  of  Philadelphia,  used  to  recommend  his 
dyspeptic  patients  to  ride  out  every  day  to  a  certain  chalybeate  spring, 
several  miles  from  the  city;  his  object  being  much  more  the  benefit  of 
the  ride  than  that  of  the  waters.  A  long  journey  on  horseback  is  an 
almost  certain  cure  for  pure  dyspepsia. 

Carriage  exercise  is  more  purely  passive  than  that  on  horseback,  for 
which,  in  its  rougher  modes,  it  is  the  best  substitute.  The  jolting  of  a 
rough  vehicle  over  smooth  roads,  or  of  a  smooth  vehicle  over  rough  and 
stony  roads,  is  often  highly  useful  in  the  cases  to  which  attention  was 
called  in  the  last  paragraph.  The  jarring  movement  of  the  railroad 
car,  and  that  of  the  steamboat,  is  next  perhaps  in  efficiency  to  that  just 
referred  to.  That  of  a  row-boat  is  of  the  same  character ;  and  the  ex- 
ercise of  the  rower  himself,  combining  the  active  and  passive  kinds,  is 
an  admirable  measure  for  imparting  vigour  to  the  system,  if  not  over- 
done. Riding  in  a  smooth  carriage  and  sailing  arc  the  mildest  methods, 
applicable  to  the  feeblest  condition  of  system  requiring  exercix-. 

Substitutes  for  these  methods  may  be  found  within  doors.  Chair? 
have  been  invented  which  enable  the  invalid  to  imitate  horseback  riding  ; 
and  the  same  effect  is  in  some  degree  obtainable  by  the  jogging  motion 
of  an  ordinary  chair.  The  rocking-chair  and  the  swing  arc  partial  sub- 
stitutes for  the  smooth  carriage  and  the  sailing  vessel;  but,  in  these 
methods,  it  must  be  recollected  that  the  peculiar  character  of  the  motion 
gives  a  special  direction  to  the  blood  ;  in  that  of  rocking  centrifugally 
to  the  head,  in  that  of  swinging  in  like  manner  centrifugally  from  the 
head.  From  the  former,  therefore,  injudiciously  indulged  in,  there  may 
be  some  risk  of  cerebral  congestion ;  from  the  latter,  of  defective  circu- 
lation in  the  brain. 

Friction  and  shampooing  may  be  considered  as  local  varieties  of 
passive  exercise.  Friction  may  be  performed  by  the  patient  himself,  in 
which  case  the  active  is  combined  with  the  passive,  and  more  universal 
effects  are  obtained.  It  may  be  performed  with  the  naked  hand,  or  by 
means  of  flannel,  a  coarse  linen  towel,  the  flesh-brush,  or  any  other 
roughish  material ;  and  should  be  carried  so  far  as  to  excite  some  redness 
in  the  surface,  but  not  to  abrade  or  inflame  it.  The  more  extensively  it 
is  performed  over  the  body  the  better ;  as  its  influence  is  thus  propor- 
tionably  generalized.  It  should  be  repeated  once  or  twice  daily  in 
chronic  cases.  Shampooing  is  a  practice  introduced  from  the  East,  and 
consists  essentially  in  a  kind  of  kneading  process,  performed  on  the  sur- 
face, but  reaching  in  its  effects  deeper  than  mere  friction,  in  fact  through- 
out the  soft  parts  of  the  body  not  protected  by  a  bony  case.  Slapping 
over  the  surface  with  the  sole  of  a  slipper,  or  any  slight  flat  body  of  a 
similar  character,  operates  in  the  same  way  as  the  above  processes.  The 
effect  of  all  of  them  is  moderately  to  excite  the  surface  and  the  soft 


CHAP.  I.]  TONICS. — PURE   AIR.  191 

parts  near  it,  thereby  attracting  the  blood  and  nervous  action,  and  pro- 
ducing a  tonic  impression;  while  they  operate  derivatively  in  relation 
to  the  internal  organs.  They  are,  therefore,  especially  indicated  in  ca-t-s 
of  torpor  of  the  skin  and  muscles,  attended  with  congestion  or  chronic 
inflammation  of  the  viscera. 


3.  PURE  AJ  &  AS  A  TONIC. 

This,  though  a  very  efficient  tonic  under  certain  circumstances,  must 
be  considered  as  acting  negatively.  In  large  towns,  the  atmosphere  is 
impregnated  with  effluvia,  the  general  effect  of  which  on  the  system  is 
at  first  depressing,  and  ultimately  debilitating.  By  removing  from  town 
into  country,  we  escape  this  influence;  and,  the  cause  of  weakness  being 
removed,  our  systems  acquire  renewed  strength  through  the  healthful 
agency  of  an  uncontaminated  atmosphere.  This  is  especially  the  case 
with  invalids,  whose  strength  has  been  impaired  by  disease,  and  whose 
systems  are  often  unable  duly  to  react,  while  exposed  to  the  air  of  cities. 
I  presume  there  are  few  inhabitants  of  large  towns  who  have  not  felt, 
even  in  their  ordinary  health,  the  refreshing  and  invigorating  effect  of 
the  country  atmosphere,  or,  to  speak  more  accurately,  of  an  escape  from 
the  enfeebling  effluvia  to  which  they  are  habitually  exposed. 

The  sick  chamber  is  liable,  in  a  still  greater  degree  than  the  general 
atmosphere  of  towns,  to  the  charge  of  unwholesomeness ;  and,  even  in 
the  country,  therefore,  invalids  are  often  greatly  benefited  by  escaping 
from  the  confined  and  sedative  air  of  their  lodgings  to  that  of  the  open 
fields. 

These  remarks,  while  applicable  to  debility  in  general,  are  peculiarly 
so  to  that  of  convalescence. 

But,  though  pure  air  may  be  only  negatively  tonic  at  the  ordinary 
atmospheric  pressure,  yet,  by  exposure  to  the  atmosphere  either  much 
ratified  or  much  condensed,  a  tonic  influence  on  the  respiratory  organs 
is  obtained,  in  the  former  case  indirectly,  in  the  latter  directly,  from 
which  much  good  may  be  expected  in  debilitated  conditions  of  those 
organs.* 


*  From  observations  by  Dr.  Hermann  Weber  on  the  climatic  influence  of  the  high 
regions  of  the  Swiss  Alps,  he  came  to  the  following  conclusions. 

Respiration  is  increased  in  frequency  and  depth,  with  increasing  elevation. 

The  heart  contracts  more  frequently  in  proportion  to  the  height  attained. 

The  appetite,  and  generally  thirst,  are  augmented. 

Sanguification  is  improved. 

The  nervous  system  is  invigorated,  and  the  sleep  more  healthy. 

The  muscular  system  acquires  increased  energy,  and  is  more  active. 

It  is  inferred  ;hat  the  metamorphosis  of  tissue  is  augmented;  though  the  urine 
does  not  appear  to  be  materially  altered  in  quantity :  the  proportion  of  solids  being 


192  GENERAL   STIMULANTS.  [PART  II. 

4.  MENTAL  INFLUENCE  AS  A  TONIC. 

Certain  states  of  the  mind  are  known,  from  experience,  to  have  a  seda- 
tive effect  upon  the  system  at  large.  Grief,  anxiety,  and  all  the  various 
modifications  of  fear  are  distinguished,  in  common  nomenclature,  as  the 
depressing  emotions.  Whatever,  therefore,  in  any  manner  counteracts 
or  removes  these  feelings,  must  be  indirectly  stimulant ;  and,  even  though 
purely  negative  in  its  operation,  would  rank  among  tonic  influences.  But 
there  are  also  mental  conditions  which  have  a  directly  elevating  or  sup- 
porting effect.  The  more  refined  pleasures  of  sense  and  perception;  the 
appreciation  of  the  beautiful,  the  picturesque,  or  the  sublime  in  nature 
and  art;  the  enjoyment  attending  the  legitimate  exercise  of  all  our  intel- 
lectual powers;  the  pleasurable  emotions  of  love,  hope,  confidence,  joy, 
of  triumphs  over  difficulties,  of  temptations  resisted,  of  a  legitimate  am- 
bition gratified;  all  these  produce  in  our  physical  systems  an  excitation, 
which,  though,  like  stimulation  from  any  other  source,  it  may  be  exces- 
sive and  injurious,  is  more  generally  within  the  limits  of  a  healthful  influ- 
ence, and,  in  states  of  debility,  is  positively  tonic  and  restorative.  No 
practitioner  can  fully  perform  his  duty  towards  his  patients,  who  does 
not  avail  himself  of  this  instrumentality  in  cases  of  debility.  It  is  prob- 
ably more  available,  in  the  treatment  of  defect  of  function  in  the  digestive 
organs,  the  liver,  and  the  brain,  than  in  pure  general  debility ;  as  it  is 
upon  these  functions  especially,  that  the  opposite  condition  of  mind  ex- 
hibits most  obviously  its  depressing  tendencies. 


6.  TEA  YELLING  AS  A  TONIC. 

This  agency  is  merely  a  combination  of  those  already  treated  of;  but 
it  affords  so  ready  and  efficient  a  method  of  obtaining  their  conjoint  influ- 

only  probably  somewhat  increased.  (Dublin  Quart.  J.  of  Med.  Sci.,  Feb.   1,  1864, 
p.  42.) 

Comprested  Air  as  a  Remedy.  Dr.  <le  Vivenot  has  ascertained,  by  n  series  of  experi- 
ments, that  by  exposure  daily  to  the  influence  of  compressed  air,  ns  in  a  diving  ma- 
chine for  example,  the  capacity  of  the  lungs  becomes  enlarged.  This  increase  of 
capacity  amounted  in  himself  and  others,  after  a  daily  exposure  for  an  hour  or  two, 
continued  for  three  months,  to  the  compressed  air  of  a  chamber,  to  3-36  per  cent., 
or  about  one-thirtieth  of  the  whole  capacity  of  the  lungs.  Nor  was  this  condition 
transitory,  as  the  augmentation  was  found  almost  undiminished  a  month  after  the 
cessation  of  the  experiments.  To  this  enlarged  capacity  was  added  an  increase  of 
elasticity  of  the  pulmonary  tissue,  and  of  the  power  of  the  respiratory  muscles. 
The  surface,  moreover,  of  the  air-cells  is  brought  into  contact,  in  a  given  time,  with 
a  greater  amount  of  air.  Great  therapeutic  advantages  might  be  expected  from 
this  kind  of  tonic  influence,  which  is  especially  applicable  to  cases  of  emphysema, 
atelectasis,  tuberculosis,  dyspnoea  from  pleuritic  exudation,  etc.  (Arch.  Gfn.  d« 
JJfd.,  Nov.  1865,  p.  611.)— Note  to  the  third  edition. 


CHAP.  I.]  TONICS. — TRAVELLING.  193 

ence,  that  it  merits  a  distinct  notice.  Exercise  steadily  maintained,  pure 
air,  and  a  favourable  mental  condition,  are  the  real  tonic  agents  which 
give  to  travelling  the  powerful  curative  influence  exerted  by  it  in  affec- 
tions complicated  with,  or  essentially  consisting  in  debility,  whether  of 
the  whole  system,  or  some  one  or  more  of  its  parts.  But,  to  be  useful, 
it  must  be  properly  conducted.  To  jump  into  a  railroad  carriage,  or  a 
steamboat;  to  be  whirled  in  crowds  from  point  to  point,  with  headlong 
rapidity ;  to  lodge  in  densely  thronged  hotels,  and  swelter  all  the  night 
in  close  apartments;  to  be  ever  on  the  anxious  watch  for  a  good  position, 
or  any  position  at  all,  in  the  immense  competition  of  the  masses;  to  eat 
hurriedly  anything  which  is  set  before  you,  and  at  times  adapted  not  to 
your  own  convenience,  but  to  that  of  the  transporting  party;  often,  in 
the  onward  rush,  to  pass  nights  without  sleep,  or  with  insufficient  sleep, 
upon  the  road  or  the  stream,  and  in  an  atmosphere  contaminated  with 
human  exhalations;  this  is  not  relaxation  and  amusement;  it  is  labour, 
often  very  fatiguing,  vexatious,  and  exhausting  labour;  and  it  is  no  won- 
der that  invalids,  who  travel  thus,  return  weaker  than  when  they  started, 
and  with  very  discouraging  impressions  as  to  the  remedial  virtues  of 
travelling.  All  this  should  be  reversed.  There  should  be  no  hurry,  no 
bustle,  no  anxiety  or  struggle.  Arrangements  should  be  made  for  quiet 
movement  on  foot,  in  a  carriage,  on  horseback,  or  in  two  or  more  of  these 
methods  successively.  The  lodgings  should  be  comfortable  and  airy, 
and  a  due  amount  of  sleep  procured.  The  meals  should  be  taken  as 
regularly  as  possible,  eaten  slowly,  and  of  wholesome  food.  With  a 
little  care  and  forethought  in  regulating  these  points,  the  happiest  effects 
may  be  hoped  for.  The  charms  of  rural  scenery  and  rural  sounds,  the 
frequent  novelties,  the  succession  of  interesting  incidents,  the  changing 
personal  intercourse,  the  sweetness  of  repose  after  moderate  fatigue, 
light  and  agreeable  reading  in  the  intervals  of  rest,  the  various  gratifi- 
cations of  the  passing  day,  the  as  varied  hopes  and  plans  for  the  mor- 
row, perhaps  a  short  sojourn  in  some  way-side  inn,  with  charming 
scenery  and  cool  shade  without,  and  cleanliness,  neatness,  and  a  cordial 
welcome  within ;  perhaps  a  longer  abode  in  some  place  of  more  general 
resort,  by  the  sea-shore,  or  near  some  mineral  spring,  for  example,  where 
salt-bathing  or  chalybeate  waters  may  superadd  their  tonic  effect  to  that 
of  cheerful  social  intercourse;  all  these  genial  influences  combine,  with 
the  sustained  exercise  and  uncontaminated  air,  to  elevate  and  support 
the  physical  functions,  and  often  serve  to  restore  energy  to  a  debilitated 
frame,  upon  which  medicines  have  been  tried  in  vain.  In  the  debility 
of  convalescence;  in  that  resulting  from  an  overstraining  of  the  mental 
and  corporeal  functions  in  the  eager  pursuits  of  business  or  ambition;  in 
various  chronic  inflammations  of  the  internal  organs,  in  which  the  local 
mischief  is  sustained  by  a  want  of  due  energy  in  the  system  to  institute 
a  restorative  course ;  in  the  nervous  affections,  particularly  the  neuralgic, 
VOL.  i. — 13 


194  GENERAL    STIMULANTS.  [PART  II. 

in  which  the  nervous  mitres  are  enfeebled  in  the  general  weakness,  and 
unable  to  resist  irritating  or  otherwise  disturbing  causes ;  in  the  torpor 
of  stomach,  liver,  and  bowels,  which  are  so  often  met  with  conjointly  in 
dyspeptic  disease;  in  such  <-ases  as  these,  it  is.  that  we  m&y  expect  good 
from  travelling.  To  obtain  its  full  advantages,  it  is  sometimes  neces- 
-urv  to  persevere  long;  and  a  journey  of  six  months,  or  of  one  or  two 
vcars,  will  often  completely  accomplish  a  cure,  which,  with  a  shorter 
continuance  of  the  same  means,  would  be  only  partial  or  temporary. 


6.  COLD  AS  A  TONIC. 

Cold  is  directly  sedative ;  but,  as  it  does  not  for  a  time  lessen  power, 
while  the  excitability  of  the  depressed  part  is  increased  by  its  compara- 
tive rest,  the  necessary  consequence  is  that,  upon  the  withdrawal  of  the 
cold,  and,  in  some  degree,  without  its  withdrawal,  the  ordinary  normal 
excitants  produce  more  than  their  ordinary  effect,  and  the  part  is  excited 
beyond  its  original  condition  Besides,  the  sensation  of  cold  has,  through 
a  wise  provision  of  nature,  an  excitant  influence  upon  the  nervous  centres, 
causing  them  to  send  a  stimulant  impression  to  the  circulatory  system, 
by  which  injury  is  obviated.  Through  the  operation  of  these  principles, 
reaction  follows  the  first  depression  produced  by  the  cold ;  and  this  reac- 
tion is  not  confined  to  the  part  first  impressed,  but  extends  throughout 
the  system.  Thus,  cold  secondarily  elevates  the  vital  functions;  and,  as 
this  effect  is  usually  moderate,  it  must  take  rank  among  the  tonics. 
The  invigorating  power  of  this  agent  has  long  been  known,  as  a  matter 
of  observation ;  and  it  has  been  much  employed  in  cases  of  local  and 
general  debility.  Caution,  however,  in  its  use  is  very  important.  If  too 
long  continued,  it  at  length  exhausts  excitability,  and  then  produces  a 
steady  depression,  without  reaction.  Too  intensely  applied,  it  rapidly 
exhausts  the  excitability ;  and  the  reaction,  if  produced  at  all,  may  be 
feeble,  and  soon  cease.  In  proportion  to  the  debility,  is  this  indisposi- 
tion to  reaction ;  and  a  degree  of  cold,  which  would  secondarily  stimulate 
a  healthy  person,  might  prostrate  still  further  one  already  much  debili- 
tated. Therefore,  in  its  employment  as  a  tonic,  the  degree  and  con- 
tinuance of  the  cold  should  be  proportioned  to  the  remaining  strength, 
and  the  remedy  should  be  abandoned  if  found  to  be  followed  by  a  feeble 
reaction,  or  by  none.  When  the  skin  is  cool,  and  at  the  same  time  re- 
laxed by  perspiration,  the  ability  to  react  is  much  diminished;  and  the 
remedy  should  never  be  employed  in  this  state  of  the  surface.  When  the 
reaction  is  insufficient,  it  should  he  aided  by  friction  upon  the  skin,  or 
by  muscular  exertion. 

As  a  general  rule,  cold  should  not  be  used  as  a  tonic  when  there  is  a 
tendency  to  dangerous  internal  congestions,  as  of  the  brain  or  lungs,  and 


CHAP.  I.]  COLD    AS    A  TONIC.  195 

should,  therefore,  be  avoided  in  organic  diseases  of  the  heart,  which  pre- 
dispose to  such  congestions.  The  reason  is  obvious ;  namely,  that  the 
blood,  driven  by  the  cold  from  the  surface,  accumulates  internally,  and 
thus  greatly  adds  to  the  pre-existing  danger. 

Methods  of  Application.  The  cold-air  bath  may  sometimes  be  use- 
fully employed.  This  is  applied  by  simply  stripping  the  body  in  a  cold 
room,  at  a  temperature  from  below  the  freezing  point  to  60°  F.,  remain- 
ing thus  exposed  for  a  short  time,  then  dressing,  and  aiding  reaction  by 
moderate  exercise. 

The  cold-water  bath  is  more  efficient.     For  the  purposes  of  a  tonic, 
this  should  seldom  have  a  lower  temperature  than  60°,  and  may  be  as 
high  as  70°  or  75°  F.    When  too  cold,  there  is  the  twofold  danger,  first 
that  it  may  not  be  followed  by  reaction,  and  secondly  that,  if  reaction  do 
take  place,  it  may  rise  too  high,  even  so  as  to  amount  to  a  febrile  parox- 
ysm.   There  can,  however,  be  no  fixed  point  of  heat  applicable  under  all 
circumstances ;  so  different  are  the  susceptibilities  of  individuals  even  in 
health,  and  so  much  are  these  susceptibilities  affected  by  habit,  by  the 
degree  of  debility,  and  by  the  varying  influence  of  peculiarity  in  disease. 
The  general  rule  is,  that  the  temperature  should  be  sufficiently  low  to 
produce  a  decided  feeling  of  coldness,  with  shivering,  paleness  and  con- 
traction of  the  surface,  and  some  reduction  of  the  pulse.     The  duration 
of  immersion  should  be  no  longer  than  sufficient  to  produce  a  decided 
impression,  and  should  cease  at  once  upon  the  occurrence  of  headache, 
pain  in  the  stomach,  cramps  in  the  muscles  of  the  extremities,  general 
uneasiness,  a  purple  colour  of  the  lips,  ears,  fingers,  etc.,  or  other  symptom 
indicating  any  material  disturbance  of  the  vital  functions.     There  is 
usually  a  shivering  on  the  first  immersion ;  and  a  repetition  of  this  should 
be  the  signal  for  leaving  the  bath.    The  time  may  be  momentary,  it  may 
be  for  a  minute  or  two,  or  it  may  extend,  when  the  temperature  is  but 
moderately  reduced,  to  fifteen  minutes  or  more.     From  70°  to  75°,  the 
bath  is  scarcely  applicable  as  a  tonic,  except  to  cases  of  ready  suscepti- 
bility, or  considerable  weakness,  with  less  than  the  usual  tendency  to 
reaction.     In  health,  the  reactive  influence,  at  this  temperature,  would 
generally  be  balanced  by  the  sedative  power  of  the  water  itself;  and 
little  tonic  effect  would  be  experienced.     A  decided,  but  not  excessive 
reaction  is  the  essential  test  of  the  propriety  of  the  remedy;  and  trial 
must  determine  how  great  a  coldness,  and  how  long  an  immersion  are 
necessary  for  this  result.     With  a  repetition  of  the  remedy,  an  increase, 
in  one  or  both  of  these  respects,  is  generally  necessary  in  order  to  sus- 
tain the  original  effect.     Should  but  a  feeble  reaction  or  none  occur,  the 
remedy  must  be  abandoned.    Upon  leaving  the  bath,  the  patient  should 
be  wiped  quite  dry,  and  then  aid  reaction  by  gentle  exercise.  If  he  be  too 
feeble  for  this,  the  reaction  may  be  promoted  by  moderate  friction.   The 
signs  of  a  sufficient  reaction  are  a  general  glow,  the  return  of  colour  to  the 


196  GENERAL   STIMULANTS.  [PART  II. 

surface,  a  fuller  and  somewhat  more  frequent  pulse,  and  a  fooling-  of  ligmV 
ness,  exhilaration,  and  increased  muscular  strength.  The  head  should 
also  be  immersed  or  wetted,  in  order  to  prevent  determination  to  that 
part.  The  cold  bath  should  not  be  employed  by  women  in  advanced 
pregnancy,  nor  during  menstruation.  It  is  applicable,  as  a  tonic,  only 
to  cases  of  chronic  debility;  and  especially  these  of  a  nervous  character, 
without  serious  structural  lesion.  It  may  be  repeated  daily,  and  should 
be  taken  rather  on  an  empty  than  a  full  stomach.  Probably  the  most 
suitable  period  in  the  twenty-four  hours  is  early  in  the  morning;  for  then 
the  excitability  of  the  system,  having  been  recruited  by  rest,  is  greatest, 
and  reaction  will  be  most  apt  to  take  place.  The  patient,  however, 
should  not  pass  immediately  from  the  warmth  of  bed  into  the  bath, 
especially  if  perspiring.  A  little  exercise  previously  is  desirable,  so  as 
to  induce  a  moderate  action  of  the  surface,  but  without  perspiration. 
An  hour  or  two  before  dinner  is  also  a  suitable  period,  if  the  excitability 
of  the  patient  has  not  been  impaired  by  physical  exertion  previously; 
but  exposure  to  the  hot  sun  is  an  objection  to  bathing,  at  this  time  of 
day,  in  the  open  air.* 

The  cold  shower  bath  is  often  employed  with  reference  to  its  second- 
ary tonic  effects.  It  is  administered  by  causing  water  to  fall  over  the 
body  from  a  greater  or  less  height,  in  minute  streams,  formed  by  passing 
the  liquid  through  a  vessel  perforated  at  bottom  by  numerous  small  holes. 
A  common  colander  may  be  employed  for  the  purpose  extemporaneously. 
The  shower  bath  acts  on  the  same  principles  as  the  cold  bath ;  but  the 
shock  is  somewhat  greater,  and  the  reaction,  therefore,  more  speedy. 
It  may  be  employed  in  similar  cases,  and  with  the  same  cautions.  The 
time  of  continuance,  for  a  given  temperature,  should  be  somewhat  shorter. 

The  cold  douche  is  often  useful  as  a  local  corroborant.  It  consists  in 
the  continuous  impinging  upon  a  part  of  the  body  of  a  column  of  cold 
water,  either  falling  upon  the  part,  or  forcibly  impelled  against  it  by 
mechanical  means.  It  operates  upon  the  same  principles  locally,  as  the 
cold  bath  does  generally ;  that  is,  it  first  depresses,  and  then  secondarily 
stimulates  the  part  by  the  reaction.  The  affections  to  which  it  is  appli- 
cable are  old  and  persistent  gouty  or  rheumatic  swellings  of  the  joints, 
obstinate  and  indolent  tumours,  local  paralysis,  debility  of  the  joints 
following  sprains,  nervous  deafness,  certain  conditions  of  amaurosis, 
and  obstinate  weakness  of  the  eyes,  sometimes  following  their  acute 
diseases. 

*  As  to  effects  produced  on  the  system  by  simple  baths,  through  the  absorption 
of  the  water,  they  do  not,  from  the  most  recent  experiments,  appear  to  be  such  as 
materially  to  modify  their  remedial  influence.  M.  Fre"de"ric  Duriau  found  that,  when- 
ever the  temperature  was  below  the  normal  heat  of  the  body,  water  was  absorbed, 
but  never  when  above  it;  but  the  whole  amount  absorbed  was  small;  not  exceeding 
the  average,  in  three  persons,  of  561  grains  after  an  immersion  of  75  minutes,  at  th« 
heat  of  77°  F.  (Archivtt  Gfnfraltt,  Fev.  1856,  p.  165.) 


CHAP.  I.]        TONICS. — TRANSFUSION  OF  BLOOD.  197 

Sea-bathing,  or  the  cold  salt-water  bath,  is  still  more  efficacious  than 
the  simple  cold  bath,  in  consequence  of  the  stimulant  influence  of  the 
salt  on  the  surface  of  the  body;  while,  from  the  same  cause,  there  IB 
less  risk  of  dangerous  prostration.  The  reaction,  under  its  use,  is  more 
speedy  and  certain,  and  from  a  less  amount  of  antecedent  depression; 
and  patients  can  remain  in  it  longer  without  exhaustion.  Hence  it  may 
be  employed  in  cases  of  debility,  in  which  reaction,  under  the  use  of  the 
simple  cold  bath,  is  imperfect  or  wanting.  While  adapted  to  chronic 
debility  in  general,  it  is  peculiarly  useful  in  scrofulous  affections,  as  of 
the  bones,  joints,  and  lymphatic  glands,  both  external  and  internal.  Sea- 
bathing has  long  been  considered  as  among  the  most  efficacious  remedies 
in  these  affections.  In  threatened  and  incipient  phthisis,  it  may  be  re- 
sorted to  with  hope  of  benefit,  when  the  air  of  the  sea-shore  is  not  found 
injuriously  to  irritate  the  lungs.  Should  it  do  so,  the  artificial  salt  bath 
should  be  substituted.  But  particular  caution  should  be  observed,  in 
this  disease,  to  abandon  the  measure  if  not  attended  with  full  reaction. 
The  probability  is  that  sea-water  acts,  in  scrofula,  not  only  as  a  tonic, 
but,  through  its  iodine  compounds,  as  .an  alterative  also  ;  and  might  be 
expected,  therefore,  to  be  more  efficacious  than  mere  salt  water  *  The 
salt-water  bath  may  be  made  by  dissolving  common  salt  in  water,  in  the 
proportion  of  four  avoirdupois  ounces  to  the  gallon.  When  a  strong 
stimulant  impression  upon  the  skin  is  desired,  in  reference  to  a  revulsive 
influence  from  within,  the  solution  may  be  much  stronger;  but  simply 
as  a  tonic,  the  strength  mentioned,  which  is  about  that  of  sea-water,  is 
probably  preferable,  at  least  as  a  general  rule. 


7.  TRANSFUSION  OP  BLOOD   AS  A   TONIC. 

By  this  process  is  meant  the  transfer  of  the  blood  of  one  individual 
into  the  blood-vessels  of  another.  It  is  eminently  a  tonic  measure,  as  it 
aims  to  do  directly  what  some  of  the  most  effective  tonic  medicines,  the 
chalybeatcs,  for  example,  do  indirectly ;  that  is,  to  increase  the  quantity, 
and  improve  the  quality  of  the  blood.  The  idea  of  this  remedial  measure 

*  Dr.  Bcnckc  infers,  from  his  experiments,  that  sea-bathing  has  the  effect  of 
increasing  the  elimination  of  uric  acid,  and  of  the  phosphates  by  the  uriiie.  This 
is  what  might  have  been  anticipated  from  its  known  tonic  effects;  as  these  are  neces- 
sarily attended  with  an  exaltation  of  the  functions  generally,  and  consequently  that 
of  nutrition,  which  implies  an  increased  metamorphosis  of  tissue,  and  increased 
discharge  of  effete  matter  by  the  kidneys.  (See  B.  and F.  Midico-chirurg.  Rev.,  Am. 
ed.,  Jan.  185G,  p.  77.)  Sea-water  is  thought  to  be  more  excitant  to  the  surface  than 
a  simple  solution  of  common  salt  of  the  same  strength  ;  and  this  effect  is  ascribed 
by  Dr.  C.  F.  Sloan,  of  Ayr,  to  the  existence  in  the  sea  of  countless  microscopic  ani- 
malcules, which  have  the  property  of  irritating  the  skin.  (Med.  Times  and  Qaz.. 
Aug.  1858,  p.  176.) 


198  GENERAL   STIMULANTS.  [PART  II. 

seems  to  have  occurred  to  the  ancients,  and,  according  to  Laniartiniere, 
was  absolutely  carried  into  effect  by  them;  but,  in  modern  times,  no 
notice  of  it  exists  antecedent  to  the  year  1615,  when  an  account  was 
published  by  Labavius  of  a  case  of  direct  transfusion  from  a  young  and 
vigorous  man  into  another  feeble  and  scarcely  breathing,  with  the  effect 
of  restoring  the  strength  of  the  latter.  (Gyc.  of  Pract.  Med.,  Am.  ed.,  iv. 
468.)  About  the  middle  of  the  same  century,  the  measure  was  tried  by 
Dr.  Christopher  Wren,  of  England,  upon  inferior  animals,  and  soon  after- 
wards (A.D.  1666)  by  MM.  Denys  and  Emmerez,  in  France,  upon  the 
human  subject.  Much  attention  was  attracted  to  it  by  the  experiments 
of  the  last-mentioned  practitioners,  and  some  favourable  results  were  ob- 
tained; but  two  instances  of  death,  following  its  employment,  bi'ought  it 
into  disrepute ;  and  it  was  forbidden  by  law  to  be  practised  in  France 
until  it  should  receive  the  approval  of  the  Faculty  of  Medicine  of  Paris, 
which  it  has  never  yet  received.  {Diet,  de  Med.,  xxix.  738.)  For  con- 
siderably more  than  a  century,  it  remained  in  total  neglect;  nor  was  it 
till  the  publication  of  the  experiments  of  Dr.  James  Blundell,  of  London 
(Phyxiolog.  and  Patholog.  Researches,  A.D.  1825),  that  general  attention 
was  again  called  to  it,  as  a  practical  measure.  By  this  practitioner,  and 
by  others  in  considerable  number  who  have  followed  him,  it  has  been 
satisfactorily  established  that  transfusion,  properly  performed,  is  a  per- 
fectly safe  operation,  and  may  be  employed  with  the  happiest  results  in 
certain  very  dangerous  cases. 

It  has  been  ascertained,  as  might  have  been  anticipated,  that  the 
blood  of  one  animal  cannot  be  safely  transfused  into  the  vessels  of 
another,  of  a  different  species,  in  which  the  normal  character  of  the 
blood  corpuscles  is  quite  different;  death,  sometimes  speedy,  sometimes 
more  or  less  protracted,  having  resulted  from  such  attempts.  But  it  is 
not  absolutely  essential  to  a  favourable  result  that  the  animals  must  be 
of  the  same  species,  provided  the'blood  be  of  a  similar  character;  for  the 
blood  of  calves  has  been  transferred  to  lambs  with  perfect  impunity ; 
and  cases  have  been  recorded  by  Denys  and  others,  in  which  blood  ab- 
stracted from  men  has  been  replaced  by  that  of  lambs  and  calves,  not 
only  without  harm,  but  with  beneficial  effects.  (Archives  General?.*,  4e 
ser.,  xxx.  333.)  Still,  as  it  is  quite  certain  that  the  blood  of  different 
individuals  of  the  same  species  may  be  interchanged  with  safety,  it  is 
undoubtedly  the  best  rule  to  confine  the  measure  practically  within  these 
limits. 

The  chief  dangers  of  the  operation  have  been  supposed  to  be,  first,  the 
entrance  of  air  into  the  blood-vessels,  and,  secondly,  the  coagulation  of 
the  fibrin  during  the  transfer.  In  reference  to  the  former,  the  case  of  an 
insane  man  operated  on  by  Denys  is  recorded,  in  whom,  upon  the  third 
trial  of  the  process,  death  suddenly  occurred,  in  consequence,  as  was 
supposed,  of  the  entrance  of  air  into  the  veins;  but  no  other  case  of  a 


CHAP.  I.]        TONICS. — TRANSFUSION  OF  BLOOD.  199 

similar  kind  has  occurred;  and  Dr.  Blundell  has  shown  that  no  danger 
need  be  apprehended  from  this  source,  with  ordinary  care.  Indeed,  from 
the  experiments  of  Dr.  Giovanni  Polli,  and  others,  it  may  be  inferred 
tha(  some  bubbles  of  air  thrown  in  with  the  blood  have  no  sensible 
effects  whatever.  As  to  the  dangers  of  coagulation,  it  has  been  said 
that  small  portions  of  fibrin,  solidified  in  the  transferring  tube,  might  be 
thrown  in  with  the  liquid  portion,  and  produce  serious  consequences  by 
obstruction.  But  this  danger  may  be  avoided  by  a  due  degree  of  ac- 
tivity in  the  transfer ;  and,  should  future  experience  show  that  there  is 
really  some  ground  for  apprehension  from  this  cause,  it  may  be  obviated 
by  defibrinating  the  blood,  previously  to  injection,  in  the  ordinary  method 
of  agitation  with  sticks.  The  experiments  of  Dumas,  Prevost,  Dieffen- 
bach,  Polli,  and  others  appear  to  show,  that  blood  thus  treated  has  all 
the  revivifying  properties  of  that  fluid  unchanged,  and  that  the  absence 
of  the  fibrin  is  of  no  account.  (Archives  Generates,  4e  ser.,  xxx.  208.)* 

Applications.  The  main  therapeutic  application  of  transfusion  has 
been  for  the  recovery  of  individuals,  greatly  exhausted  and  dangerously 
prostrated  by  the  loss  of  blood ;  and  it  is  particularly  in  puerperal  wo- 
men, suffering  under  the  effects  of  uterine  hemorrhage,  that  the  remedy 
has  been  tried.  In  these  cases,  it  has  proved  highly  serviceable  ;  having 
in  many  instances  rescued  the  patient  from  impending  death,  when  no 
other  hope  apparently  remained,  and  in  no  one  recorded  instance  been 

*  Dr.  Brown-Sdquard  has  published  some  very  interesting  conclusions  in  relation 
to  the  transfusion  of  blood,  drawn  from  his  own  experiments.  It  has  long  been 
known  that  sudden  death,  preceded  by  convulsions,  was  a  not  uncommon  result  of 
such  transfusion  made  under  unfavourable  circumstances.  This  was  ascribed  to 
the  poisonous  effects  of  the  blood  of  one  species  when  injected  into  the  vessels  of 
another.  As  defibrinated  blood  was  found  to  act  more  favourably  than  the  original 
liquid  unchanged,  some  thought  that  the  fibrin  might  be  the  noxious  agent  in  these 
cases.  It  would  appear,  from  Dr.  Brown-Se'quard's  statements,  that  the  real  poison- 
ous agent  is  carbonic  acid.  Hence  venous  blood  will  poison,  when  the  arterial  may 
produce  no  ill  effect.  If  carbonic  acid  be  expelled  from  venous  blood  by  impreg- 
nating it  with  oxygen,  so  as  to  produce  a  bright  redness,  it  may  then  be  employed 
with  impunity.  The  fact  that  venous  blood  has  not  always  done  harm,  is  merely 
ascribable  to  the  small  quantity  injected  at  a  time;  so  as  to  give  opportunity  for  the 
elimination  of  carbonic  acid  by  the  lungs.  A  certain  proportion  in  the  blood  is 
necessary  to  fatal  effects,  as  of  any  other  poison.  According  to  this  physiologist, 
blood,  whether  venous  or  arterial,  from  any  vertebrated  animal,  if  sufficiently  charged 
with  oxygen  to  become  bright-red,  may  be  injected  into  the  vessels  of  any  other 
vertebrated  animal  with  impunity,  provided  the  quantity  be  not  too  great.  On  the 
contrary,  the  same  blood,  sufficiently  charged  with  carbonic  acid  to  darken  it,  can- 
not be  injected  into  veins  of  a  warm-blooded  animal,  without  causing  symptoms  of 
asphyxia,  and  generally  death  preceded  by  violent  convulsions,  unless  the  quantity 
injected  be  less  than  a  five  hundredth  part  of  the  weight  of  the  animal,  and  (he  in- 
jection also  be  very  gradually  made.  These  are  extremely  interesting  results;  but 
cannot  be  acted  on  with  propriety,  in  the  human  subject,  until  amply  confirmed  by 
repeated  experiment.  (Archives  Gen.,  Janv.  1858,  p.  107.) — Note  to  the  second  edition. 


200  GENERAL   STIMULANTS.  [PART  II. 

productive  of  known  evil.  Of  thirty-six  cases  in  which  transfusion  was 
performed,  in  consequence  of  exhaustion  or  hemorrhage  connected  with 
the  puerperal  state,  collected  by  Mr.  Soden,  and  published  in  the  London 
Medico-chiruryical  Transactions  (xxxv.  415),  "twenty-nine  were  re- 
covered from  imminent  death  by  the  operation;"  and  of  the  seven  unsuc- 
cessful cases,  "it  does  not  appear  that  the  fatal  termination,  in  any  case, 
was  due  to  or  hastened  by  the  operation."  Though  used  chiefly,  as  just 
stated,  in  puerperal  cases,  the  remedy  has  proved  not  less  beneficial  in 
exhaustion  from  spontaneous  hemorrhage,  and  that  following  wounds 
and  operations,  of  which  Dr.  Routh  gives  examples  in  a  paper  published 
in  the  Medical  Times  (Aug.  11,  1849);  and  in  one  case  at  least  of  con- 
stitutional hemorrhage,  in  which  the  morbid  tendency  had  existed  from 
birth,  and  the  patient  had  been  reduced,  by  continual  bleedings,  for  five 
days,  to  a  state  of  extreme  peril,  not  only  were  the  urgent  symptoms 
relieved,  but  the  predisposition  appears  to  have  been  eradicated  by  a 
consequent  change  in  the  character  of  the  blood.  (Arch.  Gen.,  4e  ser., 
xxx.  338.)  The  remedy  has  also  been  found  effectual  in  inanition,  de- 
pendent on  constant  vomiting.  (Medico-chirurg.  Trans.,  xxxv.  434.) 
Indeed,  this  appears  to  me  among  its  most  promising  applications.  Cases 
now  and  then  occur  in  which,  without  incurable  disease  of  the  stomach, 
this  organ  becomes  so  irritable  that  no  food  can  be  retained,  and  death 
sometimes  results.  By  allowing  the  stomach  to  rest  in  these  cases,  and 
introducing  nothing  into  it  except  a  little  cold  water,  the  diseased  condi- 
tion may  be  corrected  by  the  efforts  of  nature,  if  the  life  of  the  patient 
can  in  the  mean  time  be  sustained.  This  has  been  done,  in  some  in- 
stances, with  the  effect  of  saving  life,  under  apparently  desperate  circum- 
stances, by  means  of  injections  of  animal  broths  into  the  rectum ;  but, 
should  this  measure  fail,  nothing  seems  to  be  more  clearly  indicated  than 
the  occasional  transfusion  of  blood,  in  such  quantities  as  may  be  neces- 
sary to  support  the  vital  functions  without  undue  excitement.  In  a  case 
of  poisoning  by  carbonic  oxide,  reported  by  Dr.  A.  S.  Meldon,  the  patient 
was  rescued  from  apparently  impending  death  by  the  injection  of  blood. 
The  case  occurred  in  Berlin,  and  the  operation  was  performed  by  Prof. 
Martin.  (N.  Y.  Med.  Journ.,  Nov.  1866,  p.  138,  from  the  Medical  Press 
and  Circular.) 

Method  of  Operating.  Under  the  impression  that  the  blood  would  be 
injured  by  exposure  to  the  air,  the  transfusion  was  originally  effected 
through  a  tube,  passing  from  an  artery  of  the  supplying  individual  into 
an  artery  of  the  patient.  But  this  was  a  very  unsatisfactory  procedure, 
and  founded,  as  has  been  fully  established  by  experiment,  upon  a  false 
basis.  The  short  period  for  which  the  blood  is  exposed  to  the  air  has 
been  found  to  be  attended  with  no  disadvantage.  The  much  more  con- 
venient and  efficient  plan,  therefore,  has  been  adopted,  of  drawing  the 
blood  from  a  vein  of  the  healthy  person  into  a  deep  vessel,  and  then  im- 


CHAP.  I.]  TONICS. COD-LIVER   OIL.  201 

mediately  injecting  it  into  a  vein  of  the  patient,  by  means  of  a  syringe. 
The  receiving  vessel  should  be  placed  in  warm  water,  so  as  to  maintain 
the  normal  temperature  of  the  blood,  and  the  syringe  should  be  warmed 
with  the  same  view.  The  syringe  should  be  plated  or  tinned  within, 
should  work  accurately,  and  should  have  the  capacity  of  three  or  four 
ounces.  It  is  better  to  operate  upon  a  vein  in  the  arm  than  in  the  neck; 
as  there  is  less  risk  of  the  admission  of  air.  The  blood  should  be  in- 
jected slowly  and  steadily.  Occasionally  some  force  is  requisite  to 
overcome  the  resistance  of  the  vein  when  collapsed.  The  quantity  of 
blood  thrown  in  must  be  regulated  by  the  effects,  and  the  apparent  wants 
of  the  system.  From  less  than  an  ounce  to  more  than  twenty-four 
ounces  has  been  employed;  about  four  ounces,  in  a  greater  number  of 
cases  than  any  other  precise  quantity.  (Ibid.,  427.)  In  a  case  operated 
on  by  Mr.  Soden,  the  happiest  effects  followed  the  introduction  of  a 
single  ounce.  (Ibid.,  423.)  A  new  instrument  for  transfusion,  which 
spares  the  necessity  of  using  the  syringe,  has  been  invented  by  Dr. 
Hamilton,  of  Edinburgh.  The  reader  will  find  it  described  in  the  Amer- 
ican Journal  of  the  Medical  Sciences  (Jan.  18G3,  p.  249). 


The  tonics  may  be  most  conveniently  arranged  for  special  consider- 
ation in  throe  subdivisions;  namely,  1.  those  of  animal,  2.  those  of  vege- 
table, and  3.  those  of  mineral  origin. 

I.  TONICS  OF  ANIMAL  ORIGIN. 

Though  an  animal  diet  may  be  considered  as  tonic,  and  this  includes 
many  distinct  substances,  cod-liver  oil  is  the  only  one,  strictly  entitled  to 
the  name  of  a  medicine,  which  belongs  to  this  subdivision. 


COD-LIVER  OIL. 
OLEUM  MORRHU^E.  U.  S.,  Br. 

Origin.  Cod-liver  oil  is  obtained  from  the  livers  of  Gadus  Morrhua, 
or  the  common  cod,  and  several  other  species  of  the  same  genus,  inhabit- 
ing the  waters  of  the  Atlantic,  near  the  shores  of  Northern  Europe  and 
America.  It  is  prepared  either  by  exposing  the  livers  in  mass  to  the 
heat  of  the  sun,  and  skimming  off  the  oil  as  it  rises;  or  by  boiling  them 
into  a  pultaceous  mass  with  water,  and  straining;  or  by  expression.* 

*  Besides  the  oil  derived  from  different  species  of  Gadus,  which  is  probably  iden- 
tical or  nearly  so,  that  of  the  livers  of  fishes  of  other  genera  has  been  tried,  for 


202  GENERAL    STIMULANTS.  [PART  II. 

Sensible  Properties.  Its  consistence  is  that  of  ordinary  fish-oil.  In 
its  purest  form,  it  is  of  a  colour  varying  from  the  slightest  tint  of  trans- 
parent yellow  to  a  fine  golden  yellow ;  when  less  pure,  of  a  light-brown 
colour,  but  still  transparent;  when  most  impure,  dark-brown  and  opaque 
in  mass,  though  transparent  in  thin  layers.  Its  odour  and  taste  are  quite 
peculiar,  scarcely  disagreeable  in  the  finer  kinds,  but  offensive  in  the 
most  impure,  which  are  also  somewhat  acrid.  The  oil  is  injured  by  long 
exposure  to  the  air. 

Composition.  It  contains  a  peculiar  principle  called  gaduin,  not  known 
to  have  any  medicinal  virtue,  various  biliary  principles,  a  little  iodine, 
olein  and  margarin,  and  many  other  constituents  of  no  special  interest. 

Characteristics.  Its  most  obvious  characteristic  properties  are  its  odour 
and  taste,  quite  different  from  those  of  ordinary  fish-oils,  and  strongly 
resembling  those  of  shoe-leather,  which  owes  these  properties  to  the  cod- 
liver  oil  used  in  its  preparation.  Another  distinctive  property,  derived 
from  its  biliary  constituents,  is  that  of  assuming  fine  changes  of.  colour 
under  the  action  of  the  mineral  acids.  A  third  peculiarity  is  that,  when 
heated  with  potassa  or  lime,  and  muriate  of  ammonia,  it  yields  a  smell 
like  that  of  herring-pickle,  owing  to  the  formation  of  a  peculiar  volatile 
alkaloid  called  propylamin.  It  is  frequently  adulterated  with  other  oils. 

Much  has  been  said  in  reference  to  the  superiority  of  one  or  another 
variety  of  cod-liver  oil.  I  believe  they  are  all  equally  effectual  if  equally 
pure,  and  equally  acceptable  to  the  stomach.  The  darker  kinds,  which 
are  at  the  same  time  very  offensive  to  the  smell  and  taste,  often  disagree 
with  the  stomach,  and  therefore  operate  less  favourably  than  the  lighter- 
coloured  ;  but  I  always  regard  the  possession  of  the  peculiar  odour  as  an 
ntial  indication  of  efficiency;  and  any  specimen  of  the  oil,  not  pos- 
sessing it,  may  be  regarded  with  suspicion. 

Effects  on  the  System.  When  taken  in  the  ordinary  doses,  cod-liver 
oil,  in  the  great  majority  of  cases,  produces,  for  some  time,  no  observable 
effect  upon  the  system.  In  two  or  three  weeks,  however,  a  fattening 
process  usually  commences;  and  there  is  a  gradual  increase  of  weight, 
with  a  moderate  exaltation  of  the  functions  generally,  and  an  augment- 
ation of  the  red  corpuscles  of  the  blood.  In  some  persons,  the  medicine 
produces  nausea  and  disagreeable  eructations,  and.  when  the  gastric 
sensiliiliiic-  are  extremely  acute,  even  vomiting;  but  these  results  are 
raoet  frequently  dependent  rather  on  its  offensive  tasle,  than  its  direct 


some  of  which  virtues  are  claimed  very  nearly  or  quite  equal  to  those  of  cod-liver 
oil.  Among  these  fish  is  the  dog-fish  (Squalus  Catulus),  the  product  of  which  M. 
Devergie  believes  to  be  superior  to  the  officinal  in  sensible  properties,  while  thera- 
peutically  it  is  scarcely  inferior.  (Secern.  J.  of  Med.  Sci.,  April.  18HO,  p.  613.)  The 
Hame  is  asserted  of  the  Duyony  oil,  obtained  from  the  superficial  fat  of  two  species 
of  Ilnlecore  (II.  Australis  and  //.  Dugonfj),  inhabiting  the  Australian  rivers  and 
bays.  ( V.  S.  Ditpensatory,  12th  ed.,  p.  588.) — Note  to  the  third  edition. 


CHAP.  I.]  TONICS. — COD-LIVER    OIL.  203 

influence  on  the  stomach ;  and,  if  the  oil  is  taken  without  exciting  dis- 
gust, are  very  rare  in  a  healthy  state  of  the  organ.  Occasionally  the 
functions  are  over-excited;  the  medicine  proving  laxative,  diaphoretic, 
or  diuretic,  and  even  augmenting  the  menstrual  flux ;  and  I  have  very 
often  noticed,  after  its  continued  use  for  two  or  three  months,  a  decided 
odour  of  the  oil  exhaling  from  the  body,  distinctly  observable  upon  a 
near  approach.  At  length  the  system  seems  to  be  accustomed  to  its  use, 
and  no  further  change  is  produced. 

In  cases  of  debility  and  emaciation,  with  an  anemic  state  of  the  blood, 
the  alteration  is  frequently  veiy  striking.  Beginning  two  or  three  weeks 
from  the  first  use  of  the  medicine,  the  patient  often  rapidly  fattens,  the 
healthy  colour  returns,  the  pulse,  instead  of  being  excitable  and  weak,  be- 
comes full,  strong,  and  equable,  the  appetite  and  digestion  improve,  and  a 
healthy  vigorous  tone  of  mind  takes  the  place  of  the  previous  languor, 
listlessness,  or  depression.  These  effects  are  all  characteristic  of  a  tonic 
operation,  and,  as  in  the  case  of  other  tonics,  may  be  carried  to  excess, 
so  as  to  produce  a  plethoric  state  of  system,  which  is  a  result  to  be 
guarded  against  in  the  use  of  this  remedy. 

Mode  of  Operation.  It  is  supposed  by  some  that  cod-liver  oil  acts 
merely  as  a  nutrient,  and  differs  from  other  articles  of  diet  only  in  con- 
sequence of  its  more  ready  assimilation.  But  from  no  other  nutritious 
substance,  and  no  combination  of  such  substances,  can  equal  effects  be 
obtained,  under  the  same  circumstances.  Surely  there  are  many  articles 
of  food,  much  more  analogous  in  constitution  to  our  own  tissues,  and 
even  more  readily  digested,  which,  in  the  ordinary  condition  of  the  sys- 
tem, nourish  it  even  better  than  this  oil  could  do,  but  utterly  fail  in  the 
morbid  states  in  which  it  proves  so  efficacious.  It  has  been  said  that  it 
fattens  by  simply  supplying  oil,  in  a  state  in  which  it  can  readily  enter 
the  blood,  and  that  other  oils  of  easy  assimilation  will  answer  the  same 
purpose.  But  it  does  not  simply  fatten.  It  improves  the  digestive  pro- 
cess, increases  the  proportion  of  red  corpuscles  in  the  blood,  and  invig- 
orates the  whole  nutritive  function.  The  mere  increase  in  the  proportion 
of  fat  in  the  system  is  one  of  the  least  important  of  its  results.  Besides, 
other  fats  do  not  produce  the  same  effects.  Butter,  fat  pork,  the  fat  of 
beef,  mutton,  and  veal,  olive  oil,  and  various  other  oleaginous  sub- 
stances, arc  often  largely  consumed  by  the  very  individuals,  who  after- 
wards find  relief,  by  the  employment  of  cod-liver  oil,  from  morbid  condi- 
tions which  had  arisen  under  the  use  of  these  articles  of  diet.  Nothing 
has  been  more  common,  in  the  hospital  of  which  I  have  until  recently 
had  charge  in  the  winter  season,  than  to  see  consumptive  seamen  rap- 
idly improve  in  their  condition,  under  the  influence  of  the  oil,  though 
they  may  have  been  previously  consuming,  on  shipboard,  much  larger 
quantities  of  oily  matter  in  the  shape  of  fat  pork.  It  is  true  that  differ- 
ent practitioners  have  suggested  different  oleaginous  substitutes  for  cod- 


204  GENERAL    STIMULANTS.  [PART  II. 

liver  oil;  each  maintaining  that  he  has  obtained  satisfactory  results  from 
the  one  specially  recommended.  Thus,  whale  oil,  and  other  kinds  of 
fish-oil,  olive  oil,  almond  oil,  poppy  oil,  etc.,  have  been  recommended; 
but,  though  most  of  them  are  much  more  readily  obtainable  than  pure 
cod-liver  oil,  not  one  of  them  has  held  its  ground,  and  secured  the  confi- 
dence of  the  profession  generally,  simply  because  it  has  failed  upon  a 
more  enlarged  trial.  It  is  proper  to  state  that  Dr.  Theophilus  Thomp- 
son, physician  of  the  Brompton  hospital  for  consumptive  persons,  states, 
in  his  published  clinical  lectures  on  pulmonary  consumption  (Am.  ed.,  p. 
128),  that  he  has  found  cocoa-nut  oil  to  possess  properties  similar  to 
those  of  cod-liver  oil,  and  to  bear  comparison  with  that  in  its  effects;  but, 
if  this  estimate  should  prove  correct,  it  would  simply  prove  a  close  anal- 
ogy in  properties  between  the  two  oils,  and  not  that  they  acted  merely 
as  nutrients.  From  these  considerations,  I  think  it  must  be  admitted 
that  cod-liver  oil  has  positive  medicinal  properties;  and  the  best  expla- 
nation, I  think,  of  its  operation  is,  that  it  possesses  the  power  of 
directly  stimulating  the  blood-making  and  nutritive  functions,  in  a  man- 
ner analogous  to  that  of  other  tonics,  and,  in  certain  cases,  more  effec- 
tively than  they.  Whether  its  virtues  depend  upon  a  peculiar  principle, 
the  co-operation  of  two  or  more  principles,  or  its  general  constitution, 
has  not  been  determined.  Some  have  ascribed  its  powers  to  the  iodine 
and  bromine  it  contains;  but  these  are  in  too  small  a  proportion  to  exert 
much  influence  on  the  system;  are  incapable,  when  given  alone,  of  pro- 
ducing the  same  effect;  and  have  quite  failed  when  they  have  been  given 
in  combination  with  other  oils,  as  has  sometimes  been  done  in  the  hope 
that  the  artificially  ioduretted  oil  might  prove  a  sufficient  substitute  for 
that  of  the  cod. 

Therapeutic  Applications.  Cod-liver  oil  has  recently  taken  a  place 
among  the  most  valuable  articles  of  the  Materia  Medica.  Used  from 
time  immemorial,  in  the  maritime  districts  of  Holland,  Germany,  and 
the  northern  parts  of  Great  Britain,  as  a  popular  remedy  in  rheumatism 
and  rickets,  it  was  first  brought  to  the  notice  of  the  medical  profession, 
in  the  year  1782,  by  Dr.  T.  Percival,  of  England,  and  was  afterwards 
referred  to  by  Dr.  Bardsley,  in  his  Hospital  Report*,  in  1807;  but  gained 
little  attention  until  the  publication  of  a  paper  by  Schenek.  in  1822,  in 
HufelancTs  Journal,  containing  a  series  of  observations  upon  its  effi- 
cacy in  chronic  rheumatism,  particularly  sciatica  and  lumbago.  After 
this  time,  its  employment  was  much  extended  in  Germany,  and  other 
parts  of  the  continent  of  Europe;  and  numerous  communications  in  the 
medical  journals  set  forth  its  claims  to  high  consideration,  not  only  in  the 
complaints  above;  mentioned,  but  in  others,  and  especially  in  the  different 
forms  of  scrofula  and  tuberculosis.  In  1841,  it  was  brought,  to  the  notice 
of  the  medical  profession  in  Great  Britain,  as  a  remedy  in  phthisis,  by 
Dr.  J.  Hughes  Bennett,  of  Edinburgh;  his  reports  in  its  favour  were 


CHAP.  I.]  TONICS. — COD-LIVER   OIL.  205 

confirmed  by  the  ample  experience  of  Dr.  C.  B.  Williams,  of  London, 
and  subsequently  by  that  of  Dr.  Walshe;  and,  both  in  that  country  and 
in  our  own,  the  use  of  it  extended  rapidly,  until  it  became  almost  uni- 
versal, in  the  complaint  referred  to,  and  in  other  forms  of  scrofulous 
disease. 

Cod-liver  oil  is  indicated  generally  in  cases  of  chronic  debility,  with 
impoverished  blood,  and  defective  nutrition  or  assimilation,  not  con- 
nected with  inflammation  of  the  stomach.  The  class  of  affections  in 
which  it  has  obtained  most  reputation  are  those  included  under  the  term 
scrofulous;  and,  in  many  of  these,  it  has  exhibited  powers  beyond  those 
of  all  other  remedies.  To  understand  its  effects,  it  is  necessary  to  dis- 
criminate between  these  affections. 

The  name  scrofulosis  maybe  applied  to  a  condition  of  system,  essen- 
tially connected  with  a  low  state  of  the  vital  forces  and  defective  or  de- 
praved nutrition,  which  exhibits  itself  under  two  aspects.  In  one  of 
these,  there  is  a  tendency  to  the  production,  in  various  parts  of  the 
body,  sometimes  in  one  part,  sometimes  in  another,  and  sometimes  in 
several  parts  at  once,  of  a  feeble,  protracted,  obstinate  kind  of  inflamma- 
tion, strongly  tending  to  the  suppurative  and  ulcerative  state,  and  indis- 
posed to  a  spontaneous  cure,  which  is  usually  designated  by  writers  as 
scrofulous  inflammation.  In  the  other,  there  is  a  disposition  to  deposit, 
in  the  various  tissues,  a  peculiar  matter  called  tubercle,  which,  at  first 
solid,  either  remains  in  this  condition,  irritating  the  neighbouring  parts 
like  foreign  matter,  or  gradually  softens,  and  is  ultimately  discharged 
through  the  inflammation,  suppuration,  and  ulceration  of  the  contiguous 
structure.  These  two  different  local  expressions  of  the  constitutional 
affection  may  exist  quite  separately,  or  may  be  conjoined  in  the  same 
case.  Now  cod-liver  oil  has  an  extraordinary  influence  over  the  state  of 
system  referred  to,  generally  controlling  it  in  a  considerable  degree,  often 
suspending  it  for  a  time  when  not  completely  eradicable,  and  sometimes 
curing  it  wholly  and  permanently. 

In  the  set  of  cases  belonging  to  the  first  category  above  mentioned, 
those,  namely,  in"  which  the  local  affection  is  simply  scrofulous  inflam- 
mation, the  oil  will  often  effect  complete  cures;  because,  the  morbid 
condition  of  system  being  corrected,  and  the  strength  improved,  the 
local  lesions  are  no  longer  produced,  and  those  already  existing  are 
allowed  to  heal ;  and  life  may  in  general  be  saved,  if  the  disorganization 
has  not  proceeded  too  far  before  the  application  of  the  remedy. 

In  the  second  set,  or  that  characterized  by  the  tuberculous  deposit, 
the  diathesis  may  be  in  like  manner  modified  or  corrected  ;  but  the  remedy 
has  no  influence  whatever  over  the  tubercle  when  already  formed,  which 
will  exercise  its  influence  upon  neighbouring  parts,  or  pursue  its  own 
regular  course  of  degeneration,  quite  independently  of  any  corrective 
that  can  be  applied.  In  such  cases,  it  is  obvious  that  the  oil  can  prove 


206  GENERAL    STIMULANTS.  [PART  II. 

curative  only  when  employed,  either  before  the  tuberculous  deposit  has 
taken  place,  or  when  it  has  occurred  in  situations,  or  in  quantities,  not 
necessarily  destructive  of  life,  through  the  disorganization  of  the  tissue 
affected.  Thus,  when  the  tubercles  are  situated  in  the  brain,  or  the 
arachnoid  membrane,  there  is  scarcely  a  chance  of  safety;  because, 
being  irremovable,  they  will  ultimately  incapacitate,  by  their  irritant  in- 
fluence, this  vital  organ  for  the  performance  of  its  functions.  When,  on 
the  contrary,  they  are  deposited  in  the  external  lymphatic  glands,  in 
the  subcutaneous  areolar  tissue,  and  even  in  the  bones,  there  is  reason- 
able hope  of  a  cure;  as  the  parts  are  less  essential  to  life,  and  the  irrita- 
tion can  generally  be  supported  until  the  offending  matter  has  been  dis- 
charged. Again,  when  such  an  organ  as  the  lungs  is  the  seat  of  the 
deposition,  as  there  is  a  possibility  that  the  tuberculous  matter  may  be 
thrown  off,  it  follows  that,  if  the  quantity  is  not  so  large  as  fatally  to 
overwhelm  the  lung  by  irritation,  as  in  diffused  miliary  tubercle,  or  to 
destroy  the  organ  by  ulcerative  inflammation  in  the  course  of  its  dis- 
charge, or  to  exhaust  the  system  by  the  profuse  suppuration,  and  the 
irritative  influence  of  the  local  disease,  one  of  which  events  generally 
happens  in  ordinary  phthisis,  there  may  be  good  hope  of  ultimate  re- 
covery. Upon  these  principles  may,  I  think,  be  explained  the  frequent 
success  complete  or  partial,  and  the  frequent  failure  also,  of  the  remedy 
in  scrofulous  diseases.  It  will  be  proper,  now,  to  treat  specially  of  the 
several  affections  of  this  kind  in  which  the  oil  is  used. 

External  Scrofula.  In  all  the  forms  of  external  scrofula,  unattended 
with  tuberculous  deposition,  much  good  may  be  expected  from  cod-liver 
oil;  and,  united  with  other  measures  calculated  to  improve  the  blood, 
and  give  vigour  .to  the  system  at  large,  a  cure  may  generally  be  ex- 
pected. Its  effects  are  peculiarly  obvious  in  the  suppurative  and  ulcer- 
ative stage  of  the  affection,  whether  the  lymphatic  glands,  the  subcu- 
taneous tissue,  or  the  skin  itself  be  the  special  seat  of  the  disease. 
Scrofulous  ulcers  and  abscesses  of  the  neck,  axilla,  and  groin,  or  of  the 
.-kin  and  the  areolar  tissue,  in  any  part  of  the  body,  often  rapidly  im- 
prove, and  ultimately  get  well  under  its  use.  I  have  seen  large  and 
exhausting  abscesses  of  the  lower  extremities,  which  have  reduced  the 
patient,  during  months  of  suppuration,  to  the  lowest  condition  of  ema- 
ciation and  debility  compatible  with  life,  recover  slowly  but  steadily, 
from  the  period  at  which  the  system  was  put  under  the  use  of  the 
remedy. 

Should  tubercle,  however,  have  been  deposited  in  the  glands,  or  other 
part  affected,  as  this  must  he  eliminated  before  a  cure  can  take  place,  the 
result  is  more  tedious  and  uncertain.  In  such  cases,  contrary  to  what 
often  happens  in  the  non-tuberculous  cases,  the  swellings,  whether 
irlandular  or  otherwise,  can  very  seldom  be  resolved;  and  a  long  pro- 
cess of  suppurative  ulceration  is  necessary,  before  the  patient  can 


CHAP.  I.]  TONICS. — COD-LIVER    OIL.  207 

recover:  but  even  in  these  cases,  much  good  is  often  done  by  prevent- 
ing the  further  deposition,  by  sustaining  the  strength  during  the  dis- 
charging process,  and  by  determining  healthy  granulation  and  cicatriza- 
tion afterwards. 

Scrofulous  Ophthalmia.  Cod-liver  oil  is  among  the  most  efficient 
remedies  in  this  obstinate  affection,  conjoined  with  the  local  application 
of  nitrate  of  silver  to  any  existing  ulcers  of  the  cornea,  or  other  part  of 
the  conjunctival  surface.  The  oil  has  been  recommended  also  as  a  local 
application  in  these  cases;  but  I  have  no  experience  of  its  use  in  this 
way. 

Cutaneous  Eruptions.  When  these  are  associated  with  scrofulous 
cachexia,  they  often  yield  to  cod-liver  oil  very  happily.  It  is  more  espe- 
cially in  the  impetiginous  and  ecthymatous  affections,  and  in  rupia,  that 
good  may  be  expected ;  but  eczema  and  pemphigus  are  sometimes  simi- 
larly associated,  and  similarly  benefited;  and,  in  that  most  obstinate 
disease  denominated  lupus,  this  is  among  the  most  efficient  remedies. 
In  all  the  cutaneous  eruptions,  however,  it  is  more  the  condition  of  the 
system  that  must  be  considered,  in  relation  to  the  use  of  this  remedy, 
than  the  particular  character  of  the  eruption  itself.  In  these,  as  in 
ophthalmia,  the  oil  has  been  recommended  locally,  as  well  as  by  the 
stomach. 

Scrofulous  Disease  of  the  Bones  and  Joints.  No  other  single  remedy 
is  probably  so  efficient  as  cod-liver  oil  in  this  form  of  scrofula.  In  swell- 
ings of  the  hip,  knee,  and  other  joints,  and  in  disease  of  the  bones  of  the 
*l>ine,  extremities,  cranium,  etc.,  with  or  without  abscess  or  caries; 
though  the  cure  is  often  protracted ;  though  more  or  less  of  deformity 
may  follow  from  the  organic  mischief  done;  and  though  death  will 
sometimes  take  place  from  exhaustion,  when  the  remedy  is  applied  too 
late,  or  even,  from  the  great  amount  of  disease,  notwithstanding  its  em- 
ployment, yet  there  are  few  practitioners,  I  presume,  by  whom  the  oil 
has  been  tried,  who  do  not  consider  it  more  effective  than  any  other 
remedy  previously  used,  and  who  have  not  found  these  affections  much 
more  manageable  by  its  means  than  they  had  been  before.  As  in  scrof- 
ulous swellings  of  the  glands,  there  may  here  also  be  tuberculous  depo- 
sition, which  adds  greatly  to  the  difficulties  and  dangers  of  the  case; 
though,  happily,  it  is  comparatively  rare. 

Tabes  Mesenterica,  or  Swelling  of  the  Mesenteric  Glands.  In  cachec- 
tic children,  there  is  often  much  abdominal  distension  with  more  or  less 
hardness,  sometimes  peritoneal  effusion  and  enlarged  liver,  great  emacia- 
tion, pallor,  and  debility,  which  have  generally  been  ascribed  to  scrofu- 
lous disease  of  the  mest-nteric  glands.  Some  of  these  cases  yield  quickly 
und  most  happily  to  cod-liver  oil,  and  co-operating  treatment ;  while  others 
are  more  or  less  obstinate,  and  not  a  few  end  fatally.  This  difference  of 
result  may  be  readily  accounted  for.  Some  of  the  cases  depend  essen- 


208  GENERAL   STIMULANTS.  [PART  II. 

tially  on  tubercles,  either  scattered  in  the  peritoneum  or  beneath  it,  or 
deposited  in  the  mesenteric  glands,  which  they  enlarge  and  harden,  or 
diffused  throughout  the  whole  abdomen,  causing  peritoneal  inflamma- 
tion, which  sometimes  agglutinates  all  the  viscera  together.  These  are, 
in  general,  essentially  incurable,  except,  perhaps,  in  a  few  instances,  in 
which  the  tubercle,  originally  small  in  amount,  may  make  its  way, 
through  ulccration,  into  the  bowels,  or  possibly  undergo  absorption  or 
degeneration.  But  not  unfrequently,  also,  there  are  no  tubercles;  the 
scrofulous  affection  of  the  liver  and  mesenteric  glands  being  simply  of  the 
characteristic  inflammatory  character;  and  cases  of  this  kind  very  often 
end  favourably.  The  latter  cases  are  most  common  in  infancy,  the 
former  in  children  from  two  to  ten ;  and,  when  adults  are  affected,  it  is 
most  commonly  in  the  tuberculous  form. 

Disease  of  the  Bronchial  Glands.  The  same  remarks  arc  applicable 
to  these  as  to  the  mesenteric  glands.  In  scrofulous  cases  without  tuber- 
cle, a  cure  may  be  expected;  in  the  tuberculous,  the  result  is  more  doubt- 
ful, though  there  is  reason  to  believe  that  the  tubercle  is  sometimes 
eliminated  through  the  bronchia,  and  that  recoveries  take  place;  but  in 
these  cases  the  danger  arises,  not  so  much  from  the  tubercle  in  the 
glands,  as  from  that  deposited  also  in  the  lungs. 

Disease  in  the  Stomach  and  Bowel*.  Diarrhoea,  with  ulceration  of  the 
bowels,  is  a  not  unfrequent  attendant  on  tuberculous  affections.  Some- 
times this  depends  on  tubercles  in  the  substance  of  the  bowels,  leaving 
ulcers  as  they  are  discharged;  in  other  instances,  it  has  been  found  to 
be  unconnected  with  tubercles.  There  is  reason  to  believe  that,  scrofu- 
lous inflammation  sometimes  attacks  especially  the  mucous  membranes, 
showing,  when.it  does  so,  a  tendency  to  affect  the  follicles,  and  to  result 
in  ulceration  of  these  structures.  The  gastric  mucous  membrane  may 
be  thus  attacked,  as  well  as  the  intestinal,  though  it  is  much  more  rarely 
tuberculous  than  the  latter.  In  these  cases,  whether  tuberculous  or  not, 
cod-liver  oil  is  indicated  whenever  it  can  be  supported  by  the  stomach. 
Even  when  tuberculous,  there  may  be  hope  of  a  favourable  result,  if  the 
affection  is  confined  to  this  part. 

Chronic  Bronchitis,  Laryngitis,  Angina,  Ozsena,  etc.  The  remark* 
made  in  the  last  paragraph  in  relation  to  the  mucous  membrane  of  the 
alimentary  canal,  are  applicable  also  to  that  of  the  respiratory  passages. 
as  well  as  of  the  pharynx,  though  tuberculization  is  uncommon.  Hence, 
in  chronic  inflammation  of  the  nostrils  or  o/ca-na,  chronic  angina,  and 
chronic  laryngitis  and  bronchitis,  when  connected  with  the  scrofulous 
diathesis,  cod-liver  oil  should  be  tried. 

Scrofulous  Inflammation  of  the  Serous  Tissues.  This  often  exists  in 
connection  with  tubercles,  as  already  stated  in  reference  to  the  perito- 
neum. The  pleura,  pericardium,  and  syuovial  membranes  are  similarly 
affected.  Whether  scrofulous  inflammation  occupies  these  tissues  with- 


CHAP.  I.]  TONICS. — COD-LIVER   OIL.  209 

out  tubercles  may  perhaps  be  considered  uncertain ;  but  analogy  is  in 
favour  of  the  opinion  that  it  does  so;  and,  in  relation  to  the  arachnoid, 
or  at  least  the  subarachnoid  tissue,  and  the  synovial,  analogy  is  strongly 
supported  by  facts.  Extensive  tuberculization  of  the  proper  serous  tis- 
sues is  almost  always  sooner  or  later  fatal ;  but  the  event  may  probably 
be  postponed  by  the  use  of  the  oil ;  and,  in  cases  where  the  inflammation 
may  be  supposed  to  exist  without  tubercle,  the  remedy  would  probably 
prove  occasionally  curative.  Hence,  in  chronic  cases  of  these  affections, 
the  oil  should  be  employed,  not  only  to  correct  the  diathesis  as  far  as 
possible  in  the  positively  tuberculous  cases,  but  as  a  curative  measure, 
in  the  hope  that  the  symptoms  may  depend  simply  on  inflammation.  I 
have  seen  cerebral  symptoms  in  infancy,  which  seemed  strongly  to 
threaten  chronic  hydrocephalus,  and  were  associated  with  other  evi- 
dences of  scrofulous  cachexia,  yield  happily  to  this  remedy. 

Phthisis.  The  principles  upon  which  cod-liver  oil  is  given  in  this  com- 
plaint have  been  already  stated.  All  that  can  be  hoped  for  from  it  is, 
by  improving  the  constitution,  to  correct  the  tendency  to  the  deposition 
of  tubercle,  and  to  support  the  system  during  the  exhausting  process  of 
its  discharge.  Unfortunately,  the  diathesis  is  often  so  strong,  so  inti- 
mately incorporated  as  it  were  with  the  inherited  constitution  of  the  pa- 
tient, that  no  known  influence  is  sufficiently  powerful  to  eradicate  it;  and, 
though  it  may  be  postponed,  the  fatal  result  is  in  most  cases  inevitable. 
This  much,  however,  may  be  said  in  favour  of  cod-liver  oil,  that  no  one 
medicine,  and  no  combination  of  medicines  are  known,  which  nearly 
equal  it  in  efficacy.  I  believe  that,  if  used  before  tubercle  has  been  pro- 
duced, it  will  not  unfrequently  prevent  it;  that,  even  after  a  moderate 
amount  has  been  deposited,  it  will  sometimes  arrest  its  progress,  and 
ultimately  save  the  patient ;  and  that  it  may,  in  some  few  cases,  even  in 
the  advanced  stage  of  the  disease,  and  after  cavities  have  been  formed, 
rescue  from  death,  if  the  quantity  of  tubercle  already  existing  be  not  suf- 
ficient fatally  to  disorganize  the  lungs.  Of  this  I  have  no  doubt,  that,  if 
begun  with  early,  and  used  perse veringly,  with  the  aid  of  other  measures 
calculated  to  invigorate  the  general  health,  it  is  capable  of  considerably 
diminishing  the  amount  of  mortality  from  this  fearful  disease.  All  agree 
that  it  will  often  prolong  life,  when  unable  to  preserve  it,  and  that  it  very 
much  contributes  to  the  comfort  of  the  patient,  especially  in  the  advanced 
period  of  the  complaint  There  is  no  stage,  from  the  beginning  to  the 
close,  in  which  it  may  not  be  given  with  reasonable  hope  of  benefit. 
The  misfortune  is,  that  it  is  often  given  insufficiently,  being  abandoned 
too  early,  or  taken  irregularly,  or  in  too  small  a  quantity ;  and  that  pa- 
tients, in  consequence  of  its  unpleasant  effects  on  the  palate  or  the  stom- 
ach, will  not,  or,  from  the  irritability  of  that  organ,  cannot  take  it  in  the 
requisite  amount,  or  for  the  requisite  length  of  time.  No  material  effect 
need  be  looked  for  under  two  or  three  weeks;  and  it  should  not  be  aban- 
VOL.  i. — 14 


210  GENERAL    STIMULANTS.  [PART  II. 

doned,  unless  after  a  totally  fruitless  trial  of  six  weeks  or  two  months. 
When  found  useful,  it  should  be  persevered  with  for  months  or  years ; 
and,  even  after  the  apparent  restoration  of  health,  the  least  sign  of  relapse 
should  be  the  signal  for  its  resumption.  In  the  inherited  cases,  there  is 
a  natural  proclivity  to  the  disease,  which,  though  it  may  be  corrected  for 
a  time,  will  again  and  again  evince  itself  when  the  restraining  cause  is 
removed;  and  the  only  chance  of  safety  is  in  the  unremitting  use  of  the 
proper  measures,  even  when  symptoms  of  disease  have  disappeared, 
until,  in  the  spontaneous  changes  which  the  system  undergoes  in  the 
advance  of  life,  the  original  tendencies  may  have  been  subverted. 

But  it  is  not  in  the  scrofulous  affections  only  that  cod-liver  oil  is  use- 
ful. There  are  other  diseases,  connected  with  a  cachectic  condition  of 
the  system,  in  which  it  has  enjoyed  much  reputation. 

Chronic  Rheumatism.  This  is  one  of  the  complaints  in  which  the  oil 
was  first  used.  It  has  been  particularly  recommended  in  chronic  lum- 
bago and  sciatica,  and  in  obstinate  swellings  and  deformities  of  the 
joints.  It  is  no  doubt  beneficial  in  some  of  these  cases ;  but  I  think  it 
highly  probable  that  not  a  few  of  the  latter,  which  were  taken  for  rheu- 
matic, were  really  scrofulous,  and  that  the  remarkable  efficacy  of  the  oil 
may  be  in  part  ascribed  to  that  cause.  In  the  Pennsylvania  Hospital,  I 
have  repeatedly  witnessed  cases  of  obstinate  and  painful  swellings  of 
the  knee,  ankle,  or  hip,  which  may  possibly  have  been  at  first  rheumatic, 
and  had  been  treated  as  such  for  months  without  success,  which  were 
attended  with  great  emaciation,  a  frequent  pulse,  night-sweats,  and 
other  evidences  of  debility,  and  were  going  on  in  a  steady  course  of  de- 
terioration, that  threatened  death  in  the  end.  These  cases,  under  the 
impression  that  they  were  really  scrofulous,  having  either  been  such  in 
the  beginning,  or  assumed  this  condition  in  their  progress,  I  have  treated 
with  cod-liver  oil,  aided  by  rest,  nourishing  food,  and  auxiliary  medicines, 
as  iron,  quiuia,  and  iodide  of  potassium,  and  with  the  happiest  results. 
At  the  usual  period  after  the  commencement  of  the  remedy,  they  have 
begun  to  exhibit  signs  of  amendment,  and  have  gone  on,  steadily  though 
gradually,  to  a  perfect  cure.  How  much  of  the  result  was  ascribable  to 
the  oil,  and  how  much  to  the  auxiliary  measures,  it  would  be  difficult  to 
decide;  but  my  impression  on  the  whole  is  that,  without  the  oil,  I  should 
have  been  much  less  successful.  The  remedy  has  been  recommended  in 
chronic  gout,  but  is  less  efficacious. 

Rickets.  Perhaps  in  no  disease  does  the  oil  display  greater  powers 
than  in  this,  occurring  in  early  childhood.  Infants,  affected  with  the 
disease,  often  begin  to  improve  in  a  few  days  under  its  use,  and  rapidly 
advance  to  complete  recovery. 

Besides  the  affections  above  mentioned,  the  oil  may  be  used  in  chronic 
anaemia  and  chlorosis,  in  paralysis  with  debility,  and  in  various  nervous 
affections  associated  with  impoverished  blood.  It  has  sometimes  proved 


CUAP.  I.]  TONICS. COD-LIVER    OIL.  211 

beneficial  in  neuralgia,  probably  from  this  cause.  Amenorrhcea  has 
sometimes  yielded  to  it;  probably  through  its  influence  over  the  blood- 
making  function. 

Contraindications.  It  is  contraindicated  in  an  inflamed  and  irritable 
stomach,  a  plethoric  state  of  the  circulation,  and  active  local  congestion; 
and  when,  in  the  course  of  its  administration,  these  conditions  may 
occur,  either  accidentally,  or  as  a  result  of  its  operation,  its  use  should 
be  suspended  for  a  time.  This  caution  it  is  particularly  necessary  to 
observe  in  phthisis,  in  which,  though  it  is  highly  important  that  the 
blood  should  be  of  good  quality,  yet  in  quantity  it  must  bear  a  due  rela- 
tion to  the  reduced  capacity  of  the  lungs;  as  otherwise  it  might  endanger 
inflammation  or  hemorrhage. 

Administration.  For  an  adult,  a  tablespoonful  three  or  four  times  a 
day  is  about  the  proper  dose ;  and  for  an  infant,  a  teaspoonful  as  often ; 
and  this  quantity  should  always  be  aimed  at.  Some  can  take  the  oil 
out  of  the  spoon  without  inconvenience;  but  generally  it  is  desirable  to 
obviate  the  disagreeable  taste  by  some  addition.  This  may  often  be 
done  sufficiently  by  taking  an  aromatic  substance  into  the  mouth,  im- 
mediately before  and  immediately  after  the  medicine.  Orange-peel  has 
been  particularly  recommended  for  this  purpose ;  so  also  has  strong 
coffee,  without  cream  or  sugar,  in  the  quantity  of  a  teaspoonful.  The 
addition  of  ten  per  cent,  of  common  salt  is  said  to  conceal  its  taste  ef- 
fectually; but  so  large  a  proportion  as  this  might  sometimes  act  injuri- 
ously on  the  stomach  or  the  blood.  The  oil  may  also  be  taken  floating 
in  an  aromatic  water,  as  -that  of  cinnamon,  or  one  of  the  mints.  But 
probably  the  best  vehicle,  on  the  whole,  is  a  little  frothy  porter  or  ale, 
which  covers  the  taste  very  well,  and  is  usually  not  contraindicated. 
In  hectic  cases,  the  dose  of  oil  may  sometimes  be  advantageously  ad- 
ministered in  a  wineglassful  of  wild-cherry  bark  tea.  When  the  stomach 
is  very  delicate,  it  may  be  given  in  the  form  of  emulsion,  made  with  an 
aromatic  water;  and,  when  it  cannot  be  otherwise  taken,  gelatin  cap- 
sules containing  it  may  be  resorted  to.* 


*  Various  preparations  of  cod-liver  oil,  in  which  it  holds  other  medicines  in  solu- 
tion, have  been  recommended  and  employed.  Such  are  the  quinated  cod-liver  oil,  in 
which  it  is  impregnated  with  quinia  in  the  alkaline  state;  l\ie  ferruginous  oil,  in 
which  powdered  iron  or  the  recently  prepared  protoxide  are  dissolved  in  the  oil ;  and 
the  iodized  oil,  in  which  it  is  incorporated  with  iodine ;  but  none  of  these  combinations 
have  peculiar  virtues;  and,  when  any  of  the  medicines  mentioned  are  indicated  in 
connection  with  the  oil,  it  ia  better  to  administer  the  two  separately;  as  the  pecu- 
liar management  which  each  may  require  cau  be  thus  better  regulated.  (Note  to  ttu 
second  edition.) 

Volatile  oil  of  bitter  almonds  has  been  found  by  M.  Jeannel,  after  numerous  ex- 
periments, entirely  to  destroy  the  offensive  smell  and  taste  of  cod-liver  oil.  The 
quantity  required  for  the  purpose  ia  in  proportion  to  the  offensiveness  of  the  oil. 
One  grain  of  the  volatile  oil  will  completely  disinfect  half  a  troyounce  of  the  moe* 


212  GENERAL   STIMULANTS.  [PART  II. 

It  has  been  recommended  to  employ  the  oil  externally,  by  friction, 
with  a  view  to  its  constitutional  impression;  but  in  this  way  it  would 
be  too  offensive  for  ordinary  use,  and  should  be  resorted  to  only  when 
the  stomach  entirely  rejects  it.  With  a  view  to  its  local  effect,  it  has 
been  applied  to  the  eye  in  scrofulous  ophthalmia,  and  to  the  skin  in 
eruptive  complaints. 

II.  TONICS  OF  VEGETABLE  ORIGIN. 

The  vegetable  tonics  may  be  subdivided  into  three  sets;  namely, 
1.  the  pure  bitters,  2.  the  bitters  with  peculiar  properties,  and  3.  the 
aromatics. 

1.  Pure  Bitters,  or  Simple  Bitters. 

These  are  characterized  by  bitterness  with  little  or  no  intermixture  of 
other  taste,  and  by  a  purely  tonic  power,  which  is  identical  or  nearly  so 
in  all.  There  appears  to  be  a  close  relation  between  the  bitter  and  tonic 
properties;  so  much  so,  that  the  possession  of  the  former  may  be  con- 
sidered as  prima  facie  evidence  of  the  possession  of  the  latter  also. 
Cullen,  indeed,  believed  this  connection  to  be  essential,  and  taught  that 
it  was  the  tonic  power  of  bodies  that  gave  them  bitterness.  Bitter  sub- 
stances might  have  other  powers  in  addition,  such  as  the  narcotic  and 
purgative,  which  might  prevent  their  use  in  reference  to  their  tonic 
property,  but  they  still  possessed  it.  He  even  seems  to  have  thought 
that  the  bitterness  might  reside  in  a  single  principle  of  peculiar  compo- 
sition. This,  however,  has  been  shown  not  to  be  true.  A  great  number 
of  proximate  bitter  principles  have  been  discovered,  very  different  in 

offensive  cod-liver  oil;  but  this  might  injuriously  affect  the  influence  of  the  medi- 
cine by  adding  its  own  sedative  action.  Not  more  than  one-qunrter  or  at  most  one- 
half  of  the  quantity  would  be  admissible;  and  the  smaller  dose  would  probably  be 
sufficient  for  any  ordinary  oil.  M.  Jeannel,  however,  thinks  thnt  the  best  agent 
for  the  purpose  is  cherry-Inure!  water;  and  it  is  sufficient  to  shake  the  oil  with  its 
volume  or  at  most  twice  its  volume  of  the  distilled  liquid.  The  effect  is  in  either 
case  owing  to  the  hydrocyanic  acid  present;  and  I  have  no  doubt  that  the  wild- 
cherry  bark  tea,  referred  to  in  the  text,  acts  in  the  same  way.  (Journ  dt  Fharm.  tt 
de  Chim.,  3e  se>.,  xxxviii.  360.) 

In  cases  in  which,  though  swallowed,  the  oil  is  soon  afterwards  rejected  by  vomit 
ing,  M.  Vigla  asserts  that  he  has  uniformly  found  this  effect  to  be  obviated  by  admin- 
istering to  the  patient,  after  he  has  swallowed  the  medicine,  eight  or  ten  grains  of 
calcined  magnesia.   (Ibit,  3e  s6r  ,  xli.  248.) 

Extract  of  Cod-liver.  A  preparation  claiming  to  be  an  extract  of  cod-liver,  and 
which,  on  chemical  examination,  has  been  found  to  contain  all  the  principles  of  the 
oil,  excepting  oily  matter  and  glycerin,  has  been  brought  before  the  notice  of  the 
profession  as  a  substitute  for  the  oil.  But  too  little  is  yet  known  of  it  to  justify  its 
adoption  among  officinnl  remedies  (Chem.  News,  Jan.  5,  1866,  p.  10.) — Notes  to  the 
third  edition. 


CHAP.  I.]  TONICS. — SIMPLE   BITTERS.  213 

composition  and  chemical  relations.  Yet  I  am  inclined  to  think  that 
there  is  some  ground  for  the  opinion  of  the  identity  of  the  two  prop- 
erties. It  is  easy  to  conceive  that  the  same  arrangement  or  shape  of 
particles  which  causes  the  impression  of  bitterness  on  the  organs  of 
taste,  may  give  rise  to  the  tonic  impression  upon  the  stomach;  and  that, 
though  all  bitters  may  not  seem  to  be  tonic,  this  may  be  owing,  not  to 
the  want  of  the  property,  but  to  the  possession  of  other  powers  of 
affecting  the  system,  so  influential  as  completely  to  overwhelm  and  con- 
ceal it.  Nux  vomica  is  tonic  in  small  doses ;  but,  largely  given,  produces 
a  peculiar  effect  on  the  nervous  system  which  quite  obscures  the  tonic. 
Even  quinia,  in  very  large  doses,  loses  apparently  all  its  tonic  powers, 
in  its  overwhelming  influence  upon  the  nervous  centres.  The  same  may 
be  the  case  with  other  bitters  of  great  medicinal  energy,  such  as  colo- 
cynthin,  elaterin,  digitalin,  morphia,  etc.  If  reduced  in  their  dose  so  as. 
to  be  unable  to  produce  their  more  powerful  and  characteristic  effect,  it 
is  very  possible  that  they  might  prove  tonic  to  the  digestive  organs. 

Effects  on  the  System.  The  effects  of  the  simple  bitters  are  to  increase 
the  appetite,  invigorate  digestion,  and  moderately  to  exalt  the  nutritive 
function.  They  have  little  direct  influence  on  the  circulation,  and  per- 
haps none  upon  the  nervous  system.  The  proper  cerebral  functions  do 
not  appear  to  be  affected  by  them  in  any  degree,  unless  in  so  far  as  these 
may  be  influenced  by  the  condition  of  the  others  mentioned.  Their  main 
operation  is  directly  upon  the  mucous  surface  of  the  alimentary  canal ; 
and  their  general  tonic  effects  may  be  ascribed  chiefly  to  the  increased 
quantity,  and  improved  quality  of  the  blood,  resulting  from  the  stimu- 
lated digestion.  It  is  probable  that  a  stimulant  effect  is  extended  sympa- 
thetically from  the  gastro-intestinal  surface  to  the  liver  and  pancreas, 
upon  the  same  principle  as  that  by  which  the  presence  of  chyme  in  the 
duodenum  excites  these  organs.  It  is  possible  that  the  bitter  principles 
may  be  absorbed,  and,  through  the  circulation,  act  on  the  nutritive  func- 
tion everywhere ;  but  this  has  not  been  proved  in  relation  to  the  set  of 
substances  now  under  consideration.  One  evidence  that  their  direct 
operation  is  mainly  upon  the  digestive  organs  is  offered  by  the  fact,  that, 
when  they  are  taken  largely,  so  as  to  prove  irritant,  their  increased  effecte 
are  exhibited  in  those  organs,  and  not  directly  elsewhere.  The  simple 
bitters  are  apt,  in  over-doses,  to  prove  laxative,  and  sometimes  nauseate 
and  even  vomit;  but  they  do  not  disturb  the  heart,  nor  the  cerebro- 
spinal  system,  nor  any  other  part  of  the  body,  unless  in  so  far  as  these 
may  feel  the  condition  of  the  digestive  organs. 

Therapeutic  Application.  The  simple  bitters  are  especially  appli- 
cable to  cases  in  which  the  indication  is  to  promote  the  digestive  func- 
tion. In  pure  dyspepsia,  they  are,  upon  the  whole,  the  best  tonic  reme- 
dies in  our  possession.  By  moderately  stimulating  the  stomach,  they 
probably  favour  the  secretion  of  a  healthy  gastric  juice,  capable  of  dis- 


•_>14  GENERAL    STIMULANTS.  [PART  II. 

solving  the  food,  and  thus  obviate  the  stomachic  uneasiness,  flatulence, 
and  sour  or  acrid  eructations,  resulting  from  the  irritation  of  undigested 
matters,  of  substances  generated  by  the  chemical  reaction  of  these  mat- 
ters, and  probably  also  of  the  unhealthy  secretions  of  the  weakened 
stomach  itself.  They  extend  a  similar  stimulant  influence  to  the  torpid 
bowels,  and  probably  also  to  the  torpid  liver,  thus  still  further  favouring 
the  digestive  function.  Even  in  deficient  action  of  the  bowels  and  of  the 
liver,  unattended  with  symptoms  of  proper  dyspepsia,  they  are  often  use- 
ful, particularly  in  combination  with  remedies  more  especially  addressed 
to  those  functions.  Hence  their  use  as  adjuvants  to  laxatives  in  consti- 
pation, and  to  cholagogues  in  jaundice  depending  on  hepatic  torpor. 
From  their  usefulness  in  debility  of  digestion,  it  follows  that  good  may 
be  expected  from  them  in  all  those  disorders  of  sensation  and  function 
.having  their  root  in  this  affection.  Hence,  they  are  among  the  most 
efficacious  remedies  in  headache,  vertigo,  and  other  deranged  cephalic 
sensations,  connected  with  excess  of  acid  in  the  stomabh ;  in  which  cases 
they  should  be  given  combined  with  an  antacid,  as  magnesia  when  there 
is  costiveness,  chalk  when  there  is  diarrhea,  the  alkaline  carbonates  or 
bicarbonates  when  there  is  neither,  and  aromatic  spirit  of  ammonia  when 
there  is  great  gastric  insensibility. 

The  simple  bitters  are  also  well  adapted  to  the  debility  of  conva- 
lescence from  acute  diseases,  whether  general,  as  fevers,  or  local,  as 
cholera,  dysentery,  and  other  affections  of  the  alimentary  canal.  When- 
ever, under  these  circumstances,  the  original  disease  has  been  removed, 
and  the  appetite  remains  feeble,  and  the  digestive  powers  insufficient  for 
the  management  even  of  the  food  that  may  be  taken,  the  gentle  stimula- 
tion of  the  simple  bitters  is  indicated,  and  will  often  contribute  to  the 
restoration  of  health. 

In  all  cases  of  general  debility,  and  of  impaired  blood,  originating  in 
or  connected  with  simple  weakness  of  the  digestive  function,  these  medi- 
cines may  be  used  with  the  hope  of  benefit ;  and  they  are  often  profitably 
combined  with  other  to/nics,  which  exercise  a  more  powerful  direct  influ- 
ence over  the  system  at  large. 

They  were  formerly  employed  in  intermittent  and  remittent  fevers; 
being  administered,  in  the  absence  or  decline  of  the  fever,  as  antiperio- 
dics,  and  were  supposed  to  be  peculiarly  applicable  to  cases  in  which 
the  apyrexia  was  not  sufficiently  complete  for  the  use  of  Peruvian  bark. 
But,  since  the  discovery  of  quinia,  this  use  of  the  simple  bitters  has  been 
in  great  measure  abandoned. 

They  have  been  supposed  to  possess  anthelmintic  properties;  and  are 
no  doubt  occasionally  useful  in  verminose  cases.  Some  have  supposed 
them  to  operate  by  poisoning  the  worms;  and  experiment  1ms  shown 
that  some  of  them  are  noxious  to  inferior  animals;  but  the  probability  is, 
that  they  do  good  much  more  by  giving  proper  tone  to  the  bowels,  and 


CHAP.  I.]  TONICS. — QUASSIA.  215 

thus  removing  the  condition  favourable  to  the  development  of  the  worms, 
than  by  a  direct  action  on  the  parasites  themselves. 

They  are  more  frequently  given  as  adjuvants  of  other  medicines  than 
by  themselves.  They  are  indicated,  in  this  way,  whenever  weakness  of 
the  digestive  function  is  complicated  with  the  special  disease  prescribed 
for.  Reference  has  already  been  made  to  their  combination  with  laxa- 
tives in  constipation,  with  the  mercurial  preparations  in  jaundice,  or 
other  cases  of  torpid  liver,  and  with  other  tonics  in  general  debility,  as 
with  the  chalybeates  in  anaemia.  In  the  various  nervous  affections,  they 
are  often  useful  in  conjunction  with  the  metallic  tonics  and  the  nervous 
stimulants,  in  dropsy  with  diuretics,  and  in  amenorrhoea  with  emmena- 
gogucs.  The  different  forms  in  which  they  are  prepared,  as  those  of 
powder,  extract,  infusion,  and  tincture,  afford  facilities  for  these  combi- 
nations, which  should  not  be  overlooked  in  prescription.  When  given 
in  chief,  they  are  themselves  often  aided  by  the  addition  of  aromatics,  as 
of  ginger,  orange-peel,  etc.,  which  render  them  more  stimulant  to  the 
stomach  when  very  languid,  and  more  easily  retained  by  it  when  irritable. 

The  different  simple  bitters  are  so  similar  in  their  effects,  that  they 
may  be  given  indiscriminately;  one  being  preferred  to  another  according 
to  convenience,  the  choice  of  the  patient,  or  the  existence  of  some  idiosyn- 
crasy which  may  render  any  one  or  more  of  them  inadmissible. 


I.  QUASSIA.  U.S.,Br. 

Origin.  Quassia  is  the  wood  of  Quassia  excelsa  (Simaruba  excelsa, 
De  Cand.;  Picrsena  excelsa,  Liiidley),  a  lofty  tree  growing  in  Jamaica 
and  other  West  India  islands ;  and  of  Quassia  amara,  a  small  tree  or 
shrub  inhabiting  Surinam.  At  present,  little  or  none  from  the  latter 
source  is  imported. 

Properties.  Quassia  is  brought  to  as  in  billets,  with  the  bark  generally 
attached;  but,  as  kept  in  the  shops,  it  is  in  the  form  of  raspings  or  shav- 
ings, or  split  into  small  pieces.  The  wood  is  light,  porous,  yellowish, 
inodorous,  and  of  an  intense,  unmixed,  and  adhesive  bitterness. 

Active  Principle.  This  is  a  peculiar,  bitter,  crystallizable  principle, 
named  quassin. 

Chemical  Relations.  Quassia  yields  its  virtues  to  water  and  alcohol. 
Its  chemical  relations  are  such  as  not  to  interfere  with  the  use  of  any 
other  medicine,  with  which  it  may  be  desirable  to  associate  it  in  pre- 
scription. It  is  asserted  to  have  the  property  of  opposing,  in  some  de- 
gree, though  it  will  not  altogether  prevent  the  putrefaction  of  animal 
substances. 

Therapeutic  Application.  The  use  of  quassia  as  a  medicine  originated 


216  GENERAL   STIMULANTS.  [PART  II. 

in  Surinam,  in  South  America.  It  was  introduced  into  Europe  in  the 
year  1756,  but  was  not  made  generally  known  until  the  publication  of  a 
dissertation  by  Linnaeus  in  1763,  after  which  it  came  quickly  into  gen- 
eral use.  It  was  at  first  supposed  to  have  virtues  closely  analogous  to 
those  of  Peruvian  bark,  and  was  employed  in  intermittent  and  remittent 
fevers,  and  sometimes  also  continued  fevers,  in  the  low  forms  of  which 
its  antiseptic  properties  were  thought  to  render  it  useful.  It  was  con- 
sidered as  especially  applicable  to  cases  in  which,  in  consequence  of  irri- 
tability of  stomach,  the  more  powerful  febrifuge  could  not  be  retained. 
But  this  use  of  quassia  has  been  abandoned.  It  is  now  generally  admit- 
ted to  be  nothing  more  than  a  simple  bitter,  and  to  be  applicable  only  to 
affections  in  which  the  tonics  belonging  to  this  last  subdivision  are  indi- 
cated. 

Quassia  is  asserted  to  be  noxious  to  insect  life.  Employed  in  cabinet- 
ware,  it  is  said  to  afford  protection  against  insects,  and  the  infusion  has 
been  used  as  a  fly-poison.  A  grain  of  the  alcoholic  extract,  inserted  into 
a  wound  in  the  leg  of  a  rabbit,  is  said  to  have  caused  the  death  of  the 
animal  on  the  third  day,  without  any  signs  of  inflammation ;  and  from 
this,  and  other  observations  made  of  its  effects  on  other  animals,  and  on 
man,  it  has  been  supposed  to  have  narcotic  properties ;  but  I  have  never 
witnessed  any  effect  of  this  kind,  or  anything  approaching  it;  and  do  not 
believe  that  it  has  the  least  special  influence  on  the  brain.  In  over- 
doses, its  only  known  effects  are  to  irritate  the  stomach  and  bowels. 

The  uses  of  quassia  are  those  of  the  simple  bitters  generally,  of  which 
it  is  probably  the  purest  and  most  powerful.  For  an  account  of  these,  the 
reader  is  referred  to  the  general  remarks  on  this  sot  of  substances.  (See 
page  213.)  It  is  sufficient  here  to  state  that  the  medicine  is  applicable 
to  all  cases  of  simple  weakness  of  the  digestive  organs,  being  much 
1  in  dyspepsia,  and  the  debility  of  convalescence,  especially  that  of 
febrile  diseases  and  disorders  of  the  alimentary  canal,  after  the  entire 
subsidence  of  inflammatory  action. 

In  consequence  of  its  noxious  influence  on  worms,  it  has  been  em- 
ployed, in  the  form  of  enema,  in  the  treatment  of  ascarides,  and  with 
asserted  success.  A  decoction,  made  by  boiling  half  an  ounce  of  it  in  a 
pint  of  water,  has  been  used  for  this  purpose. 

Administration.  Quassia  has  been  little  used  in  the  form  of  powder. 
Some  dyspeptic  patients,  who  have  no  objection  to  its  bitterness,  carry 
the  wood  along  with  them  in  small  pieces,  and  chew  it  habitually  with 
advantage.  But  care  must  be  taken  that  this  habit  do  not  grow  into  an 
abuse.  . 

The  Infusion  (!NFUSUM  QUASSL/E,  U.  S.)  is  the  preparation  in  which 
it  is  most  frequently  administered.  This  is  made  in  the  proportion  of 
two  drachms  to  a  pint  of  water.  Either  cold  or  hot  water  may  be  used, 
the  former  making  a  clearer  infusion,  the  latter  acting  more  rapidly. 


CHAP.  I.]  TONICS. — SIMARDBA.  217 

The  officinal  Extract  (EXTRACTUM  QUASSIAS,  U.  S.)  is  a  very  efficient 
preparation,  and  is  preferable  when  it  is  desirajl  to  administer  the  med- 
icine in  the  form  of  m|L  It  is  a  watery  extract,  and  probably  stronger, 
in  a  given  a  weight,  tnan  any  other  preparation  of  the  simple  bitters.  It 
is  very  convenient  for  combination  with  other  medicines  in  the  pilular 
form ;  such  as  the  chalybeates,  aloes  and  rhubarb,  myrrh,  mercurial  pill 
or  calomel,  etc. 

The  Tincture  (TINCTURA  QUASSLJE,  U.  £)  is  also  officinal,  and  is  re- 
sorted to,  in  cases  of  considerable  insensibility  of  stomach  as  an  addition 
to  the  infusion,  to  other  tonic  infusions  or  decoctions,  and  to  liquid  pur- 
gative preparations. 

The  dose  of  the  powder  is  twenty  or  thirty  grains,  of  the  infusion  two 
fluidounces,  of  the  extract  from  two  to  five  grains,  of  the  tincture  one  or 
two  fluidrachins ;  each,  three  or  four  times  a  day. 


II.  SIMARUBA.  U.S. 


Origin.  This  is  the  bark  of  the  rof  Quassia  Simaruba  (Simaruba 
officinalis,  De  Cand.),  a  tree  of  considerable  size,  growing  in  the  West 
Indies,  and  in  Guiana. 

Properties.  It  is  in  long  flat  pieces,  folded  longitudinally,  fibrous 
flexible  and  tenacious,  yellowish  internally,  inodorous,  and  very  bitter, 
without  admixture  of  other  taste.  It  yields  its  taste  and  medical  virtues 
to  water  and  alcohol. 

Active  Principle.  It  owes  its  virtues  to  the  same  bitter  princ^ile 
found  in  quassia. 

Therapeutic  Application.  Simaruba  was  first  introduced  into  Europe 
from  South  America  in  the  year  1713,  as  a  remedy  in  dysentery,  diar- 
rhea, and  the  hemorrhages;  and  acquired  great  reputation  in  these  com- 
plaints. With  our  present  experience,  it  can  be  admitted  to  have  been 
useful  in  these  affections  only  when  complicated  with  a  debilitated  state 
of  the  alimentary  canal,  or  of  the  system,  calling  for  the  use  of  tonics  ; 
and,  as  there  are  other  remedies  more  efficient  under  these  circumstances, 
it  has  fallen  into  almost  entire  neglect.  It  is  in  fact  a  simple  bitter,  hav- 
ing nothing  peculiar  in  its  action,  and  so  closely  analogous  in  properties 
to  quassia,  that  it  may  be  looked  on  as  identical  with  that  medicine  in  its 
effects  and  applications.  It  is  usually  administered  in  the  form  of  infu- 
sion, which  may  be  made  in  the  proportion  of  two  drachms  of  the  bark 
to  a  pint  of  water,  hot  or  cold,  and  given  in  the  dose  of  two  fluidounces 
three  or  four  times  a  day. 


218  GENERAL   STIMULANTS.  [PART  II. 

III.  GENTIAN. 

GENTIANA.  U.  S.,  Br. 

Origin  and  Sensible  Properties.  Gentian  is  the  root  of  Oentiana  lutea, 
and  of  some  other  species  of  Gentiana,  herbaceous  perennials,  growing  in 
the  mountainous  regions  of  Europe.  It  is  usually  several  inches  in  length, 
tapering,  occasionally  branching,  sometimes  longitudinally  sometimes 
transversely  sliced,  spongy,  wrinkled  spirally,  grayish-brown  externally, 
yellowish  or  brownish-yellow  internally,  of  a  feeble  peculiar  odour,  and 
an  intensely  bitter,  slightly  sweetish  taste. 

Chief  Constituents.  The  root  contains  a  peculiar  bitter  principle 
called  gentianin,  on  which  its  tonic  properties  depend;  a  peculiar 
organic  acid,  called  gentisic  acid  or  gentisin,  which  is  without  effect  on 
the  system;  a  minute  proportion  of  volatile  oil,  uncrystallizable  sugar, 
gum,  pectin,  etc. 

Chemical  Relations.  Gentian  yields  its  bitterness  and  medical  virtues 
to  water  and  alcohol.  Containing  no  tannic  or  gallic  acid,  it  may  be  asso- 
ciated in  prescription  with  the  salts  of  iron;  but,  in  consequence  of  its 
mucilaginous  matter  or  pectin,  it  gives  precipitates  with  the  acetate  and 
subacetate  of  lead;  and  sulphate  of  zinc  occasions  a  slight  flocculent  de- 
posit with  the  hot  infusion.  Tannic  acid  causes  a  bulky  precipitate. 
Sulphuric,  citric,  and  probably  other  acids  sensibly  diminish  its  bitter- 
ness. The  addition  of  alkalies  does  not  affect  the  bitterness;  but  causes 
the  infusion  to  gelatinize  on  standing.  (Procter.)  In  consequence  of  its 
saccharine  matter,  the  infusion  undergoes  the  vinous  fermentation  on  the 
addition  of  yeast,  and  by  distillation  yields  a  spirituous  liquor,  said  to  be 
used  as  drink  in  Switzerland. 

Effects  on  the  System.  Gentian  has  all  the  characteristic  physiological 
effects  of  the  simple  bitters,  being,  perhaps,  somewhat  more  excitant  to 
the  circulation  than  most  of  them.  It  is  said  to  render  the  perspiration 
and  urine  bitter;  and  hence  its  active  principle  is  inferred  to  undergo 
absorption.  In  over-doses  it  is  liable  to  produce  nausea  and  vomiting, 
and  to  act  also  on  the  bowels.  According  to  Planche,  the  djstilled  water 
of  gentian  occasions  violent  nausea  and  a  kind  of  intoxication. 

Therapeutic  Application.  Gentian  was  known  by  the  ancients,  and 
has  ranked  among  standard  remedies  from  a  period  anterior  to  the  Chris- 
tian era.  It  is  applicable  to  all  the  purposes  for  which  the  simple  bitters 
are  used,  and  is  among  those  most  employed.  (See  page  213.)  As  it  is 
thought  to  be  somewhat  more  excitant  than  the  others,  it  should  be  used 
more  cautiously  when  there  is  any  suspicion  of  febrile  action  or  gastric 
inflammation.  Its  chief  employment  is  as  a  stomachic  in  feeble  digestion 
and  defective  appetite,  either  original,  or  connected  wi^i,  or  consequent 
upon  other  diseases.  As  an  ingredient  in  the  Portland  powder,  it  was 


CHAP.  I.]  TONICS. GENTIAN.  219 

at  one  time  much  used  in  gout;  but  it  is  indicated  in  this  complaint  only 
when  complicated  with  dyspeptic  symptoms,  and  even  then  should  be 
used  cautiously,  lest  it  may  prove  too  heating  and  otherwise  excitant. 
At  one  time  it  was  thought  to  be  febrifuge;  and  Dr.  Cullen,  in  his 
Treatise  on  Materia  Medica,  states  that,  mixed  with  equal  parts  of  tor- 
mentil  or  galls,  and  given  in  sufficient  quantity,  it  had  not  failed  in  any 
intermittents  of  his  own  country  in  which  he  had  tried  it;  but  it  would 
command  little  confidence  at  present  in  the  treatment  of  miasmatic  in- 
termittents. Locally,  the  powder  has  been  used  as  a  gentle  stimulant  in 
malignant  and  sloughing  ulcers,  and  to  maintain  the  discharge  from 
issues ;  and  the  root,  from  its  property  of  swelling  with  absorbed  moist- 
ure, has  been  employed  as  a  tent  for  enlarging  stricturedvpassages. 

Administration.  Gentian  is  given  in  powder,  infusion,  extract,  wine, 
or  tincture. 

The  officinal  Infusion  (!NFUSUM  GENTIANS  COMPOSITUM,  U.  £)  is 
made  with  half  an  ounce  of  the  root,  a  drachm  of  bitter  orange-peel,  and 
a  drachm  of  coriander,  to  a  pint  of  menstruum,  containing  two  fluid- 
ounces  of  alcohol  and  fourteen  of  water.  It  is,  therefore,  a  very  feeble 
tincture,  and  should  be  used  only  when,  in  addition  to  the  effects  of  a 
pure  bitter,  a  somewhat  more  stimulant  impression  is  indicated.  The 
use  of  the  alcohol  is  to  extract  the  bitterness  more  thoroughly,  and  to 
enable  the  infusion  to  keep  better.  When  this  is  made  with  water  alone, 
especially  with  hot  water,  it  spoils  readily,  in  consequence  probably  of 
the  pectin  and  mucilage  it  contains.  This  disadvantage  may  be  in  some 
degree  obviated  by  the  use  of  cold  water,  which  dissolves  less  of  the 
principles  referred  to.  The  most  elegant  method  of  preparing  the  infu- 
sion is  undoubtedly  by  percolation  with  cold  water,  by  which  the  bitter- 
ness may  be  sufficiently  extracted ;  and  the  Pharmacopoeia  has  adopted 
this  plan,  using,  however,  the  alcohol  with  the  menstruum.  When  the 
infusion  is  wanted  hastily,  and  is  not  required  to  be  kept  long,  it  may  be 
most  conveniently  made  with  hot  water.  A  combination  of  senna,  gen- 
tian, and  one  of  the  aromatics,  in  infusion,  is  well  adapted  to  cases  of 
dyspepsia  with  constipation. 

The  Watery  Extract  (EXTRACTUM  GENTIANS,  U.  S.)  is  a  good  prepa- 
ration, and  is  very  much  used  in  the  form  of  pill,  either  alone,  or  com- 
bined with  chalybeates,  laxatives,  etc.  Though  much  weaker  than  the 
extract  of  quassia,  it  is  more  convenient  for  making  pills  in  consequence 
of  its  tenacity. 

The  Fluid  Extract  (EXTRACTUM  GENTIANS  FLUIDUM,  U.  £)  is  a 
preparation  peculiar  to  our  Pharmacopoeia.  It  is  in  fact  a  concentrated 
tincture,  and  may  be  given  in  the  dose  of  from  ten  to  forty  minims. 

The  Compound  Tincture  (TINCTURA  GENTIANS  COMPOSITA,  U.  S.) 
is  prepared  with  the  addition  of  orange-peel  and  cardamom.  It  is  an  ex- 
cellent tonic  and  stomachic  tincture,  and  was  formerly  much  used,  not  only 


220  GENERAL    STIMULANTS.  [PART  II. 

in  debilitated  conditions  of  the  stomach,  but  also  in  health,  as  an  addition 
to  wine  before  dinner,  under  the  impression  that  it  promoted  digestion, 
and  increased  the  strength.  It  was  called  wine  bitters.  In  the  present 
state  of  medical  knowledge,  it  will  be  generally  admitted  that  this  prac- 
tice could  do  only  harm.  Indeed,  the  bitter  tinctures  generally  require 
to  be  used  with  much  caution,  even  in  dyspeptic  cases,  lest  incurable 
habits  of  intemperance  should  be  formed.  Many  a  drunkard,  in  former 
times,  could  trace  his  bad  habit  back  to  the  use  of  one  of  these  tinctures, 
originally  perhaps  prescribed  by  his  physician. 

The  Wine  of  Gentian  (YiNUM  GENTIANS),  formerly  directed  by  the 
Edinburgh  Pharmacopoeia,  has  been  very  properly  abandoned  in  the 
British,  as  there  is  no  occasion  for  it. 

The  dose  of  the  powder  is  from  a  scruple  to  a  drachm ;  of  the  infusion 
one  or  two  fluidounces ;  of  the  extract  from  ten  to  thirty  grains ;  of  the 
tincture  one  or  two  fluidrachms;  of  the  wine  half  a  fluidounce  to  a  fluid- 
ounce. 


Subordinate  to  gentian,  and  closely  analogous  to  it  in  properties,  are 
several  medicines  derived  from  plants  belonging  to  the  same  natural 
family  of  Gentianace®,  which  merit  a  brief  notice. 

1.  CHIRETTA.  U.  S.  —  CHIRATA.  Br. — Chiretta  or  chirayta  consists 
of  the  herb  and  root  of  Agathotes  Chirayta  (Don.),  an  annual  plant, 
growing  in  Nepaul  and  other  parts  of  Northern  India.  It  is  imported  in 
bundles  consisting  mainly  of  the  stems,  with  portions  of  the  root  attached. 
It  is  inodorous  and  extremely  bitter,  and  yields  its  bitterness  and  medical 
virtues  to  water  and  alcohol.  MM.  Lassaigne  and  Boissel  have  ex- 
tracted from  it  a  yellow  bitter  matter,  upon  which  its  virtues  no  doubt 
depend,  but  which  cannot  be  considered  as  a  pure  proximate  principle. 
The  medicine  has  been  long  used  in  Bengal,  but  has  only  recently  been 
introduced  into  Europe  and  this  country.  It  possesses  the  properties  of 
the  simple  bitters,  and  probably  no  other;  though  supposed  by  some  to 
be  more  disposed  to  act  on  the  liver  and  bowels ;  being  nauseating  and 
laxative  in  large  doses,  and  asserted  to  produce  bilious  stools.  In  India 
it  has  been  employed  as  a  febrifuge  in  intermittent  and  remittent  fevers, 
as  a  cholagogue  in  torpor  of  the  liver,  and  as  a  laxative  in  habitual  con- 
stipation ;  but  it  probably  acts,  in  all  these  cases,  as  gentian  and  the 
other  simple  bitters.  Like  them,  too,  it  may  be  used  in  the  anorexia  of 
convalescence,  feeble  digestion,  and  general  debility  connected  with 
inertness  of  the  prima?  via.  The  dose  of  the  powder  is  twenty  irrains; 
of  an  infusion  made  in  the  proportion  of  half  an  ounce  of  the  herb  to  a 
pint  of  hot  water,  one  or  two  fluidounces;  of  the  tincture  (Tinctura 
Chiratse,  Br.),  one  or  two  fluidrachms. 


CHAP.  I.]  TONICS. — AMERICAN   COLUMBO.  221 

2.  AMERICAN  CENTAURY. — SABBATIA.  U.  S. — This  is  the  herb 
and  root  of  Sabbafia  angularis,  an  indigenous,  annual  or  biennial  plant, 
growing  in  the  Middle  and  Southern  States,  and  collected  for  use  when 
in  flower.     The  leaves  are  so  small,  and  shrink  so  much  in  drying,  that 
the  dried  herb  seems  to  consist  mainly  of  the  stems,  with  a  few  shrivelled 
flowers  at  the  end.     American  centaury  is  inodorous  and  strongly  bitter, 
and  yields  all  its  virtues  to  water  and  alcohol.     It  has  long  been  popu- 
larly used,  in  this  country,  as  a  remedy  and  prophylactic  in  intermittent 
and  remittent  fevers,  and  has  enjoyed,  to  a  considerable  degree,  the  con- 
fidence of  some  practitioners.     But  it  has  no  special  virtues  in  these 
affections,  in  which  it  acts  as  a  simple  bitter,  like  gentian  and  quassia,  for 
which  it  may  be  substituted  in  dyspepsia,  the  debility  of  convalescence, 
etc.,  when  on  any  account  more  convenient.     The  dose  of  the  powder 
is  from  thirty  grains  to  a  drachm.     The  infusion,  which  is  the  most  con- 
venient form,  and  may  be  made  in  the  proportion  of  an  ounce  to  a  pint 
of  boiling  water,  is  given  in  the  dose  of  two  fluidounces,  which,  in  the 
remission  or  intermission  of  miasmatic  fever,  should  be  repeated  every 
two  hours,  in  other  cases  three  or  four  times  a  day. 

3.  EUROPEAN  CENTAURY.  —  CEXTAURIUM.  Ed. — This  is  often 
called  lesser  centaury  (centaurium  minus),  and  consists  of  the  flowering 
tops  of  Ery/hrasa  Centaurium  (Persoon),  Chironia  Centaurium  (Linn.), 
a  small  annual  plant,  growing  wild  in  some  parts  of  Europe.     Its  medi- 
cinal virtues  are  said  to  have  been  known  to  the  ancients.     They  are  the 
same  as  those  of  gentian,  for  which  it  is  sometimes  employed  as  a  sub- 
stitute in  its  native  country.    In  the  United  States  it  is  scarcely  known ; 
its  place  being  supplied  by  our  indigenous  centaury,  which  resembles  it 
so  closely  as  to  have  received  the  same  name  from  the  earlier  settlers. 
The  dose  and  mode  of  preparation  are  the  same  as  those  of  the  preceding 
article. 

4.  AMERICAN  COLUMBO.— FRASERA.  U.  S. — This  is  the  root  of 
Frasera  Walleri  (Michaux),  Frasera  Carolinensis  (Walter),  an  elegant, 
indigenous  plant,  growing  profusely  in  our  Western  and  South- Western 
States.     Its  long,  spindle-shaped,  fleshy  root,  being  cut  into  transverse 
slices  and  dried,  bears  a  slight  resemblance  in  appearance  to  columbo, 
whence,  and   from  a  supposed  resemblance  in   medical  properties,  it 
derived  its  common  name.     Sometimes  the  root  is  sliced  longitudinally, 
and  thus  somewhat  resembles  gentian,  to  which  it  is  botanically  allied, 
belonging  to  the  same  natural  family.     It  has  a  yellowish  colour,  and  a 
bitter,  sweetish  taste,  and  yields  its  virtues  to  water  and  alcohol.     The 
bitterness  is  much  less  intense  than  that  of  gentian;  and,  though  similar 
in  properties,  the  medicine  is  not  so  powerful.     The  fresh  root  is  said  to 
operate  as  an  emetic  and  cathartic;  but  this  probably  happens  only 
when  it  is  largely  administered;  and  the  same  is  to  some  extent  the 
case  with  most  of  the  simple  bitters      It  may  be  used  as  a  mild  tonic, 


'222  GENERAL    STIMULANTS.  [PART  II. 

either  in  substance  or  infusion.  The  dose  of  the  powder  is  from  half  a 
drachm  to  a  drachm ;  of  the  infusion,  made  with  an  ounce  of  the  bruised 
root  to  a  pint  of  boiling  water,  two  fluidounces. 


IV.  COLUMBO. 

CALTJMBA.  U.  S.,  Br. 

Origin  and  Properties.  Columbo  is  the  root  of  Cocculus  palmalus, 
a  climbing  plant,  growing  in  the  forests  of  Mozambique,  on  the  south- 
eastern coast  of  Africa.  As  brought  into  the  market,  it  is  in  transverse 
slices,  circular  or  oval,  from  one  to  two  inches  in  diameter,  usually  three 
or  four  lines  thick,  consisting  of  a  thick  exterior  cortical  portion,  with 
a  brownish  wrinkled  epidermis,  and  of  an  interior  medullary  portion, 
light,  spongy,  and  more  or  less  shrunk.  The  cut  surface  is  yellowish, 
with  a  greenish  tinge  near  the  circumference,  of  a  feeble  somewhat  aro- 
matic odour,  and  a  very  bitter  taste,  which  is  strongest  in  the  cortical 
part.  The  powder  is  greenish  when  fresh. 

Active  Principles.  The  root  contains  two  bitter  principles  on  which 
its  virtues  depend ;  one  peculiar  to  it  called  columbin,  the  other  sup- 
posed to  be  identical  with  berberina,  an  alkaloid  found  in  Berberis  vul- 
garis.  Besides  these,  there  are  a  peculiar  volatile  oil,  in  small  propor- 
tion, albumen  and  starch  in  large  quantity,  and  other  principles  of  leas 
importance. 

Chemical  Relations.  The  bitterness  and  medical  virtues  of  columbo 
are  extracted  by  water  and  alcohol.  The  infusion,  prepared  either  with 
hot  or  cold  water,  is  precipitated  by  tincture  of  galls,  and  the  acetate 
and  subacetate  of  lead ;  but  the  bitterness  is  not  affected.  No  precipi- 
tates are  produced  by  the  salts  of  iron,  zinc,  or  copper,  nor  by  tartar 
emetic  or  corrosive  sublimate.  Tincture  of  iodine  does  not  affect  the 
infusion  prepared  with  cold  water,  but  gives  to  the  decoction  or  hot 
infusion,  after  cooling,  a  blue  colour. 

Effects  on  the  System.  Columbo  has  the  properties  of  the  simple  bit- 
ters, with  the  advantage  over  several  of  them,  that  it  is  less  heating  and 
.-tiuiuhuit,  and  less  apt  to  irritate  the  stomach.  Buchner  states  that  a 
grain  of  the  ethereal  extract,  introduced  into  a  wound  in  the  leg  of  a  ral>- 
bit,  caused  the  death  of  the  animal  in  ten  hours;  and  hence  it  has  been 
inferred  that  the  root  might  possess  narcotic  properties;  but  this  is  much 
too  narrow  a  basis  for  the  support  of  such  an  opinion.  I  have  never 
seen  the  slightest  appearance;  of  narcotism  from  the  use  of  columbo, 
though  I  have  prescribed  it  very  frequently  and  freely.  It  is  probably 
nothing  more  than  a  simple  bitter,  somewhat  qualified  by  the  minute  pro- 
portion of  volatile  oil  contained  in  it,  which,  however,  can  scarcely  have 


CHAP.  I.]  TONICS. COLUMBO.  223 

any  other  effect  than  possibly  to  render  the  medicine  more  acceptable  to 
the  stomach. 

Therapeutic  Application.  This  root  is  said  to  have  been  long  em- 
ployed, in  bowel  affections,  by  the  natives  of  the  country  where  it  is 
produced.  The  first  published  notice  of  it  was  by  Francis  Redi  in  1685; 
but  it  was  not  until  after  the  publication  of  Dr.  Thomas  Perceval's  Med- 
ical Essays,  in  1773,  that  it  came  into  general-  use.  It  may  be  employed 
for  all  the  purposes  to  which  the  simple  bitters  generally  are  applied 
(see  page  213),  with  this  advantage,  that,  in  consequence  of  its  mild- 
ness and  acceptability  to  the  stomach,  it  may  sometimes  be  advanta- 
geously given  when  others  prove  offensive.  The  affection  to  which  it  is 
best  adapted  is  probably  dyspepsia.  I  have  found  few  medicines  more 
efficient  in  this  complaint,  when  complicated  with  constipation  and  flatu- 
lence, than  a  compound  infusion  prepared  with  half  an  ounce  of  bruised 
columbo,  half  an  ounce  of  ginger,  a  drachm  or  two  of  senna,  and  a  pint  of 
boiling  water.  A  wineglassful  should  be  taken  before  breakfast;  if  this 
do  not  open  the  bowels,  another  before  dinner;  and  if  this  fail,  a  third  in 
th<'  evening.  I  have  found  the  combination  also  promptly  successful  in 
severe  gastralyic  pains  attendant  on  an  enfeebled  stomach.  Even  when 
there  is  reason  to  suspect  the  coexistence  of  some  degree  of  chronic  in- 
flammation with  dyspepsia,  columbo  is  not  always  contraiudicated; 
though  its  use  requires  more  caution.  In  gastric  irritability,  uncon- 
nected with  active  congestion  or  inflammation,  it  is  thought  by  some  to 
have  the  effect  of  composing  the  stomach ;  and  hence  it  has  been  recom- 
mended in  the  vomiting  of  pregnancy  or  hysteria,  bilious  vomiting,  eic.; 
but  I  have  no  experience  with  it  in  these  affections.  It  has  also  been 
i -specially  recommended  in  the  declining  stages,  or  the  imperfect  conva- 
lescence of  remittent  fevers,  and  of  various  affections  of  the  primal  viae, 
as  cholera  morbus,  cholera  infantum,  diarrhoea,  dysentery,  etc.,  under 
circumstances  requiring  the  use  of  tonics. 

Administration.  Columbo  is  sometimes  given  in  the  form  of  powder, 
which  may  be  combined  with  ginger,  subcarbonate  of  iron,  or  rhubarb, 
when  one  or  more  of  these  medicines  is  indicated.  The  infusion,  how- 
ever, is  generally  preferable. 

The  officinal  Infusion  (!NFUSUM  CALUMB^E,  U.  5.)  is  made  with  half 
an  ounce  of  the  bruised  or  coarsely  powdered  root  and  a  pint  of  water. 
The  present  U.  S.  Pharmacopoeia  prepares  it  preferably  by  percolation; 
and  this  may  be  followed  by  the  apothecary;  but  the  old  method  of 
maceration  is  more  convenient  extemporaneously.  It  is  a  question  for 
consideration  whether  the  water  should  be  cold  or  hot.  The  infusion  is 
apt  to  spoil  quickly;  depositing  a  considerable  quantity  of  insoluble 
matter,  becoming  more  or  less  ropy,  and  acquiring  a  disagreeable  taste. 
This  tendency  has  been  ascribed  to  the  use  of  boiling  water,  by  which 
the  starch  is  di>-  jived.  Hut  it  has  been  found  that  the  infusion  made 


2'24  GENERAL   STIMULANTS.  [PART  II. 

with  cold  water  is  also  liable  to  change,  even  more  so,  according  to  one 
observer,  than  the  hot,  though  this  does  not  exactly  accord  with  my  own 
observation.  If  cold  water  does  not  dissolve  the  starch,  it  does  dissolve 
the  albumen,  which  boiling  water  coagulates  and  renders  insoluble ;  and, 
as  albumen  undergoes  decomposition  very  readily  itself,  and  promotes 
the  decomposition  also  of  other  associated  substances,  it  may  be  readily 
understood  why  the  infusion  prepared  with  cold  water  will  not  keep 
well.  To  obviate  both  these  difficulties,  the  infusion  may  first  be  pre- 
pared with  cold  water,  by  which  the  starch  is  left  behind,  and  then 
quickly  raised  to  the  boiling  point,  so  as  to  coagulate  the  albumen  dis- 
solved, which  may  then  be  separated  by  nitration.  This  nicety,  how- 
ever, is  necessary  only  when  the  infusion  is  required  to  be  kept  for 
several  days.  The  most  convenient  method  is  to  prepare  it  with  hot 
water,  and  in  small  quantities  at  a  time,  as  wanted  for  use.  When  cold 
water  is  employed,  a  much  greater  length  of  maceration  is  required,  not 
less  than  twelve  hours,  unless  the  process  of  percolation  be  resorted  to. 
The  infusion  of  columbo  may  be  appropriately  combined  with  the  solu- 
ble salts  of  iron,  zinc,  or  copper,  or  with  corrosive  sublimate  when  in- 
dicated ;  but  not  with  the  salts  of  lead.  Free  iodine  should  not  be  given 
with  the  hot  infusion. 

There  is  an  officinal  Tincture  of  Columbo  (TmcTURA  CALUMB^E,  U.  S.), 
which  may  be  used  like  the  other  bitter  tinctures,  and  is  liable  to  the 
same  objections.  (See  Compound  Tincture  of  Gentian,  page  219.) 

The  BritiKh  Pharmacopoeia  directs  an  extract  (EXTRACTUM  CALUM- 
B^E,  Br.),  which,  being  prepared  with  diluted  alcohol,  is  free  from  the 
inert  starch  and  albumen,  and  may  be  given  in  the  dose  of  from  five  to 
fifteen  grains  three  times  a  day.  The  small  proportion  of  volatile  oil 
contained  in  the  root  is  mainly  driven  off  in  the  process  of  evaporation; 
but  the  loss  of  it  is  probably  of  little  importance. 

The  dose  of  powdered  columbo  is  from  ten  to  thirty  grains ;  of  the 
infusion,  two  fluidounces;  of  the  tincture,  from  one  to  four  fluidrachms; 
in  each  case,  to  be  taken  three  or  four  times  a  day. 


From  the  simple  bitters  above  described,  all  the  effects  which  this 
subdivision  of  tonics  is  capable  of  producing  may  be  obtained;  but  there 
are  three  others,  of  indigenous  growth,  which,  though  less  frequently 
used,  deserve  a  brief  notice,  as  they  are  scarcely  less  efficacious,  and 
may  sometimes  be  found  convenient. 

1.  GOLDTHREAD.— Corns.  U.  S. 

This  is  the  product  of  Coptis  trifolia,  a  very  small  plant,  with  a  per- 
ennial creeping  root,  inhabiting  low  and  shaded  places  in  the  northern 
parts  of  this  continent,  and  of  Asia.  It  is  abundant  in  our  own  Northern 


CHAP.  I.]  TONICS. — PECULIAR    BITTERS.  225 

States.  All  parts  of  it  have  some  bitterness,  which,  however,  is  strongest 
in  the  root;  and  this  is  the  portion  directed  by  the  U.  S.  Pharmacopoeia, 
though,  as  the  medicine  is  kept  in  the  shops,  the  roots,  leaves,  and  stems 
are  generally  intermingled.  The  root  is  long,  slender,  thread-like,  of  a 
deep  orange-yellow  colour,  inodorous,  and  intensely  and  purely  bitter.  It 
yields  its  bitterness  to  water  and  alcohol.  The  medicine  is  closely  allied 
to  quassia  in  its  properties,  and  might  probably  be  substituted  for  it  in 
all  cases  without  disadvantage ;  but  the  smallncss  of  the  product  of  each 
plant  will  always  be  an  obstacle  to  its  general  use,  unless  some  superi- 
ority of  virtues  can  be  shown.  It  is  sometimes  used,  in  New  England, 
in  aphthous  affections  of  the  mouth,  as  a  local  application.  The  dose  of 
the  powder  is  from  ten  to  thirty  grains ;  of  an  infusion  made  with  two 
drachms  to  a  pint  of  water,  one  or  two  fluidounces;  of  a  tincture,  con- 
taining the  virtues  of  an  ounce  in  a  pint  of  diluted  alcohol,  one  or  two 
fluid  rachms. 

2.  YELLOW-ROOT. — ZANTHORRHIZA.  U.  S. 

By  this  name  is  designated,  in  the  secondary  list  of  the  U.  S.  Pharma- 
copoeia, the  root  of  Xanthorrhiza  apiifolia,  an  indigenous  shrub,  grow- 
ing iu  the  interior  of  the  Southern,  and  in  the  Western  States.  Though 
the  bark  of  the  stem,  as  well  as  the  root,  is  bitter,  the  latter  only  is  officinal. 
This  is  cylindrical,  from  three  inches  to  a  foot  long,  about  half  an  inch 
thick,  yellow,  inodorous,  and  extremely  bitter,  without  astringency.  It 
imparts  its  colour,  bitterness,  and  medical  virtues  to  water;  and  the  infu- 
sion is  not  affected  by  the  salts  of  iron.  It  may  be  employed  in  the  same 
affections,  in  the  same  manner,  and  in  the  same  dose  as  quassia. 

3.  STAR-GRASS.— ALETRIS.  U.  S. 

This  is  the  root  of  Aletris  farinosa,  a  small  indigenous  herbaceous 
perennial,  named  from  the  star-like  form  assumed  by  the  leaves,  which 
spread  out  on  the  ground  at  the  base  of  the  stem.  The  root  is  small, 
branching,  crooked,  blackish  outside,  brownish  within,  and  strongly  bit- 
ter. It  imparts  its  bitterness  to  water  and  alcohol,  but,  it  is  asserted, 
much  more  freely  to  the  latter.  Little  is  known  of  its  composition.  In 
small  doses  it  acts  as  a  simple  tonic,  and  may  be  given  for  the  same  pur- 
poses as  the  simple  bitters.  But  in  large  doses,  like  most  of  the  article* 
of  this  class,  it  is  apt  to  disturb  the  stomach  and  bowels,  and  is  said, 
when  taken  in  great  excess,  to  have  acted  as  a  narcotic.  The  powder 
may  be  given  in  the  dose  of  ten  grains  for  the  tonic  effect. 


2.  Peculiar  Bitters. 

These  are  medicines  which,  with  the  simple  tonic  powers  character- 
istic of  the  pure  bitters,  possess  others  also,  which  modify  the  tonic 
action,  and  give  them  an  influence  on  the  system  more  or  less  peculiar. 
VOL.  i. — 15 


226  GENERAL   STIMULANTS.  [PART  II. 

This  peculiarity  may  be  owing  either  to  the  distinctive  character  of  the 
bitter  principle  itself,  or  to  some  other  principle  or  principles  which  may 
be  associated  with  it.  Thus,  Peruvian  bark  owes  its  characteristic 
remedial  virtues  to  the  peculiarity  of  its  bitter  principles ;  while  serpen- 
taria  and  wild-cherry  bark  have  other  active  constituents  besides  the  bit- 
ter; the  additional  constituent  being,  in  the  one,  hydrocyanic  acid  which 
is  sedative,  and  in  the  other,  a  stimulating  volatile  oil. 


I.  PERUVIAN  BARK. 
CINCHONA. 

Origin.  This  is  the  bark  of  different  species  of  Cinchona,  trees  grow- 
ing in  South  America,  along  the  course  of  the  Andes,  extending  from 
the  northern  coast  near  Caracas  to  La  Paz  in  Bolivia,  through  nine  de- 
grees of  latitude,  at  various  elevations  on  the  mountain  sides,  seldom 
less  than  four  thousand  feet  above  the  level  of  the  sea.  The  species 
known  to  yield  bark  to  commerce  are  C.  Calisaya  and  C.  Boliviano,, 
growing  in  Bolivia;  C.micrantha,C.  nitida,  and  C.  ovata.  inhabiting  the 
provinces  of  Huamilies,  Huanuco,  etc.,  in  the  interior  of  Peru ;  C.  Con- 
daminea,  C.  scrobiculata,  and  C.  succiruba,  of  northern  Peru  and  Ecua- 
dor; and  C.lancifolia,  (7.  cordifolia,  and  C.  Pitayensis,  of  New  Granada ; 
beside  several  others  less  known,  or  of  Jess  importance. 

Classification.  The  varieties  of  Peruvian  bark  may  be  arranged  in 
two  divisions ;  1.  the  officinal  or  those  recognized  in  the  U.  S.  Pharma- 
copoeia, and  brought  exclusively  from  the  Pacific  coast  of  S.  America; 
and  2.  the  non-officinal,  commonly  designated  as  Carthayena  barks,  and 
exported  from  the  northern  coast  of  the  continent.  The  officinal  barks 
are  divided  by  the  Pharmacopoeia  into  the  pale,  yellow,  and  red;  the 
non-officinal  include  the  three  varieties  of  hard  Carthagena.  fibrous  Car- 
thagena,  and  hard  Pitaya  bark. 

Properties.  Peruvian  bark  is  in  quills  or  flat  pieces,  of  various  dimen- 
sions, with  or  without  epidermis,  of  a  yellowish-brown,  reddish-brown, 
reddish,  or  orange-brown  colour  in  the  interior,  of  a  feeble  somewhat 
aromatic  odour  in  powder  or  decoction,  and  of  a  bitter  taste  varying  in 
degree,  sometimes  nearly  pure,  but  more  commonly  also  nauseous  or 
astringent.  It  yields  its  virtues  partially  to  pure  water,  but  completely 
to  alcohol,  or  to  water  acidulated  with  sulphuric  or  muriatic  acid.  The 
several  varieties  require  special  notice. 


CHAP.  I.]  TONICS. PERUVIAN    BARK.  227 

1.  Classification  of  Peruvian  Barks. 
a.  Officinal  Barks. 

1.  PALE  BARK  (CINCHONA  PALLIDA,  U.  S.,  Br.)  is  in  cylindrical 
pieces,  called  quills  from  being  rolled,  from  a  few  inches  to  eighteen  in 
length,  from  two  lines  to  an  inch  in  diameter,  and  from  half  a  line  to  two 
or  three  lines  thick.  The  colour  of  the  epidermis,  which  is  always  ad- 
herent, is  light-gray,  brownish-gray,  or  gra}rish-fawn ;  of  the  true  bark, 
^brownish,  more  or  less  deep,  and  inclining  to  red,  yellow,  or  orange;  of 
*the  powder,  pale-fawn,  and  sometimes  dusky.  The  taste  is  moderately 
bitter,  somewhat  astringent,  and  not  nauseous. 

The  commercial  varieties  belonging  to  this  division  are  1.  Loxa  bark*. 
usually  in  smallish  quills,  derived  from  C.  Condaminea  and  other  species, 
and  named  from  the  town  of  Loxa,  which  was  formerly  the  entrepot  of 
the  trade  in  them;  2.  Lima  or  Huanuco  barks,  usually  larger  than  the 
.  preceding,  derived  from  C.  micrantha,  and  C.  nitida,  and  named  from 
the  town  of  Huanuco  in  the  neighbourhood  of  which  they  are  gathered,  or 
from  Lima,  where  the  trade  in  them  centres ;  3.  Jaen  or  ash-bark,  dif- 
fering little  in  size  from  the  Loxa  Barks,  named  from  the  town  of  Jaen, 
supposed  to  be  derived  from  C.  ovata,  and  scarcely  known  as  a  distinct 
variety  in  the  commerce  of  the  United  States ;  and  4.  Huamilies  bark, 
of  larger  size,  in  flat  pieces  and  quills,  named  from  the  province  where  it 
is  gathered,  conjecturally  referred  to  C.  pubescens,  and  little  if  at  all 
known  in  our  markets. 

2.  YELLOW  BARK  ( CINCHONA  FLAVA,  U.  S.,  Br.),  called  in  com- 
merce Calisaya  Bark,  is  in  quills  and  flat  pieces;  the  former  from  three 
inches  to  two  feet  in  length,  from  a  quarter  of  an  inch  to  two  inches  in 
diameter;  the  latter,  quite  flat  or  slightly  curved,  usually  thicker  than  the 
quilled,  and  derived  from  the  larger  stems  or  branches.  The  epidermis  is 
in  general  easily  separable,  and  is  often  separated  from  the  proper  bark, 
especially  in  the  flat  pieces,  which  are  almost  always  quite  free  from  it, 
and,  on  their  outer  surface,  show  that  it  was  removed  without  violence, 
from  the  mere  looseness  of  adhesion.  When  present,  it  is  of  a  brownish 
colour  diversified  with  whitish  lichens,  is  marked  with  longitudinal 
wrinkles  and  transverse  fissures,  and  is  tasteless  and  inert.  Without  it, 
the  bark  is  from  one  to  two  lines  thick,  firm  and  compact,  of  a  short 
fibrous  fracture  with  shining  points,  and,  when  viewed  along  its  length, 
exhibiting  similar  shining  points,  which  are  the  ends  of  small  transparent 
spicula.  These  spicula,  when  the  bark  is  rubbed,  separate  from  it,  and 
prove  highly  irritant  to  the  fingers,  like  cowhage.  The  colour  of  the 
bark  is  a  fine  brownish-yellow,  usually  with  a  tinge  of  red ;  the  taste, 
intensely  bitter  without  astringency  or  nauseousness ;  the  powder,  of  a 
bright  yellowish-cinnamon  hue,  often  inclining  to  orange.  The  officinal 


228  GENERAL    STIMULANTS.  [PART  II. 

yellow  or  Calisaya  bark  is  the  product  mainly  of  Cinchona  Calisaya,  and 
is  obtained  exclusively  from  Bolivia. 

3.  RED  BARK  (CINCHONA  RUBRA,  U.  S.,  Br.)  is,  like  the  preceding, 
in  quills  or  flat  pieces;  the  former,  completely  or  partially  rolled,  of 
various  lengths,  sometimes  exceeding  eighteen  inches,  and  from  less 
than  half  an  inch  to  more  than  two  inches  in  diameter;  the  latter,  often 
very  large  and  thick.  The  epidermis  is  strongly  adherent,  of  a  reddish- 
brown,  gray,  or  whitish  colour,  wrinkled  longitudinally,  and  sometimes 
warty.  Beneath  the  epidermis  is  a  layer,  dark-red,  compact,  brittle,  and 
of  feeble  taste.  The  proper  bark  is  woody  and  fibrous,  of  a  brownish- 
red  colour,  passing  from  deep-red  to  reddish-yellow,  and  of  a  taste  very 
bitter  and  somewhat  astringent.  The  colour  of  the  powder  is  a  fine 
brownish-red.  The  origin  of  this  bark  was  till  recently  unknown ;  at 
present,  however,  through  the  researches  of  Mr.  Howard,  of  London,  it 
is  referred  very  confidently  to  C.  succiruba  of  Pavon  (G.  ovata,  var. 
erythrodrrma  of  Weddell),  growing  in  the  republic  of  Ecuador,  on  the 
western  slope  of  Chimborazo. 

b.  Non-officinal  or  Carlhagena  Barks. 

1.  HARD  CARTHAGENA  BARK  comes  usually  in  pieces  some- 
what regular  in  shape,  either  completely  or  partially  quilled,  or  fiat,  and 
frequently  warped;  the  quills  being  from  five  inches  to  a  foot  long,  from 
three  to  eight  lines  in  diameter,  and  from  half  a  line  to  a  line  and  a  half 
thick ;  the  flat,  somewhat  thicker,  about  the  same  in  length,  and  from 
one  to  two  inches  broad.     But  sometimes  also  it  comes  in  small  irregu- 
larly square  or  oblong,  flattish  pieces,  variously  warped,  and  mixed  with 
small  quills  or  fragments  of  quills.    The  epidermis  is  often  absent,  especi- 
ally from  the  larger  and  flatter  pieces,  having  been  obviously  scraped  or 
pared  off  with  a  knife,  and  not  separated,  as  in  the  Calisaya  bark,  by 
the  natural  juncture.     When  present,  it  is  usually  soft,  whitish  or  yel- 
lowish, and  of  the  character  which  has  been  called  micaceous.     The 
proper  bark  is  of  a  pale,  dull,  brownish-yellow  colour,  often  appearing  as 
if  rubbed  over  with  the  powder.     Its  texture  is  firm  and  compact;  its 
fracture  abrupt,  though  not  smooth ;  its  taste  bitter  and  nauseous.    It  is 
derived  from  Cinchona  cordifolia. 

2.  FIBROUS  CARTHAGENA  BARK  is  in  quills,  half  quills,  slightly 
rolled,  or  flat  pieces,  of  dimensions  and  shape  not  materially  diU'crent  from 
the  preceding,  and  like  that  coming  generally  in  somewhat  regular  forms. 
but  sometimes  in  small  irregular  fragments.    Some  of  the  largest  pieces 
exceed  in  thickness  and  other  dimensions  any  that  I  have  seen  of  the 
hard  variety.     The  epidermis  when  remaining  is  soft,  whitish  or  yel- 
lowish, and  micaceous;  but  in  the  larger  and  flatter  pieces  it  is  gen- 
erally absent,  being  artificially  removed,  as  in  the  preceding.   The  proper 
bark  differs  much  in  character  from  the  hard  variety,  being  very  fibrous, 


CHAP.  I.]  TONICS. — PERUVIAN    BARK.  229 

light,  loose,  soft,  and  spongy  under  the  teeth.  Its  colour  varies  from  a 
light  brownish-yellow  to  an  orange  or  red,  the  latter  existing  especially 
in  the  largest  pieces.  The  colour  of  the  powder  is  yellowish,  often  with 
an  orange  tint.  The  taste  is  usually  bitter,  but  varies  much  in  degree, 
being  in  some  specimens  strong,  in  others  very  feeble.  The  fibrous 
Carthagena  bark  bears  considerable  resemblance  in  colour  to  the  Cali- 
saya,  but  differs  greatly  in  its  soft  and  spongy  consistence,  and  in  the 
circumstance  that  its  epidermis  has  been  artificially  removed  by  the 
knife,  instead  of  spontaneously  separating  at  the  natural  junction.  It  is 
the  product  of  Cinchona  lancifolia. 

3.  HARD  PITAYA  BABK,  or  Brown  Garthayena  bark,  as  it  has 
sometimes  been  called  to  distinguish  it  from  the  two  preceding,  which 
are  sometimes  designated  as  yellow  Carlhagena  bark,  is  usually,  as  I 
have  seen  it,  in  small  irregular  pieces,  either  quilled  or  flat,  from  one  to 
four  inches  long,  and  from  one  to  four  lines  thick.  The  epidermis  is 
sometimes  whitish  and  soft  as  in  the  other  Carthagena  barks,  but  some- 
times also  dark  brown,  with  innumerable  cracks  in  different  directions, 
giving  the  surface  a  grater-like  appearance.  Sometimes  it  is  absent. 
Beneath  the  epidermis  there  is  often  a  resinous  layer,  of  a  dark  reddish- 
brown  colour,  and  a  shining  surface  when  cut;  but,  though  highly  char- 
acteristic when  present,  it  is  wanting  in  some  of  the  pieces.  The  proper 
bark  is  rather  hard,  compact,  and  heavy,  closely  and  finely  fibrous,  and 
of  a  dull  yellowish-brown  colour  with  a  reddish  tint.  It  somewhat  re- 
sembles the  hard  Cathagena,  but  differs  in  the  resinous  layer,  the  grater- 
like  epidermis  of  many  of  the  pieces,  and  the  deeper  and  redder  colour. 
It  has  a  very  bitter  taste.  It  is  probably  the  product  of  the  Cinchona 
Pitayensis  of  Weddell. 

2.   Constituents  and   Chemical  Relations. 

Constituents.*  The  most  important  of  these  are  the  alkaloids,  quinia, 
cinchonia,  qninidia,  cinchonidia,  quinicia  and  cinchonicia.  Of  these 
there  are  two  distinct  groups,  one  consisting  of  quinia,  quinidia,  and 
quinicia,  all  isomeric,  and  cinchonia,  cinchonidia,  and  cinchonicia,  which 
are  also  isomeric,  but  differ  in  composition  from  the  first  group.  The 
last  of  each  group,  quinicia,  namely,  and  cinchonicia,  appear  to  result 
from  the  influence  of  heat  upon  the  respective  alkaloids  with  which  they 
are  isomeric,  and,  though  they  may  possibly  sometimes  pre-exist  in  the 
bark,  are  more  frequently  the  result  of  the  chemical  processes  employed 

*  Since  the  publication  of  the  first  edition  of  this  work,  the  subject  of  the  cin- 
chona alkaloids  lias  been  carefully  investigated;  and  a  general  view  of  the  results, 
somewhat  different  from  the  account  of  these  alkaloids  given  in  the  former  edition, 
is  now  presented  in  the  text.  (Note  to  the  second  edition.) 


:>30  GENERAL    STIMULANTS.  [PART  II. 

in  the  extraction  of  the  others.  The  alkaloids  are  believed  to  exist  in 
the  bark  chiefly  in  combination  with  kinic  acid,  in  the  form  of  soluble 
kinates,  but  partly  also  combined  with  colouring  matter  or  tannic  acid, 
forming  compounds  insoluble  in  water,  which,  therefore,  is  of  itself  in- 
competent to  exhaust  all  the  virtues  of  bark.  Other  constituents  are  a 
bitter  substance  called  kinovic  bitter  or  kinovic  acid,  tannic  acid,  a  red 
colouring  matter  called  cinchonic  red,  a  yellow  colouring  matter,  resin, 
gum,  starch,  fatly  matter,  kinate  of  lime,  etc. 

Properties  of  the  Alkaloids.  The  alkaloids  are  the  active  principles, 
and  exist  probably  in  all  the  varieties  of  bark,  though  in  very  different 
proportion.  In  the  pale  barks,  cinchonia  predominates;  in  the  officinal 
yellow  or  Calisaya  bark,  quinia  is  most  abundant;  in  the  red,  both  these 
alkaloids  are  found  in  considerable  proportion ;  while  in  the  more  active 
of  the  Carthagena  barks,  quinidia  exists  largely. 

Quinia,  which  may  be  obtained  by  decomposing  the  sulphate  by 
means  of  an  alkali,  is  whitish,  flocculent,  crystallizable  with  difficulty, 
inodorous,  and  very  bitter.  It  is  fusible  by  heat  without  chemical  change, 
is  very  slightly  soluble  in  cold  water,  somewhat  more  so  in  boiling  water, 
and  very  soluble  in  alcohol,  ether,  and  the  volatile  and  fixed  oils.  With 
the  acids  it  forms  crystallizable  salts,  of  which  there  are  two  sets,  one 
containing  twice  as  much  acid  as  the  other.  Different  views  are  enter- 
tained of  the  equivalent  constitution  of  these  salts;  some  believing  those 
containing  the  smaller  proportion  of  acid  to  be  sub-salts  (with  one  eq.  of 
acid  and  two  eqs.  of  base),  and  those  containing  the  larger  proportion  to 
be  neutral  (with  one  eq.  of  acid  and  one  of  base);  while  others  consider 
the  first  set  to  be  neutral  (with  one  eq.  of  acid  and  one  eq.  of  base),  and 
the  second  to  be  super  or  bi-salts  (with  two  eqs.  of  acid  and  one  eq.  of 
base).  Thus,  the  two  sulphates  would  be  denominated  by  one  party 
disulphate  and  sulphate  of  quinia,  by  the  other  sulphate  and  bisulphate. 
Of  course,  the  equivalent  of  the  alkaloid  is  stated  differently,  according 
to  these  different  views;  being  162  in  accordance  with  the  former,  and 
double  that  number  with  the  latter.  Quinia  is  distinguished  from  all 
other  substances,  with  the  exception  of  its  isomeric  alkaloids,  by  the 
emerald-green  colour  which  its  solution,  or  that  of  its  salts  assumes,  when 
treated,  first  with  chlorine,  and  then  with  ammonia,  and  which  changes 
to  violet  upon  saturation  with  a  dilute  acid. 

Quinidia,  though  isomeric  with  quinia,  differs  from  that  alkaloid  in 
crystallizing  readily,  in  being  less  soluble  in  ether,  and  in  its  influence  on 
polarized  light  It  differs  also  from  this,  and  all  the  other  cinchona  alka- 
loids, in  the  circumstance,  that  a  solution  of  its  sulphate  yields  a  white 
precipitate  with  solution  of  iodide  of  potassium.  Its  crystals  effloresce 
on  exposure  to  the  air.  It  resembles  quinia  in  its  chemical  relations 
with  chlorine  and  ammonia. 


CI1AP.   I.]  TONICS. PERUVIAN    BARK.  231 

Quinicia  differs  from  quinia  in  being  apparently  quite  uncrystallizable, 
and  in  its  effects  on  polarized  light;  but  agrees  with  it  in  composition, 
and  iff  most  of  its  chemical  relations.  It  is,  indeed,  in  all  probability, 
the  result  of  certain  molecular  changes  produced  in  quinia  by  the  influ- 
ence of  heat  used  in  its  extraction.  It  is  not  employed  separately  in  a 
pure  state. 

Cinchonia  may  be  prepared  from  the  sulphate  in  the  same  manner  as 
quinia  from  its  sulphate.  It  is  white,  crystallizable,  almost  insoluble  in 
cold  water,  very  slightly  soluble  in  boiling  water,  freely  soluble  in  boil- 
ing alcohol,  which  deposits  it  on  cooling,  scarcely  soluble  in  ether,  and 
but  slightly  so  in  volatile  or  fixed  oils.  In  consequence  of  its  compara- 
tive insolubility,  it  is  much  less  bitter  than  quinia;  scarcely  having 
any  taste  when  first  applied  to  the  tongue,  but  becoming  bitter  in  a  short 
time  as  it  dissolves;  and  its  solutions  are  very  bitter.  By  a  moderate 
heat  it  melts,  but  is  at  the  same  time  decomposed.  It  forms  with  the 
acids  crystallizable  salts,  of  which,  as  in  the  case  of  quinia,  there  are 
two  sets,  to  which  the  same  remarks  are  applicable  as  those  made  in 
reference  to  the  salts  of  the  latter  alkaloid.  Its  equivalent  is  conse- 
quently given  differently,  either  154,  or  double  that  number.  It  is  dis- 
tinguished by  affording  a  white  precipitate,  when  its  solution,  or  that  of 
its  salts,  in  chlorine  water  is  treated  with  ammonia. 

Cinchonidia  bears  the  same  relation  to  cinchonia  that  quinidia  does 
to  quinia.  Like  cinchonia  it  forms  anhydrous  crystals,  which  do  not  like 
those  of  quinidia  effloresce  in  a  warm  air.  It  also  agrees  with  its  iso- 
meric  alkaloid  in  not  producing  a  green  colour  with  chlorine  and  ammo- 
nia; but  is  more  soluble  in  ether  than  cinchonia,  and  differs  in  its 
influence  on  polarized  light. 

Cinchonicia,  which  is  derived  from  cinchonia,  is  isomeric  with  it,  and 
resembles  it  in  chemical  relations,  but  differs  in  being  amorphous  or 
uncrystallizable.  Neither  this,  nor  the  preceding  alkaloid  is  prepared 
separately  for  use,  in  a  pure  state,  at  least  in  any  considerable  quantity. 

Under  the  name  of  quinidia  or  qitinidine,  an  alkaloid  substance  was 
some  time  since  brought  into  notice,  and  to  some  extent  introduced  into 
commerce,  which  Pasteur  found  to  consist  usually  of  the  two  alkaloids, 
named  respectively  quinidia  and  cinchonidia,  but  chiefly  and  sometimes 
exclusively  of  the  latter.  This  has  led  to  an  unfortunate  confusion  of 
nomenclature;  but  the  student  should  remember  that  what  was  com- 
monly called  quinidia  in  commerce,  and  still  to  a  certain  extent  retains 
that  name,  is  really  in  great  measure  cinchonidia.  'The  nomenclature 
adopted  here,  after  Pasteur,  is  necessary  as  expressive  of  the  true  rela- 
tions of  the  several  alkaloids. 

The  substance  sometimes  called  quinoidine,  which  in  its  pure  state  is 
the  amorphous  quinia  of  Liebig,  and  is  obtained  from  the  mother  waters 
left  after  the  precipitation  of  sulphate  of  quinia,  in  the  process  for  pre- 


232  GENERAL   STIMULANTS.  [PART  II. 

paring  that  salt,  is  usually  a  mixture  of  quinicia  and  cinchonicia,  and 
results  from  the  reactions  which  take  place  in  the  process ;  the  crystal- 
lizablc  alkaloids  having  been  rendered,  by  molecular  change,  amorphous 
or  uucrystallizable. 

Chemical  Relations  and  Incompatibilities.  The  alkalies  and  their 
carbonates,  and  the  alkaline  earths,  precipitate  the  alkaloids  from  the  in- 
fusion and  decoction  of  bark;  tannic  acid,  and  all  the  astringent  sub- 
stances containing  it,  precipitate  insoluble  tannates  of  the  alkaloids.  By 
the  reagents  mentioned,  therefore,  the  liquid  aqueous  preparations  of 
bark  are  deprived  of  the  active  principles  of  that  medicine;  but,  as  the 
precipitated  matter  is  active,  the  preparations,  if  the  sediment  be  diffused 
through  them,  will  still  be  efficient,  though  inelegant  from  their  turbid- 
ness.  The  same  may  be  said  of  the  slight  precipitates  produced  by  the 
soluble  salts  of  oxalic,  tartaric,  gallic,  and  acetic  acids,  in  consequence 
cf  the  difficult  solubility  of  the  compounds  of  these  acids  with  the  cin- 
chona alkaloids.  These  precipitates,  moreover,  are  redissolved  by  a 
slight  excess  of  acid.  Besides  the  precipitants  mentioned,  all  of  which 
disturb  the  relations  of  the  active  principles,  there  are  many  others, 
which,  through  reaction  with  the  tannic  acid  often  found  in  bark,  or  with 
other  relatively  inert  constituents,  form  insoluble  compounds,  and  occa- 
sion turbidness  or  deposition  in  the  infusion.  Among  these  are  the  solu- 
ble salts  of  Ipad,  iron,  zinc,  silver,  and  mercury,  tartar  emetic,  arsenious 
acid,  and  solutions  of  gelatin.  Some  of  these  act  on  certain  varieties  of 
bark,  and  not  on  others;  as,  for  example,  tartar  emetic,  which  sometimes 
produces  copious  precipitates,  and  sometimes  does  not  disturb  the  infu- 
sion. In  consequence  of  the  large  proportion  of  kinate  of  lime  in  the 
Calisaya  or  officinal  yellow  bark,  a  strong  infusion  of  this  variety  is 
precipitated  by  sulphate  of  soda,  which  does  not  affect  most  of  the 
other  barks.  But  the  virtues  of  the  infusion  are  not  impaired  by  these 
reagents,  as  the  active  principles  remain  undisturbed;  so  that  the  incom- 
patibility has  reference,  not  to  the  Peruvian  bark,  but  to  the  substance 
added. 

Signs  of  Value.  The  taste  affords  some  evidence  of  the  strength  of 
bark,  which*as  a  general  rule,  may  be  considered  proportionate  to  the 
bitterness;  but  this  test  cannot  be  relied  on  with  certainty;  as  in  some 
inferior  barks  there  is  considerable  bitterness,  in  consequence  of  the 
presence  of  kinovic  acid,  which  has  not  the  characteristic  virtues  of  the 
medicine.  The  best  method  of  testing  any  specimen  of  bark  is  to 
determine  the  percentage  of  the  alkaloids  contained  in  it,  which  is  a 
pretty  accurate  measure  of  its  medicinal  activity.  For  the  method  of 
doing  this,  the  reader  is  referred  to  the  U.  S.  Dispensatory  (12//i  ed.t 
p.  295). 


CHAP.  I.]  TONICS. — PERUVIAN    BARK.  233 


3.  Effects  of  Peruvian  Baric  on  the  System. 

As  the  virtues  of  the  bark  reside  mninljr  in  its  alkaloids,  and  these  are 
closely  analogous  in  their  effects,  it  will  be  most  convenient  to  treat  first 
of  quinia,  as  the  one  best  known  and  most  used  ;  and  afterwards  to  point 
out  any  difference  that  may  exist  between  its  operation  and  that  of  the 
bark  itself,  or  the  other  alkaloids.  The  effects  of  quinia  are  usually  ob- 
tained from  the  sulphate;  and  this  may  be  considered,  in  the  following 
observations,  as  representing  the  alkaloid. 

When  sulphate  of  quinia  is  administered  to  a  healthy  person,  in  quan- 
tities not  exceeding  six  grains  daily,  in  doses  of  half  a  grain  or  a  grain, 
it  produces  effects  very  analogous,  if  not  identical  with  those  of  the 
simple  bitters.  At  first  no  sensible  effects  whatever  may  be  experienced ; 
but,  after  a  short  time,  the  appetite  is  increased,  the  food  appears  to  be 
more  rapidly  digested,  the  pulse  becomes  somewhat  fuller  and  stronger, 
if  not  accelerated,  the  temperature  of  the  surface  is  correspondingly  ele- 
vated, the  processes  of  sanguification  and  nutrition  arc  promoted,  and 
other  vital  functions  are  moderately  stimulated  either  directly  or  indi- 
rectly. In  other  words,  the  medicine  operates  as  a  pure  tonic,  accord- 
ing to  the  definition  of  the  term  given  in  this  work.  In  irritable  states 
of  the  digestive  organs,  or  of  the  system  at  large,  these  effects  are  some- 
times exalted,  by  the  free  use  of  the  medicine,  into  a  moderately  febrile 
state,  with  anorexia,  gastric  oppression,  thirst,  a  furred  tongue,  accelera- 
ted pulse,  heat  and  dryness  of  the  surface,  and  headache  or  other  cephalic 
uneasiness.  This  condition,  however,  is  probably  not  the  direct  result 
of  the  action  of  the  medicine  upon  the  system  at  large,  but  indirect,  and 
symptomatic  of  some  local  irritation  produced  by  it,  especially  in  the 
stomach  or  other  parts  of  the  digestive  apparatus.  This  state  of  exces- 
sive excitement  is  rarely  experienced  in  health;  because,  with  an  inr-rease 
in  the  quantity  of  quiuia  administered,  other  effects  are  developed,  of  a 
contrary  tendency,  which  overcome  its  general  excitant  influence. 

Given  to  the  amount  of  from  six  to  twelve  grains  daily,  in  divided 
doses,  or  to  a  less  amount  in  a  single  dose,  sulphate  of  quinia  evinces  a 
tendency  to  act  specially  upon  the  brain,  and  often  produces  very  decided 
effects  upon  that  organ.  The  quantity,  however,  necessary  to  the  pro- 
duction of  obvious  cerebral  symptoms,  varies  greatly  in  different  indi- 
viduals; some  evincing  an  extraordinary  susceptibility  to  the  influence 
of  even  small  doses,  while  others  scarcely  feel  the  largest  quantity  above 
mentioned.  The  first  cerebral  phenomenon  usually  presented  is  abnor- 
mal sound,  such  as  buzzing,  roaring  like  that  of  a  strong  wind  or  of  a 
cataract,  singing,  hissing,  ringing,  etc.  Along  with  this  there  is  gen- 
erally more  or  less  hardness  of  hearing,  which,  indeed,  is  one  of  the  most 
characteristic  effects  of  quinia.  Uneasy  sensations  in  the  head  are  also 


234  GENERAL    STIMULANTS.  [PART  II. 

frequent,  as  of  weight,  fulness,  tension,  and  sometimes  positive  pain, 
though  very  seldom  severe.  The  circulation  is  not  much  affected;  the 
pulse  being  sometimes  increased  sometimes  diminished  in  frequency,  but 
for  the  most  part  little  altered. 

When,  instead  of  the  quantities  above  mentioned,  from  twelve  to  sixty 
grains  or  more  are  given  daily,  in  divided  doses,  the  effect  upon  the 
cerebral  functions  is  increased,  and  a  decided  sedative  influence  upon  the 
circulation  produced,  as  evinced  by  a  diminution  of  the  frequency  and 
force  of  the  pulse,  proportionate  to  the  amount  of  the  salt  used.  Along 
with  the  abnormal  sounds  before  referred  to,  there  is  now  giddiness  or 
dizziness;  the  individual,  if  erect,  often  staggers;  occasionally  there  is 
irregular  muscular  movement;  the  hardness  of  hearing  is  not  unfre- 
quently  increased  to  positive  deafness,  and  in  a  few  instances  vision  is 
disturbed  and  blindness  induced.  At  first,  if  the  individual  dose  is  large, 
there  may  be  flushing  of  the  face,  headache,  and  sometimes  epistaxis, 
indicating  decided  sanguineous  determination  to  the  head;  and  occa- 
sionally, though  very  rarely,  active  delirium  occurs.  In  experiments 
upon  dogs,  even  meningitis  has  in  some  relatively  few  instances  been 
brought  on  by  very  large  doses.  (Briquet,  Traite  Therap.  du  Quinquina, 
p.  161.)  But  these  evidences  of  over-excitement  of  the  brain  give  way 
to  others  indicating  a  reduction  of  nervous  power,  such  as  diminished 
hearing  and  sight,  uncontrollable  tremblings,  depressed  spirits,  sighing 
or  yawning,  and  very  rarely  a  kind  of  mental  disorder,  compared  by  Dr. 
James  McCaw  of  Virginia  to  delirium  tremens.  (Stethoscope,  ii.  666.) 
In  some  instances,  a  tendency  to  drowsiness  or  stupor  is  evinced;  in 
others,  morbid  wakefulness;  but  in  the  greater  number,  neither  the  one 
nor  the  other.  Though  the  pulse  is  at  first  sometimes  temporarily  ex- 
cited by  these  large  doses,  probably  in  sympathy  with  the  excited  brain, 
it  in  general  soon  becomes  slower,  and  always  feebler.  The  pulsations 
of  the  heart  are  often  reduced  ten  or  twelve  in  the  minute,  sometimes 
as  much  as  twenty  or  twenty-five;  and  the  whole  number  in  the  minute 
to  forty,  but  seldom  if  ever  lower.  In  strength,  the  pulse  is  diminished 
very  nearly  in  proportion  to  the  dose,  as  shown  by  the  experiments  of 
Briquet  upon  dogs,  by  means  of  Poiseuille's  haemadynametcr;  and,  in 
extreme  cases,  it  may  be  so  much  reduced  as  no  longer  to  be  felt  at  the 
wrist  The  skin  at  the  same  time  becomes  cool,  pale,  and  moist,  and  the 
face  pale  or  livid,  and  shrunk. 

This  prostration  under  the  use  of  quinia  may  be  carried  so  far  as  to 
constitute  real  poisoning.  Death  has  often  been  produced  in  dogs  by 
excessive  doses;  and  in  one  case,  cited  by  M.  Guersent.  the  same  ro.sult 
is  said  to  have  taken  place  in  the  human  subject.*  (jJiacommini,  who 

*  In  this  case,  M.  Knzire,  a  practitioner  of  medicine,  in  an  excited  state  of  imagi- 
nation bordering  on  insanity,  believing  himself  to  be  attacked  with  pernicious  fever, 


CHAP.  I.]  TONICS. PERUVIAN    BARK.  235 

first  called  attention  to  the  powerful  sedative  influence  of  quinia,  records 
the  case  of  an  individual,  who  took  by  accident  about  three  drachms  of 
the  sulphate.  Extreme  prostration  came  on,  with  an  almost  absent 
pulse,  cold  skin,  slow  respiration,  feeble  voice,  and  apparently  imminent 
danger  of  death,  which  was,  however,  averted.  In  these  prostrate  cases, 
the  pupil  is  often  dilated,  and  there  is  sometimes  coma. 

Hitherto  our  attention  has  been  directed  to  the  influence  of  quinia,  in 
large  doses,  upon  the  circulation,  or  the  cerebral  functions. 

But  it  also  produces  other  effects.  It  has  been  supposed  by  some  to 
render  the  blood  more  fluid,  and  to  lessen  its  coagulability  by  diminishing 
the  proportion  of  fibrin,  or  altering  its  quality ;  and  in  some  cases,  in 
which  death  has  occurred  during  its  administration,  the  blood  has  been 
found  fluid.  But  this  result  was  ascribable  to  the  existing  disease,  and 
not  to  quinia;  and  more  numerous  experiments  and  observations  have 
proved  that,  in  any  quantity  in  which  it  can  be  introduced  into  the  sys- 
tem, it  docs  not  impair  the  coagulability  of  the  blood.  Indeed,  Briquet 
found,  in  his  experiments,  that  it  had  the  opposite  effect  of  increasing 
the  proportion  of  fibrin. 

It  has  been  said  that  quinia  has  the  property  of  immediately  reducing 
the  bulk  of  the  spleen.  This  view  of  it  was  taken  by  Piorry,  but  has 
not  been  fully  sustained  by  other  observers;  and  the  existence  of  the 
property  must  be  considered  as  doubtful.  Enlargement  of  the  spleen  is 
undoubtedly  often  gradually  diminished  under  the  use  of  quinia,  espe- 
cially in  miasmatic  fevers ;  but  it  is  quite  as  probable  that  the  effect  pro- 
ceeds indirectly  from  the  removal  of  the  cause,  as  directly  from  the  opera- 
tion of  the  remedy  on  the  organ. 

In  the  urinary  passages  quinia  occasionally  induces  irritation,  proba- 


took  within  a  short  time  60  grammes  (very  nearly  two  ounces  Troy)  of  sulphate  of 
quinia  by  the  mouth  and  rectum.  Symptoms  of  great  prostration,  with  loss  of  sight 
and  hearing,  came  on,  which  he  unfortunately  ascribed  to  the  pernicious  fever,  and 
hoped  to  counteract  by  a  continuance  of  these  endrmous  doses.  In  the  course  of 
nine  or  ten  days,  he  took  additionally  five  ounces  of  the  salt.  Another  physician 
being  then  called  in,  found  him  covered  with  cold  sweat,  completely  deaf  and  blind, 
with  difficult  and  rattling  respiration,  profound  stupor,  and  an  expression  of  coun- 
tenance like  that  of  drunkenness.  Though  partially  roused  with  much  difficulty, 
so  as  to  give  rational  answers,  he  quickly  became  delirious,  and  died.  (Diet,  de  Med., 
2e  ed.,  xxvi.  570.) 

A  case  is  recorded  in  the  London  Med.  Times  and  Gaz.  (April.  1864,  p.  461),  in 
which  one  ounce  of  sulphate  of  quinia  was  given,  by  mistake,  to  a  soldier  affected 
with  ague,  with  no  other  unpleasant  effect  than  a  kind  of  stupor  and  complete  deaf- 
ness, which  left  him  after  a  time;  and  at  the  end  of  a  week  he  was  quite  well,  hav- 
ing lost  his  ague.  No  antidote  was  used.  From  these  two  cases  it  may  be  inferred 
that,  though  quinia  may  sometimes  be  taken  with  impunity,  by  a  strong  man,  in 
the  quantity  of  an  ounce;  yet  double  the  quantity  may  prove  fatal;  and  a  legitimate 
caution  would  limit  the  dose  far  wiihin  the  smaller  amount  mentioned.  (Note  to  the 
third  edition.) 


236  GENERAL    STIMULANTS.  [PART  II. 

bly  by  its  direct  contact  with  the  mucous  membrane  of  these  passages, 
as  it  escapes  with  the  urine.  Dr.  E.  Hardy  has  shown  that  quinia  begins 
to  pass  out  with  the  urine  in  less  than  seven  minutes  from  its  exhibition 
by  the  mouth.  (Journ.  de  Pkarm.  et  de  Ghim.,  3e  s;n\,  xliv.  lf>0.)* 

The  alkaloid  is  not  generally  thought  to  exercise  any  special  influence 
on  the  genital  function;  though  it  may  no  doubt  operate  beneficially,  in 
certain  abnormal  states  of  that  function,  through  its  tonic  powers.  It 
is,  however,  believed  by  Dr.  Cochran,  on  the  basis  of  numerous  experi- 
ments, that  it  has  the  property  of  exciting  the  menstrual  function  by  a 
special  influence;  accelerating  and  augmenting  the  menses  when  it  is 
given  a  short  time  before  the  regular  period,  and  restoring  them  when 
arrested  by  cold  or  other  cause.  (Ann.  de  Therap.,  A  D.  I860,  p.  194.) 

Occasional  effects  are  experienced  from  quinia  differing  from  those 
which  are  most  common  and  characteristic.  Sometimes  it  irritates  the 
stomach  considerably,  causing  a  sense  of  weight  or  oppression,  gastric 
pains,  and  nausea  or  vomiting.  This  is  especially  the  case  in  febrile 
diseases,  in  which  the  stomach  is  already  not  unfrequently  in  a  state  of 
irritation,  or  strongly  disposed  to  it.  Sometimes  also  it  acts  similarly  on 
the  bowels,  causing  griping  pain,  and  diarrhoea.  It  has  been  accused 
of  producing  constipation;  but  this  is  doubtful.  Its  operation,  in  large 
doses,  is  sometimes  attended  with  great  oppression  of  chest  and  p re- 
cordial  uneasiness,  probably  dependent  upon  its  irritant  influence  over 
the  nervous  centres.  Mr.  W.  II.  Yipan  states  that,  in  several  cases 
which  have  come  under  his  notice,  purpura  has  appeared  immediately 
after  the  use  of  quinia.  (Lancet,  July  8,  1865,  p.  37.) 

The  constitutional  effects  of  quinia  are  essentially  the  same,  by  what- 
ever avenue  it  enters  the  system,  whether  taken  by  the  stomach,  injected 
into  the  rectum,  or  introduced  into  the  areolar  tissue,  the* serous  cavities, 
or  directly  into  the  circulation.  When  applied  to  the  skin  denuded  of 
the  cuticle,  it  produces  so  much  irritation  as  materially  to  interfere  with 
its  absorption. 

The  period,  after  its  administration,  at  which  quinia  begins  to  evince 
signs  of  its  characteristic  action  on  the  nervous  system,  and  the  length 
of  time  during  which  these  signs  persist,  vary  with  the  dose  and  the  in- 
tervals of  exhibition.  Less  than  three  or  four  grains,  in  one  dose,  rarely 

*  Some  experiments  have  been  made  to  determine  the  influence  of  quinia  on  the 
excretion  of  substances  with  the  urine.  Dr.  Win.  A.  Hammond,  of  the  U.  S.  .Army, 
found,  as  the  result  of  his  investigations  in  cases  of  interuiittent  fever,  that  the  use 
of  quinia  was  followed  by  a  diminution  of  the  uricaci'l  in  the  urine,  and  an  increase 
of  the  urea  (Am.  Journ.  of  Med.  Sci.,  April,  1858,  p.  3Uli);  and  the  same  result,  aa 
relates  to  the  diminution  of  uric  acid,  was  obtained  by  Dr.  II.  Rankc  (Lond.  Med. 
Time*  and  Gaz.,  May,  1867,  p.  537).  But  we  have,  as  yet,  insufficient  facts  to  jus- 
tify any  positive  inference,  as  to  its  general  physiological  action,  from  its  influence 
on  this  secretion.  (Note  to  the  tecond  edition.) 


CHAP.  I.]  TONICS. — PERUVIAN    BARK.  237 

produces  any  sensible  effect;  six  or  eight  grains  usually  occasion  some 
cerebral  disturbance  in  half  an  hour,  an  hour,  or  at  the  latest  two  hours; 
while  from  twelve  to  sixteen  grains,  or  more,  may  operate  sensibly  in  so 
short  a  time  as  fifteen  minutes.  But,  when  the  medicine  is  given  in  the 
dose  of  a  grain  or  two,  repeated  at  intervals  of  one  or  two  hours,  little 
or  no  effect  on  the  nervous  system  is  experienced  until  nine  or  ten  grains 
have  been  taken;  and  often  considerably  more  is  required.  The  opera- 
tion of  a  single  dose,  just  large  enough  to  make  itself  felt,  say  five  or  six 
grains,  continues  generally  two  or  three  hours ;  of  double  the  quantity, 
given  through  the  day,  in  divided  doses,  about  eight  or  ten  hours;  of 
larger  amounts,  given  in  the  same  way,  up  to  a  drachm  daily,  from 
twelve  to  thirty-six  hours.  (Briquet.) 

In  animals  which  have  perished  under  the  influence  of  quinia,  no 
lesion  has  been  discovered,  as  a  general  result,  sufficient  to  account  for 
the  fatal  effect.  Almost  invariably  the  pia  mater  has  been  found  more  or 
less  injected;  but  not  to  such  a  degree  as  to  account  for  the  fatal  issue, 
though  the  appearance  may  aid  in  the  explanation  of  its  mode  of  opera- 
tion. It  has  already  been  stated  that,  in  a  few  instances,  traces  'of 
meningitis  have  been  noticed.  The  probability  is  that,  if  any  character- 
istic lesion  be  found,  it  will  be  in  the  nervous  centres  near  the  base  of 
the  brain,  upon  which  the  medicine  appears  mainly  to  expend  its  in- 
fluence, so  far  as  that  organ  is  concerned.  Perhaps  a  careful  examina- 
tion of  these  parts,  by  means  of  the  microscope,  might  reveal  some 
characteristic  abnormal  condition. 

In  relation  to  Peruvian  bark  itself,  the  effects  are  essentially  the  same 
as  those  of  quinia;  but,  in  consequence  of  its  bulk,  or  of  certain  non- 
alkaline  principles  contained  in  it,  as  the  cinchonic  red  and  the  yellow 
colouring  ruatte*r,  it  is  much  more  disposed  to  irritate  the  stomach  and 
bowels.  It  often,  therefore,  nauseates,  and  occasionally  causes  vomiting 
or  purging,  especially  if  the  alimentary  mucous  membrane  is  in  an  irri- 
table state ;  and  in  some  instances  it  cannot  be  borne  on  the  stomach, 
in  quantities  sufficient  to  produce  its  characteristic  effects  on  the  system. 
When  very  largely  given,  it  generally  becomes  intolerably  offensive  to 
the  stomach;  so  that  it  is  difficult  to  obtain  from  it  the  sedative  and 
prostrating  effects  produced  by  excessive  doses  of  sulphate  of  quinia; 
and,  when  such  effects  are  observed,  it  is  not  always  easy  to  discrimi- 
nate between  them,  and  the  sympathetic  effects  of  the  attendant  nausea. 
Hence,  the  highly  important  property  of  diminishing  the  force  and  fre- 
quency of  the  pulse  long  escaped  attention,  and  became  known  only 
after  the  discovery  of  quinia  The  bark  differs  also  from  its  alkaloids  in 
another  particular;  in  its  occasional  tendency,  namely,  to  produce  con- 
stipation, resulting  probably  from  the  tannic  acid  it  contains.  This  effect 
is  of  course  evinced  only  in  states  of  the  bowels,  in  which  they  are  not 
disposed  to  be  irritated  by  it. 


238  GENERAL   STIMULANTS.  [PART  II. 

Cinchonia  has  been  found  to  be  identical  in  its  effects  with  quinia, 
except  that  it  is  about  one-third  weaker;  in  other  words,  requires  to  be 
given  in  a  quantity  about  one-third  greater  to  produce  the  same  result. 
Briquet,  in  his  experiments,  never  obtained  from  it  the  effect  upon  the 
vision  sometimes  produced  by  quinia;  but  this  was  probably  owing 
either  to  the  insufficient  number  of  trials,  or  to  the  insufficient  amount 
employed. 

Quinidia  and  quinicia  appear  not  to  differ  from  quinia,  in  their 
operation  on  the  system,  whether  physiologically  or  therapeutically.  In 
relation  to  cinchonidia  and  cinchonicia,  their  effects  have  not,  so  far  as 
I  know,  been  separately  studied ;  but  the  probability  is  that  they  would 
be  found  to  operate  identically  with  cinchonia,  to  which  they  hold  so 
close  a  chemical  relation. 

4.  Mode  and  Nature  of  Operation. 

It  is  probable  that  the  tonic  operation  of  quinia  upon  the  digestive 
organs  is  chiefly  direct;  as  it  certainly  possesses  the  property  of  local 
stimulation.  This  is  evinced  by  the  pain  and  inflammation,  often  fol- 
lowed by  superficial  sloughing,  which  result  from  its  application,  undiluted, 
to  the  surface  of  the  skin  deprived  of  the  epidermis.  The  gastric  and 
intestinal  irritation,  occasionally  caused  by  it,  is  probably  nothing'  more 
than  an  exaggeration  of  its  legitimate  tonic  influence  upon  the  alimentary 
mucous  membrane.  There  is  reason  to  suppose  that  the  febriculous  con- 
dition, sometimes  attendant  upon  its  action,  is  the  result  of  the  sympa- 
thetic extension  of  this  irritation  to  the  system  at  large.  But  the  con- 
stitutional impression  thus  produced  is  not  the  normal  and  characteristic 
effect  of  quinia  upon  the  system.  The  latter  arises  from  the  absorption 
of  the  medicine,  and  its  direct  contact  with  all  parts  of  the  body  affected ; 
and  is  in  fact  interfered  with  by  any  gastric  irritation  which  may  pro- 
ceed from  the  quinia,  because  absorption  is  thus  impeded.  Nevertheless, 
it  is  not  impossible  that  the  tonic  effect  of  the  medicine  on  the  digestive 
organs  may  depend,  in  part,  upon  its  entrance,  through  the  circulation, 
into  the  interior  of  their  tissues,  and  the  exercise  there  of  an  excitant 
influence  upon  their  nutrition. 

That  the  active  principles  of  Peruvian  bark  enter  the  circulation  run 
no  longer  be  doubted.  Several  experimenters  have  detected  quinia  in 
the  blood;  and  it  may  easily  be  recognized  in  the  urine,  a  short  time 
after  its  administration,  by  a  simple  chemical  test.  A  solution  of  iodide 
of  potassium,  in  which  free  iodine  has  been  dissolved,  throws  down  un 
orange-brown  precipitate  from  the  solution  of  a  salt  of  quinia.  In  ordi- 
nary urine  no  such  effect  is  produced;  but,  during  the  use  of  sulphate  of 
quinia,  the  application  of  the  reagent  is  followed  by  a  precipitate  as  soon 


CHAP.  I.]  TONICS. — PERUVIAN    BARK.  239 

as  the  system  becomes  affected,  and  as  long  as  it  continues  to  be  so.* 
The  quantity  wliich  passes  by  urine  is  proportionate  to  that  adminis- 
tered; and,  as  little  or  none  has  been  satisfactorily  detected  in  other 
secretions,  it  follows  that  most,  if  not  all  of  the  salt,  is  eliminated  by  the 
kidneys.  It  is  an  interesting  fact,  moreover,  that  the  quinia  ceases  to 
appear  in  the  urine  soon  after  its  observable  effects  upon  the  system 
have  ceased.  The  inferences  deducible  from  these  facts  are,  in  the.  first 
place,  that  Peruvian  bark  acts  on  the  system  through  the  medium  of 
the  circulation,  and,  secondly,  that  its  action  is  dynamic,  that  is,  upon 
the  vital  properties  of  the  parts  affected,  and  not  through  any  chemical 
combination  with  the  tissues,  which  would  otherwise  retain  the  alkaloid. 

But  are  the  effects  of  the  medicine  on  the  system  at  large  the  same  as 
those  upon  the  digestive  organs?  Is  it  a  general  as  well  as  local  tonic? 
Does  it  stimulate  the  functions  of  the  brain,  heart,  and  other  organs 
which  it  roaches  by  the  route  of  the  circulation,  as  it  is  admitted  to 
stimulate  the  stomach?  These  are  questions  of  great  importance,  as  they 
are  not  theoretical  merely,  but  have  a  strong  practical  bearing.  There  are 
many  who  agree  with  the  Italian  contra-stimulant  school,  in  believing 
that  sulphate  of  quinia  is  a  powerful  direct  sedative,  especially  in  large 
doses,  and  consequently  that  it  is  applicable  to  cases  of  high  excitement, 
and  even  of  active  inflammation.  If,  as  others  suppose,  it  is  essentially 
stimulant,  this  application  of  it  is  certainly  not  indicated,  and  must  often 
be  highly  injurious. 

I  believe  that  it  is  the  general  impression,  and  it  certainly  is  my  own, 
that,  in  small  doses,  quinia  is  essentially  and  universally  tonic.  Not  only 
upon  the  digestive  organs,  but  in  all  the  parts  to  which  it  is  carried  by 
the  circulation,  its  effects  thus  administered  are  to  excite  moderately  the 
nutritive  function,  and  probably  in  some  degree  also  that  of  secretion. 
Through  its  influence  upon  the  processes  by  which  the  blood  is  formed, 

*  The  solution  employed  by  Briquet  for  this  purpose  contained  2  parts  of  iodine, 
8  of  iodide  of  potassium,  and  2f>0  of  water.  .He  found  the  action  of  the  test  to  cor- 
respond closely  with  the  observable  effects  of  the  medicine  upon  the  nervous  system. 
Thus,  after  the  exhibition  of  8  grains  of  sulphate  of  quinia  in  one  dose,  a  precipi- 
tate sometimes  appeared  in  half  an  hour,  though  more  frequently  at  the  end  of  two 
hours;  after  4  grains,  in  two  or  three  hours;  after  2.5  grains,  if  any  appeared,  it 
was  not  till  the  expiration  of  five  or  six  hours.  The  length  of  time,  therefore,  before 
the  appearance  of  quinia  is  inversely  proportionate  to  the  quantity  taken;  and  the 
same  rule  holds  in  relation  to  the  period  at  which  the  effects  are  felt.  (Trail.  Thf- 
rap.  du  Quinquina,  p.  220.) 

Another  fact,  noticed  by  the  same  experimenter,  is  that  the  quantity  of  the  salt 
of  quinia  eliminated  is  directly  proportionate  to  that  introduced. 

A  third,  also  highly  interesting,  is  that  the  elimination  always  ceases  after  a  short 
time,  generally  little  exceeding  that  during  which  the  effects  of  the  quinia  persist. 
Thus,  after  a  single  dose  of  about  3  grains,  tlie  quinia  disappeared  from  the  urine 
in  from  20  to  24  houi  •  ;  aftor  oO  grains  taken  during  12  hours,  in  about  40  hours; 
and  after  large  doses  taken  tor  several  days,  in  from  6U  to  80  hours,  (fbid.,  p  230.) 


240  GENERAL    STIMULANTS.  [PART  II. 

it  probably  tends  to  augment  the  quantity  of  that  fluid,  and  to  render  it 
richer.  Thus,  by  its  own  operation  upon  the  nutrition  of  the  heart,  and 
through  the  agency  of  the  enriched  blood,  it  gives  greater  energy  to  the 
contractions  of  that  organ;  and  hence  the  fuller  and  stronger  pulse,  not 
unfrequcntly  resulting  from  its  moderate  and  continued  use.  It  does 
not,  however,  appear,  like  the  arterial  stimulants,  to  excite  the  heart 
immediately  into  increased  frequency  of  pulsation ;  and,  when  this  effect 
is  occasionally  experienced,  it  is  probably  through  sympathy  with  the 
irritated  stomach  or  brain.  In  all  the  points  just  referred  to  quinia 
agrees  with  the  simple  bitters.  But  there  is  another  in  which  it  mate- 
rially differs  from  that  set  of  tonics;  I  refer  to  its  action  on  the  brain. 
The  simple  bitters  may  affect  that  organ  through  the  enriched  blood,  or 
possibly  by  directly  stimulating  its  nutrition;  but  its  special  functions 
arc  not  immediately  excited,  and  in  no  degree  observably  interfered  with. 
Quinia,  on  the  contrary,  acts  with  a  special  predilection  on  the  cerebral 
functions;  stimulating  them  gently,  and  within  the  limits  of  tonic  action, 
when  given  moderately;  but,  in  excess,  producing  the  effects  of  over- 
excitement  or  irritation  proportionate  to  the  quantity  used.  In  small  doses, 
this  influence  is  not  evinced  by  any  striking  phenomena ;  but  it  is  no  doubt 
felt,  and  contributes  to  give  to  Peruvian  bark  that  pre-eminence  over 
other  tonics  which  it  has  so  long  enjoyed.  But  discrimination  is  neces- 
sary in  order  to  an  accurate  understanding  of  its  operation  on  the  brain. 
Resembling  in  some  respects  the  stimulant  narcotics,  it  yet  differs  from 
them  in  the  special  seat  of  its  action.  Both  obey  the  general  laws  of 
stimulation;  that  is,  they  at  first  increase  the  normal  function  of  the  ex- 
cited part,  then  derange  it,  and  finally,  by  a  continuance  of  their  influ- 
ence, diminish  or  suppress  it.  But,  while  the  cerebral  stimulants  or 
stimulating  narcotics  operate  more  or  less  upon  the  whole  encephalon, 
and  especially  upon  the  seat  of  the  intellectual  and  emotional  functions 
in  the  cerebral  lobes;  quinia  leaves  these  almost  unaffected,  and  confines 
its  influence  more  especially  to  the  centres  near  the  base  of  the  brain ; 
those,  namely,  of  sensation,  and  those  which  control  the  organic  func- 
tions of  the  system.  Hence  we  seldom  see  mental  exhilaration,  delirium, 
or  stupor  produced  byquiuia;  while  excitement,  disturbance,  and  de- 
pression of  hearing  or  sight,  and  of  the  reflex  muscular  movements  of 
circulation  and  respiration,  are  its  constant  results  when  taken  in  full 
doses.* 

*  la  reference  to  the  effects  of  quinia  on  Bight  and  hearing,  I  recently  had  a 
patient  who,  under  the  full  influence  of  the  medicine,  was  affected  with  curious 
hallucinations,  not  only  seeing  either  strange  or  familiar  faces,  but  hearing  unreal 
voices,  sometimes  from  visible,  sometimes  invisible  sources;  and,  as  the  patient  was, 
on  a  moment's  reflection,  conscious  that  they  were  illusions,  they  were  often  sources 
of  amusement.  There  was  no  fever,  and  no  other  evidence  of  cerebral  excitement. 
The  hallucinations  vanished  when  sufficient  lime  had  passed  for  the  elimination  of 
the  medicine.  (Note  to  the  third  edition.) 


CHAP.  I.]  TONICS. PERUVIAN  BARK.  241 

Admitting  quinia  to  be  moderately  stimulant,  in  small  doses,  to  those 
cerebral  functions  which  it  specially  affects,  we  have  next  to  consider 
the  question,  whether  the  sedative  effects  undoubtedly  produced  by  it, 
when  largely  given,  are  direct  or  indirect ;  that  is,  whether  they  proceed 
from  an  immediately  depressing  influence  exerted  by  the  quinia  upon  the 
encephalic  centres,  or  are  the  consequences  of  a  preceding  state  of  exci- 
tation. To  solve  this  question,  it  must  (irst  be  determined,  what  are  the 
immediate  effects  of  a  large  dose  of  the  medicine,  sufficient  to  induce  the 
ultimate  prostration.  Close  observation  upon  the  human  subject  and 
the  lower  animals  has  shown,  I  think,  that  so  far  as  the  brain  is  con- 
cerned, these  effects  are  such  as  characterize  excitation.  The  flushed 
face,  the  feeling  of  tension  or  fulness  in  the  head,  the  sensitiveness  to 
light,  the  buzzing  and  roaring  in  the  ears,  the  vertiginous  sensations,  the 
involuntary  muscular  movements,  the  increased  frequency  of  pulse  and 
heat  of  skin,  and  the  active  delirium  and  convulsions  which  occasionally 
though  rarely  occur,  are  all  proofs  of  stimulation  and  active  congestion 
of  the  brain  ;  and  these  proofs  are  still  further  strengthened  by  the  ful- 
ness of  the  vessels  of  the  pia  mater,  uniformly  observed  on  post-mortem 
examination,  and  the  evidences  of  positive  meningitis  which  have  been 
observed  in  a  few  instances.  It  is  true  that  these  phenomena  of  excita- 
tion are  much  less  observable,  when  the  same  quantity  is  administered 
in  small  portions,  at  intervals  of  an  hour  or  two ;  but,  in  this  case,  the 
stimulation  from  the  several  portions,  not  exceeding  the  degree  of  tonjc 
action,  is  scarcely  observable  in  the  pulse,  and  subsides  before  being  fully 
reinforced  by  the  succeeding  doses ;  while  the  secondary  depression  of 
the  whole  accumulates,  and  in  the  end  becomes  very  obvious.  The  ex- 
citant effects  of  the  large  single  dose  may  continue  for  two  or  three  hours, 
when  they  gradually  subside  into  a  contrary  condition,  proportionate  to 
the  quantity  taken,  and,  when  this  is  in  great  excess,  the  prostration  is 
in  the  end  extreme.  Now  this  is  the  ordinary  and  necessary  Ault  of 
over-stimulation ;  and  it  is  altogether  superogatory  to  imagine  the  exist- 
ence of  a  directly  depressing  power  in  the  medicine.  The  stimulation  of 
an  organ  first  excites  its  function;  if  it  be  continued  and  increased,  the 
function  is  disturbed  and  becomes  irregular;  if  still  further  increased, 
the  organ  is  overwhelmed  by  the  congestion  induced,  and  its  function  is 
impaired  or  suppressed.  The  first  excitement  is  thus  followed  by  de- 
pression ;  and  this  is  deepened  through  another  physiological  law,  which 
determines  that  the  excitability  of  a  part  i-  exhausted  by  over-exercise. 
Thus,  after  the  first  excitant  effects  of  quiuia  above  referred  to  have  con- 
tinued a  short  time,  the  cerebral  centres  become  incapacitated  for  their 
duties  through  their  congestion,  and  secondary  exhaustion ;  and  cease 
to  send  forth  the  influence  necessary  for  the  support  of  the  functions 
over  which  they  preside,  or  which  they  in  any  degree  control.  Hence 
the  diminution  or  loss  of  hearing,  the  occasional  loss  of  sight,  the  general 
VOL.  i. — 16 


242  GENERAL   STIMULANTS.  [PART  II. 

feebleness  of  the  muscular  power,  the  trembling-,  the  gradually  diminish- 
ing frequency  and  force  of  the  pulse,  the  coldness  and  pallor  of  the  sur- 
face, and  the  universal  prostration.  Now  this  is  a  very  different  condi- 
tion, in  relation  to  therapeutic  indications,  from  an  apparently  similar 
condition  produced  by  a  direct  sedative  to  the  nervous  centres,  or  to  the 
heart  itself;  and,  though  it  might  prove  useful  in  certain  cases  if  safely 
induced,  yet,  in  determining  upon  the  propriety  of  having  recourse  to  it, 
reference  must  always  be  had  to  the  possible  danger  of  the  great  over- 
excitement  and  congestion  of  the  nervous  centres  involved.  This  point 
will  again  be  brought  under  discussion,  when  we  come  to  treat  of  certain 
therapeutic  applications  of  quinia,  proposed  on  the  ground  of  its  sedative 
properties.* 

In  explaining  the  effects  of  quinia  on  the  system,  a  new  path  of  inves- 
tigation has  been  opened  by  Dr.  H.  Bence  Jones,  through  the  discovery 
in  the  animal  tissues  of  a  substance  strongly  resembling  quinia  in  its 
reagencies;  not  only  exhibiting  the  same  remarkable  fluorescence  in  solu- 
tion, but  responding  in  like  manner  to  various  other  tests  of  quinia.  But 
much  further  investigation  is  requisite  in  order  to  form  a  satisfactory 
opinion  of  the  relation  of  this  new  substance  with  quinia,  and  how  far 


*  Some  experiments  of  Briquet  upon  dogs  would  seem  to  prove  a  direct  sedative 
influence  of  quinia  upon  the  motor  power  of  the  heart.  By  injecting  quantities  of 
sulphate  of  quinia  in  solution,  varying  from  7.5  to  80  grains,  into  the  external 
jugular  vein  of  dogs,  he  found  the  force  of  the  heart's  contractions,  as  measured  by 
the  haemadynameter  of  Poiseuille,  to  be  diminished  in  proportion  to  the  quantity 
used,  very  slightly  by  the  first  quantity,  and  very  greatly  by  the  lust,  which  caused 
the  speedy  death  of  the  animal  by  syncope.  In  other  experiments,  in  which  similar 
solutions  were  made  to  enter  directly  the  cerebral  vessels,  the  brain  was  excited, 
and  the  force  of  the  heart's  pulsation  considerably  increased.  (Traile  Therap.  du 
Quinquina.)  The  inference  from  these  results  is  that  quinia  is  directly  stimulant  to 
the  brain,  and,  through  it,  is  capable  of  exciting  the  heart;  while,  introduced  into 
the  hestt  it.self,  it  has  a  tendency  to  paralyze  that  organ.  A  great  objection  to 
these  experiments,  so  far  as  the  heart  is  concerned,  is  that,  in  order  to  produce  the 
least  depressing  effect  on  that  organ,  the  quantity  of  sulphate  of  quinia,  introduced 
into  the  jugular  vein,  must  produce  a  much  stronger  impregnation  of  the  blood 
reaching  the  heart,  than  can  be  produced  by  any  amount  of  the  medicine  swallowed, 
which  is  eliminated  by  the  kidneys  almost  as  fast  as  it  is  absorbed.  The  inference 
is,  that  no  direct  observable  depression  of  the  heart  would  follow  the  internal  ad- 
ministration of  quinia.  But,  even  though  we  should  admit  the  entire  accuracy  and 
relevancy  of  these  experiments,  they  do  not  invalidate1  the  force  of  the  argument  in 
the  text,  in  relation  to  the  use  of  quinia  as  a  sedative.  Whether  the  depression  in 
the  actions  of  the  heart,  produced  by  large  doses,  depends  wholly  upon  the  secondary 
depression  of  the  brain,  as  supposed  in  the  text,  or  partly  upon  that,  and  partly 
upon  the  direct  action  of  the  quinia  on  the  heart,  in  either  case  the  danger  of  an 
over-excitement  of  the  brain,  which  the  same  experiments  show  to  result  from  the 
medicine,  must  be  encountered,  whenever  the  sedative  effect  on  the  circulation  is 
resorted  to  as  a  therapeutic  agency. 


CHAP.  I.]  TONICS. — PERUVIAN    BARK.  243 

any  supposed  similarity  or  identity  between  them  can  have  a  bearing 
on  the  svstemic  influence  of  the  cinchona  alkaloid. 


5.  Injurious  Effects  and  their  Treatment. 

In  ordinary  doses,  quinia  is  not  apt  to  produce  deleterious  effects,  un- 
less through  want  of  appropriateness  to  the  pathological  condition  in 
which  it  may  be  prescribed;  but,  when  very  largely  administered,  it 
sometimes  causes  unpleasant  symptoms  from  congestion  or  over-excite- 
ment of  the  brain,  among  which  a  greater  or  less  degree  of  deafness  is 
the  most  common.  Generally  this  deafness  subsides,  with  the  other  phe- 
nomena, in  a  period  of  time  varying  from  a  few  hours  to  two  or  three 
days ;  but  sometimes  it  persists  much  longer,  at  length  gradually  yield- 
ing; and,  in  very  rare  instances,  has  proved  permanent  and  incurable. 
Cases  are  on  record  in  which  death  has  occurred  from  inflammation  of 
the  brain,  under  the  excessive  use  of  quinia ;  though  there  is  reason  to 
believe  that  there  may  have  been,  in  these  cases,  either  a  strong  predis- 
position requiring  only  a  special  cause  to  call  it  into  action,  or  a  certain 
amount  of  pre-existing  inflammation,  which  was  easily  aggravated  into 
fatal  violence.  Still,  experiments  upon  animals  have  shown  that,  even 
in  healthy  conditions  of  the  brain,  encephalitis  may  possibly  result  from 
the  abuse  of  this  medicine.  In  all  cases  of  over-excitement  of  the  brain, 
the  obvious  remedies  are  leeching  or  cupping  behind  the  ears,  cold 
water  to  the  head,  a  saline  purgative  not  only  to  deplete  and  act  revul- 
sively,  but  to  carry  off  any  unabsorbed  portion  of  the  alkaloid,  and,  lastly, 
bleeding  from  the  arm,  if  the  symptoms  should  be  urgent,  and  the  pulse 
permit. 

The  irritation  occasionally  produced  by  quinia  in  the  urinary  passages, 
during  its  elimination,  is  said,  in  some  instances  where  large  doses  have 
been  taken,  to  have  been  aggravated  into  cystitis;  and  even  ret^fcon  of 
urine  is  asserted  to  have  been  produced  by  it. 

Another  danger  from  quinia  is  the  great  secondary  prostration  from 
enormous  doses,  which,  in  persons  already  feeble,  may  possibly  in  sonic 
instances  prove  fatal.*  Experience  has  shown  that,  under  such  circum- 
stances, stimulants  are  not  only  safe,  but  useful.  Carbonate  of  ammo- 
nia I  should  prefer  to  the  alcoholic  stimulants,  as  it  excites  the  heart, 
with  k-ss  effect  on  the  brain;  but,  if  this  fail,  recourse  may  be  had  to 

*  It  is  strange,  however,  considering  the  powerful  effects  often  produced  by  com- 
paratively moderate  doses,  how  far  the  quantity  may  be  increased  without  fatal 
results.  The  case  of  Giacommini  has  already  been  referred  to  (see/jojre  235).  An- 
other is  mentioned  by  Briquet,  in  which  41  grammes  (about  ten  drachms  and  a 
half)  were  taken  in  the  course  of  a  few  days.  The  patient  lost  for  a  time  sight, 
hearing,  and  speech,  and  became  as  cold  as  a  corpse,  but  nevertheless  recovered. 
(Trait.  Tltcrap.  du  Quinquina,  p.  490.) 


•241  GENERAL   STIMULANTS.  [p ART  IT. 

wine  or  other  fermented  liquor,  and  even  to  brandy,  should  the  prostra- 
tion be  alarming.  If  much  nervous  disturbance,  as  tremulousness,  con- 
vulsions, or  delirium,  attend  the  prostration,  one  of  the  salts  of  morphia 
may  be  employed.  Giacommini  found  coffee  useful  in  cases  of  cinchonic 
syncope  which  came  under  his  notice.  In  all  cases  in  which  the  salts 
of  the  cinchona  alkaloids  hdve  been  given  too  largely,  tanuic  acid  or  an 
astringent  infusion  should  be  administered  internally;  for,  though  the 
tannate  is  not  without  effect  on  the  system,  it  is  certainly  less  rapidly 
absorbed  than  the  soluble  salts. 

6.  Therapeutic  Application. 

It  is  an  undecided  question,  whether  Peruvian  bark  was  known  as  a 
medicine  to  the  aborigines  of  S.  America,  before  the  discovery  of  the 
country  by  Europeans.  Both  sides  of  the  question  have  the  support  of 
high  authority;  the  affirmative  being  maintained  by  Ruiz  and  Joseph  de 
.Jussieu,  and  the  negative  by  Humboldt.  Leaving  aside  some  absurd 
stories  in  reference  to  the  manner  in  which  the  remedy  was  discovered 
by  the  natives,  and  the  mysterious  secrecy  said  to  have  been  observed 
by  them  in  relation  to  it,  the  weight  of  probability  appears  to  me  to  be 
in  favour  of  its  indigenous  employment,  long  before  the  invasion  of  the 
Spaniards.  The  traditions  in  the  country  were  to  this  effect;  and  it 
M-urcely  seAis  probable  that  a  people,  so  civilized  as  the  ancient  Peru- 
vians, should  have  overlooked  a  remedy  so  abundant,  so  easy  of  access, 
and  so  vitally  important  in  the  treatment  of  the  fevers  which  must  have 
prevailed  among  them.  That  among  the  ignorant  and  degenerate  na- 
tives, at  the  time  of  the  visit  of  Humboldt,  violent  prejudices  should  have 
•ed  against  the  bark,  and  an  idea  been  entertained  that  it  was  pois- 
onous instead  of  remedial,  can  hardly  be  admitted  as  an  argument 
against  this  view  of  the  subject;  as  a  similar  prejudice  may  be  found 
among  the  vulgar,  even  in  the  most  enlightened  countries,  where  the 
ivmedy  is  much  employed,  and  highly  valued  by  the  intelligent. 

Peruvian  bark,  either  of  itself,  or  in  some  one  of  its  preparations,  is 
calculated  to  meet  several  distinct  therapeutic  indications ;  1.  as  a  simple 
tonic,  2  as  an  antiperiodic  or  anti-intermittent,  3.  as  a  supersedent,  and 
4.  in  reference  to  its  secondary  sedative  properties.  Of  these  I  shall 
treat  severally,  premising  that  not  unfrequently  two  or  more  of  these 
indications  are  presented  conjointly  in  the  same  disease. 

1.  As  A  SIMPLE  TONIC.  For  this  purpose,  the  medicine  is  employed 
in  small  doses,  repeated  several  times  a  day.  Difference  of  opinion  exists 
as  to  the  preferable  form  of  administration.  Some  suppose  that  the  tonic 
property  resides  mainly,  if  not  exclusively,  in  the  alkaloids ;  others,  that 
it  belongs  essentially  to  other  principles  in  the  bark,  the  alkaloids  having 
little  or  none  of  it;  while  a  third  opinion,  admitting  its  existence  in  quinia, 


CHAP.  I.]  TONICS. — PERUVIAN  BARK.  245 

cinchonia,  etc.,  maintains  that  the  colouring  matters,  tannic  acid,  etc., 
associated  with  them  in  the  bark,  so  modify  their  influence  as  to  render 
the  conjoint  operation  of  all  considerably  more  effective  than  that  of  the 
alkaloids  alone.  My  own  conviction,  derived  from  no  little  experience 
with  the  different  forms  of  preparation  of  Peruvian  bark,  is,  that  its 
medicinal  powers  reside  almost  exclusively  in  the  alkaloids,  and,  though 
the  form  of  combination  in  which  these  naturally  exist  may  somewhat 
modify  their  effects,  by  influencing  their  acceptability  to  the  stomach,  or 
the  facility  of  their  absorption  or  elimination,  yet  that  the  bark  itself, 
wholly  deprived  of  them,  would  be  nearly  if  not  quite  medicinally  inert 
and  useless.  The  general  experience  too  corresponds,  I  suspect,  with 
my  own;  as  quinia  and  its  associated  alkaloids  have  to  a  considerable 
extent  superseded,  even  in  reference  to  tonic  effects,  the  use  of  bark,  and 
of  the  various  preparations  most  completely  representing  it. 

The  medicine  may  be  used  in  simple  debility  of  the  digestive  organs, 
or  dyspepsia.  Bark,  in  substance,  is  too  apt  to  nauseate  and  oppress 
the  stomach  to  be  employed  advantageously  for  this  purpose;  but  re- 
course may  be  had  to  the  extract,  or  one  of  the  liquid,  preparations, 
especially  the  compound  infusion  of  the  U.  S.  Pharmacopoeia,  which,  in 
great  debility  of  the  stomach  or  system,  may  sometimes  be  usefully 
combined  with  the  simple  or  compound  tincture.  Sulphate  of  quinia, 
however,  is,  upon  the  whole,  the  most  convenient  preparation.  Still, 
it  is  in  no  respect  superior,  in  this  affection,  to  the  simple  bitters ;  while 
it  is  more  apt  to  oppress  the  stomach,  and  is,  therefore,  comparatively 
little  used. 

In  general  debility,  however,  it  stands  at  the  very  head  of  the  tonics. 
It  probably  owes  its  superiority,  in  this  condition,  over  the  simple  bit- 
ters, to  the  greater  universality  of  its  action.  The  latter  medicines, 
though  stimulant  to  the  digestive,  blood-making,  and  nutritive  functions, 
have  little  influence  over  the  nervous  centres.  Quinia  acts  energetically 
upon  those  centres,  and  extends,  through  them,  independently  of  its 
direct  influence  upon  the  tissues,  a  powerful  support  to  the  weakened 
organic  functions. 

In  the  debility  of  convalescence  it  acts  very  favourably.  In  pure 
anaemia,  when  the  morbid  condition  exists  specially  in  the  blood,  with- 
out obvious  deficiency  in  the  digestive  or  nutritive  powers,  or  in  nervous 
excitability,  as  often  happens  in  chlorosis,  quinia  does  little  good;  the 
appropriate  tonic  in  such  cases  being  iron.  But,  in  that  debility  of  all 
the  functions  which  is  apt  to  follow  the  agitations  of  acute  febrile  and 
inflammatory  diseases,  and  from  which  it  often  happens  that  the  un- 
aided system  rises  slowly  and  with  difficulty,  no  medicine  is  probably 
more  efficient;  and,  if  along  with  this  condition  there  is  a  relative  defi- 
ciency of  the  red  corpuscles,  it  adds  greatly  to  the  effectiveness  of  the 
chalybeates. 


246  GENERAL    STIMULANTS.  [PART  II. 

When  debility  is  associated  with  any  organic  mischief,  as  in  the  ulcer- 
ative  condition  left  by  inflammation  and  gangrene,  the  system  is  some- 
times so  prostrated  as  to  be  unable  to  carry  on  the  reparative  process, 
and  ultimately  sinks  unless  sustained.  The  tendencies  are  towards 
health,  but  the  power  to  act  duly  is  wanting.  Under  these  circum- 
stances, the  preparations  of  Peruvian  bark,  in  connection  with  a  nu- 
tritious diet,  are  highly  important. 

When  debility  is  produced  or  maintained  by  temporary  exhausting 
influences,  as  by  profuse  suppuration,  excessive  secretion,  or  passive 
hemorrhage,  it  is  often  of  the  utmost  importance  to  support  the  strength 
until  the  discharge  has  ceased;  and  a  strong  indication  is  offered,  in 
such  cases,  for  quinia  or  bark  in  some  other  shape,  which  may  often  be 
advantageously  combined  with  opiates  and  alcoholic  stimulants,  espe- 
cially the  fermented  liquors.  Examples  of  this  kind,  dependent  on  pro- 
fuse suppuration,  we  have  in  the  advanced  stages  of  extensive  inflam- 
mation of  the  ordinary  character,  whether  of  the  internal  organs  or 
external  parts;  in  scrofulous  abscesses;  in  erysipelas  affecting  the 
subcutaneous  tissue ;  in  metastatic  abscess,  purulent  infection,  pyogenic 
fever,  or  suppurative  phlebitis;  and  in  the  last  stage  of  confluent 
smallpox,  in  which  large  portions  of  the  surface  are  bathed  in  pus,  and 
subcutaneous  purulent  deposits  sometimes  form  in  enormous  quantity. 

Of  exhaustion  from  excessive  secretion  we  have  examples  in  the 
effects  of  colliqualive  sweats,  diuresis,  and  diarrhoea,  and  of  copious 
mucous  discharges  from  the  bronchial  tubes  and  urinary  passages.  In 
these  cases,  quinia  sometimes  acts  happily,  not  only  by  sustaining  the 
system  under  the  exhaustion,  but  by  correcting  the  excessive  discharge, 
which  itself  not  unfrequently  depends  on  a  pre-existing  debility  and  re- 
laxation. But  astringents  are  generally  still  more  useful  here  than 
quinia,  which  may  often  be  advantageously  associated  with  them ;  and 
it  is  probable  that  the  infusion,  decoction,  tincture,  or  extract  of  bark 
may  be  more  useful  than  the  alkaloids,  in  consequence  of  the  tannic 
acid  they  may  contain. 

The  same  remark  is  applicable  to  passive  hemorrhages,  which  at  once 
depend  upon  and  increase  debility,  and  in  which  the  conjunction  of 
astringents  with  the  preparations  of  bark  is  often  indicated. 

Another  condition  of  debility,  in  which  this  medicine  is  highly  service- 
able, is  that  produced  and  kept  up  by  some  directly  depressing  agency, 
independently  of  any  exhausting  discharge.  Such  arc  all  those  condi- 
tions of  the  system  in  which  extensive  gangrene  1ms  taken  place,  or 
even  a  small  degree  of  it,  if  in  one  of  the  internal  and  vital  organ.-. 
How  it  is  that  the  connection  of  a  mortified  part  with  living  tissue 
should  produce  general  prostration  is  not  always  very  evident:  but  such 
is  certainly  the  case,  even  where  there  has  been  no  preceding  debility. 
When  the  debility  gradually  ensues,  and  is  attended  with  typhoid  symp- 


CHAP.  I.]  TONICS. — PERUVIAN    BARK.  247 

toms,  there  has  probably  been  absorption  of  the  deleterious  matters 
resulting  from  putrefaction,  and  a  consequent  contamination  of  the  blood. 
But  frequently  the  result  is  too  sudden  to  admit  of  this  explanation.  A 
part  dies;  and  almost  instantaneously  the  pulse  becomes  feeble,  the  skin 
cold,  the  countenance  pale,  shrunken,  and  ghastly;  arid,  though  reaction 
to  a  certain  extent  may  take  place,  yet  the  energies  of  the  system  are 
still  depressed,  and  continue  so  more  or  less  until  the  offending  cause  is 
removed.  Possibly  a  depressing  effect  from  the  dead  matter  upon  the 
adjoining  nerves  may  be  reflected  to  the  system,  through  the  nervous 
centres,  in  the  same  manner  as  local  irritation.  But,  however  produced, 
the  debility  exists,  and  often  requires  the  interference  of  tonics  and  other 
stimulants  to  support  life,  and  give  the  parts  power  to  throw  off  the 
offending  cause.  Certainly,  among  the  tonics  there  is  none  so  efficient 
for  this  purpose  as  cinchona.  So  beneficial  is  it,  that  an  idea  formerly 
prevailed  that  it  possessed  a  positive  and  peculiar  property  of  checking 
or  obviating  mortification  and  putrescency.  At  present,  however,  this 
idea  is  not  admitted.  All  that  the  bark  can  do  is  to  sustain  the  failing 
energies ;  and  this  it  is  perhaps  better  able  to  do  than  others,  because  of 
its  stimulating  influence  on  those  very  nervous  centres  through  which 
the  depressing  impression  is  propagated. 

In  the  gangrenous  cases  in  which  a  pre-existing  condition  of  system, 
or  depraved  state  of  the  blood,  has  caused  the  mortification,  there  is  a 
double  indication  for  the  tonic.  Hence,  the  preparations  of  bark  have 
always  been  among  the  most  approved  remedies  in  anthrax,  gangrsena 
oris,  malignant  sore-throat  with  or  without  scarlet  fever,  and  erysipelas 
with  sloughing  of  the  subcutaneous  tissue. 

Another  large  list  of  diseases,  in  which  debility,  depending  on  a  direct 
sedative  influence,  indicates  the  use  of  bark  until  the  depressing  cause 
shall  cease  to  act,  are  the  typhoid  affections.  In  these,  either  the  mor- 
bific cause  itself,  or  the  depraved  state  of  the  blood  resulting  from  it,  acts 
with  a  special  influence  on  the  brain,  producing  dulness,  stupor,  low  de- 
lirium, and  other  evidences  of  cerebral  debility.  Cinchona,  therefore,  is 
specially  called  for,  both  for  its  excitant  action  on  the  nervous  centres, 
and  the  rapidity  with  which  it  acts.  Typhus  fever,  the  advanced  stages 
of  typhoid  or  enteric  fever,  petechial  or  spotted  fever,  scarlatina  par- 
ticularly of  the  anginose  and  malignant  varieties,  malignant  smallpox 
and  erysipelas,  and  even  the  phlegmasite  when  they  assume  the  typhoid 
condition,  as  typhoid  pneumonia  and  dysentery,  are  often  usefully 
treated  with  this  pervading  and  powerful  tonic.  Though  of  itself  insuf- 
ficient to  support  life  in  many  of  these  cases,  and  therefore  requiring  the 
aid  of  more  potent  stimulants,  as  carbonate  of  ammonia,  opium,  and  the 
alcoholic  liquids,  it  gives  a  durability7  of  impression,  and  power  of  resist- 
ance, not  equally  obtainable  from  these  agents,  and,  therefore,  cannot  be 
fully  replaced  by  any  one  or  all  of  them. 


248  GENERAL    STIMULANTS.  [PART  II. 

In  protracted  diseases,  particularly  those  of  a  febrile  character, 
though  perhaps  stbenic  in  the  beginning,  the  vital  forces  are  gradually 
impaired  by  their  over-exercise,  and  a  state  of  debility  ensues  requiring 
tonic  treatment.  Here  too  the  preparations  of  bark  are  the  most  efficient. 
It  is  highly  important  to  know  when  exactly  the  period  for  this  treat- 
ment has  arrived ;  for,  if  prematurely  employed,  it  may  injuriously  ag- 
gravate the  excitement.  I  have  noticed  that  the  occurrence  of  night- 
sweats,  under  these  circumstances,  offers  one  of  the  best  criteria  of  the 
new  condition.  When  a  patient  with  a  febrile  disease,  not  having  been 
especially  affected  with  diaphoresis,  begins  to  sweat  profusely  whenever 
he  sleeps,  and  only  then,  I  consider  the  symptom  as  an  almost  sure  sign 
of  debility;  and  quinia,  though  previously  contraindicated,  may  now  be 
used  with  safety  and  advantage.  This  condition  is  quite  different  from 
the  typhoid.  In  both  there  is  debility ;  but  in  the  latter,  it  is  connected 
essentially  with  depravation  of  the  blood ;  in  the  former,  it  is  merely  the 
result  of  an  over-exercise  and  consequent  exhaustion  of  the  vital  forces, 
and  the  blood  is  no  otherwise  diseased  than  as  it  may  be  deficient  in 
quantity,  either  considered  generally,  or  in  relation  to  the  red  coqjuscles. 
My  attention  has  been  particularly  directed  to  the  condition  as  it  occurs 
in  acute  rheumatism,  in  which  it  is  not  very  uncommon,  though  the 
disease  may  still  be  associated  with  considerable  pain  and  swelling  in 
the  joints.  Whenever  night-sweats  take  place  in  that  disease,  I  invaria- 
bly employ  quinia,  and  almost  uniformly  with  favourable  effects,  not 
only  checking  the  excessive  sweating,  but  very  much  ameliorating  if  not 
promptly  curing  the  rheumatism  itself.  I  have  been  long  in  the  habit 
of  employing  and  recommending  this  practice;  for  many  years,  indeed, 
before  the  recent  revival  of  an  old  method  of  treating  acute  rheumatism 
by  Peruvian  bark. 

Various  derangements  of  health  which  have  been  classed  together 
under  the  designation  of  cachectic,  the  only  common  characters  of  which 
are  chronic  debility,  and  a  not  well  understood  depravity  of  system,  in 
which  the  blood  is  probably  always  involved,  such  as  syphilis  in  its  ad- 
vanced stages,  scrofula,  and  various  obstinate  cutaneous  eruptions,  in- 
cluding ecthyma,  rupia,  and  impetigo,  are  not  (infrequently  benefited  by 
quinia,  in  conjunction  with  certain  alterative  remedies,  as  iodine,  mercury, 
and  arsenic. 

Under  this  head  may  perhaps  also  be  ranked  the  use  of  quinia  in 
enlarged  spleen,  especially  when  following  miasmatic  fevers,  or  occur- 
ring in  malarious  regions.  Some  ascribe  the  efficacy  of  the  medicine,  in 
these  cases,  to  a  property  which  they  suppose  it  to  possess  of  directly 
contracting  the  spleen.  But  quite  as  probably  it  is  ascribable  to  an 
alteration,  under  the  tonic  influence  of  the  remedy,  of  that  condition  of 
system,  and  especially  perhaps  of  the  blood,  which  originated  and  sus- 
tains the  affection.  In  many  instances  of  enlarged  spleen  of  a  different 


CHAP.  I.]  TONICS. — PERUVIAN   BARK.  249 

origin,  even  when  there  is  no  reason  to  suspect  cancer,  tubercle,  or  other 
incurable  heterologous  formation,  quinia  proves,  as  I  have  often  wit- 
nessed, wholly  inoperative. 

2.  As  AN  ANTIPEIUODIC,  or  ANTI-INTERMITTENT.  No  remedy  ap- 
proaches Peruvian  bark  in  antiperiodic  powers.  There  is  scarcely  a 
doubt  that,  for  its  peculiar  properties  in  this  respect,  it  is  indebted  ex- 
clusively to  its  alkaloid  constituents,  and  that  everything  which  bark 
can  do,  can  be  effected  by  quinia.  Indeed,  in  consequence  of  being  less 
offensive  to  the  stomach,  the  latter  is  the  more  effective  of  the  two,  where 
a  strong  impression  is  necessary,  or  when  the  affection  is  complicated 
with  gastric  irritability.  In  all  regularly  intermittent  or  periodic  dis- 
eases, quinia  may  be  considered  as  an  almost  certain  remedy ;  at  least  I 
do  not  remember  to  have  met  with  a  case  which  has  not  yielded  to  it, 
since  the  management  of  this  medicine  has  been  well  understood.  But 
it  is  not  all  diseases  occurring  paroxysm  ally  that  belong  to  the  category 
here  referred  to.  To  come  under  the  head  of  regular  intermittent  dis- 
eases, the  affection  must  occur  about  the  same  hour,  at  the  interval  of  a 
certain  number  of  days,  one,  two,  or  more,  without  any  positive  or  re- 
cognizable disease,  in  the  period  between  the  paroxysms,  by  which  they 
can  be  reproduced.  In  other  words,  the  complaint  must  be  at  once 
idiopathic,  and  regularly  periodic.  Hectic  fever,  therefore,  though  it  has 
paroxysms  closely  resembling  those  of  intermittent  fever,  does  not  belong 
to  the  class  referred  to ;  because  it  depends  upon  an  ever-present  organic 
source  of  irritation,  and  its  paroxysms  are  irregular  in  their  recurrence. 
Epilepsy  and  hysteria  are  equally  excluded,  though  both  paroxysmal, 
because  often  dependent  on  a  constant  though  perhaps  concealed  lesion, 
and  almost  always  more  or  less  irregular.  But  even  these  affections,  or 
imitations  of  them,  when  purely  functional,  and  occurring  at  regular 
periods  of  one  or  a  few  days,  will  yield  for  a  time  to  the  antiperiodic 
treatment.  Indeed  this  treatment  is,  in  its  nature,  essentially  temporary; 
its  only  effect  being  to  guard  the  system  against  the  recurring  paroxysms, 
not  to  secure  future  immunity,  when  its  direct  influence  has  ceased.  If, 
therefore,  there  should  be  some  cause  in  operation  capable  of  inducing  a 
paroxysm  of  the  disease,  the  patient  is  still  liable  to  an  attack  after  ap- 
parent cure,  supposing  the  direct  influence  of  the  remedy  to  have  been 
withdrawn.  Hence,  even  in  ordinary  intermittent  fevers,  it  very  fre- 
quently happens  that  the  paroxysms  recur,  at  a  somewhat  varying 
period,  after  the  suspension  of  the  antiperiodic  treatment.  All  that  we 
can  accomplish,  then,  by  this  treatment,  is  to  prevent  the  recurring 
paroxysms  so  long  as  the  remedy  acts.  If,  in  the  mean  time,  the  cause 
cease  to  operate,  or  the  susceptibility  to  its  influence  no  longer  exist, 
when  the  chain  of  morbid  association,  or  the  force  of  habit  is  broken,  a 
permanent  cure  is  effected;  if  not,  the  disease  is  liable  to  return,  and 
may  continue  to  do  so  until  the  cause  is  at  length  removed,  or  the  sys- 


250  GENERAL    STIMULANTS.  [PART  II. 

tern  becomes  insensible  to  its  influence,  as  it  does  in  time  to  noxious 
agencies  in  general,  when  not  fatal  in  their  effects,  or  applied  in  increased 
quantity  or  force. 

Intermittent  fever  is  a  disease  in  which  quinia  exhibits,  probably,  its 
most  extraordinary  powers.  Before  the  discovery  of  Peruvian  bark, 
some  of  the  forms  of  this  affection  were  extremely  embarrassing  to  phy- 
sicians, and  an  obstinate  quartan  was  scarcely  less  dreaded  than  pul- 
monary consumption.  Afterwards  it  was  found  in  general  to  be  very 
manageable  under  the  new  remedy ;  but  cases  were  now  and  then  met 
with  which  resisted  its  influence,  in  consequence  sometimes  of  insur- 
mountable obstacles  to  its  administration  in  the  ordinary  quantity,  or  to 
its  retention  when  administered,  and  sometimes  of  the  impossibility  of 
introducing  into  the  system  a  quantity  large  enough  to  meet  the  requi- 
sitions of  the  case.  But,  since  the  introduction  of  quinia  into  use,  the 
disease  may  be  considered  as  completely  under  command,  so  far  at  least 
as  regards  any  single  attack.  The  only  requisitions  are,  that  the  remedy 
be  administered  iu  sufficient  quantity,  and  at  the  proper  time.  If  upon 
trial  a  certain  amount  is  not  found  to  answer,  it  must  be  increased;  and 
no  limitation  should  be  put  to  this  increase,  except  the  production  of  the 
desired  effect,  or  a  reasonable  apprehension  of  serious  mischief  to  the 
patient.  The  general  rule  is  to  give  enough  to  affect  the  cerebral  centres 
decidedly,  as  indicated  by  the  buzzing  or  roaring  in  the  ears,  or  by  a 
greater  or  less  degree  of  deafness. 

The  question  at  once  presents  itself,  whether  any  previous  preparation 
is  necessary,  and,  if  any,  what?  Formerly,  it  was  customary  to  antici- 
pate the  antiperiodic  by  an  emetic.  Experience  has  shown  this  to  be 
unnecessary  in  the  vast  majority  of  instances.  Should,  however,  the 
attack  surprise  the  system  with  the  stomach  loaded,  and  evidences  of 
gastric  irritation  at  the  same  time  exist,  it  might  be  advisable  to  aid  na- 
ture in  getting  rid  of  the  offending  matter,  by  means  of  warm  water,  or 
warm  chamomile  tea  drank  freely,  or  if  necessary  by  a  dose  of  ipecac- 
uanha. Ordinarily  the  only  preliminary  measure  desirable  is  the  evacu- 
ation of  the  bowels.  In  urgent  cases,  where  it  is  important  to  produce 
the  antiperiodic  impression  as  soon  as  possible,  even  this  may  be  dis- 
pensed with,  and  the  administration  of  the  quinia  commenced  at  once. 
I  think,  however,  that  it  is  generally  best  to  begin  with  a  cathartic,  in 
order  to  remove  any  possibly  offending  matter  from  the  bowels,  and 
unload  the  portal  circulation,  and  thus  promote  the  absorption  of  the 
medicine.  If  the  liver  is  torpid,  a  portion  of  calomel  or  blue  mass  should 
be  given  with  the  cathartic. 

Another  question  to  be  decided  is,  how  far  the  treatment  is  to  be  in- 
fluenced by  any  existing  complication  of  the  intermittent  fever.  Some 
have  supposed  that  a  coexisting  inflammation  contraindicates  the  use  of 
quinia,  and  that  the  inflammation  should  be  subdued  before  commencing 


CHAP.  I.]  TONICS. — PERUVIAN  BARK.  251 

with  the  administration  of  that  medicine.  I  have  long  been  of  a  con- 
trary opinion.  If  the  inflammation  is  insufficient  to  sustain  a  febrile 
excitement  between  the  paroxysms,  that  is,  to  convert  the  intermittent 
into  a  remittent,  iU'is  either  periodical  itself,  and  obeys  the  laws  of  peri- 
odical diseases  in  general,  or  is  insufficient  to  be  materially  aggravated 
by  the  stimulant  properties  of  sulphate  of  quinia.  Indeed,  the  general 
stimulation  of  the  paroxysm  is  vastly  greater  than  that  of  the  medicine, 
and  consequently  much  more  likely  to  aggravate  the  inflammation.  It 
would  seem  clear,  therefore,  that  by  interrupting  the  paroxysms  we  must, 
instead  of  aggravating,  really  relieve  the  inflammation,  by  removing  the 
most  powerful  source  of  excitement,  If  theory  justifies  the  use  of  the 
antiperiodic  under  these  circumstances,  experience  is  no  less  decidedly 
in  its  favour.  I  have  never  known  the  inflammation,  attendant  on  a 
perfect  intermittent,  to  be  increased  by  the  use  of  quinia;  I  have  not 
known  it  to  prevent  the  antiperiodic  medicine  from  having  its  due  effect; 
while  I  have  observed  that  the  inflammation  is  mitigated,  and  indeed 
often  ceases,  almost  immediately  upon  the  interruption  of  the  paroxysms; 
and  I  believe  that  my  experience,  upon  these  points,  coincides  with  that 
of  the  great  majority  of  practitioners  in  the  miasmatic  districts  of  the 
United  States.  I  am,  indeed,  prepared  to  go  further,  and  to  state  that 
the  same  thing  is  true,  in  a  great  degree,  even  when  the  inflammation  is 
sufficient  to  maintain  some  fever  between  the  paroxysms ;  but,  in  such 
cases,  I  should  premise  blood-letting,  general  or  topical,  or  both,  when 
apparently  called  for  by  the  severity  of  the  local  disease,  and  permitted 
by  the  state  of  the  pulse.  The  same  reasoning  applies  here  as  in  the 
former  case ;  the  stimulation  of  the  paroxysm  is  vastly  greater  than  that 
of  the  medicine ;  and  experience  equally  confirms  its  justness  by  the  result. 
There  are  only  two  instances,  in  which  I  would  admit  of  an  exception 
to  the  general  rule ;  namely,  when  the  cerebral  centres,  which  are  espe- 
cially susceptible  to  the  stimulant  influence  of  quinia,  and  the  mucous 
membrane  of  the  stomach,  which  is  liable  to  be  irritated  by  it,  are  the 
seat  of  the  inflammation;  and,  in  the  latter  case,  though  I  might  not 
administer  the  medicine  by  the  stomach,  I  should  not  hesitate  to  give  it 
freely  by  the  rectum  or  hypodermically.  If  inflammatory  complication 
offer  no  contraindication  to  the  use  of  quinia  in  intermittent  fever,  I 
know  of  no  other  impediment,  unless  it  may  be  active  cerebral  conges- 
tion, which  should  if  possible  be  removed,  prior  to  its  employment. 

Much  has  been  said  of  the  proper  period  for  the  administration  of 
quinia.  Some  give  it  indiscriminately  at  all  periods  of  the  disease, 
without  reference  to  pyrexia  or  apyrexia;  but  the  great  majority  confine 
its  employment  to  the  intermission,  and,  as  I  tm'nk,  correctly,  unless  in 
certain  cases  of  pernicious  fever,  where  it  is  of  the  utmost  importance 
that  the  approaching  paroxysm  should  be  prevented,  and  there  is  reason 
to  apprehend  that  the  intermission  may  be  too  short  for  the  purpose.  In 


252  GENERAL   STIMULANTS.  [PART  II. 

the  first  place,  there  is  no  necessity  for  giving  the  quinia  during  the 
paroxysm  ;  and,  secondly,  though  it  may  often  be  given  with  impunity, 
yet  there  is  always  some  risk  of  aggravating  into  positive  inflammation 
any  pre-existing  tendency  to  it  in  the  brain  or  the  stomach,  or  of  causing 
effusion  of  blood  in  cases  of  active  cerebral  congestion.  In  the  true  per- 
nicious variety,  in  which  the  great  danger  arises  from  defective  or  per- 
verted innervation  of  the  vital  organs,  and  there  is  little  tendency  to 
active  congestion  or  inflammation,  the  risk  from  quinia  in  the  paroxysm 
can  scarcely  be  said  to  exist,  while  the  loss  of  time  in  withholding  it  may 
be  fatal.  There  is  one  caution,  however,  which  should  be  observed  in 
the  use  of  quinia  during  the  pernicious  paroxysm  ;  namely,  never  to  give 
it  so  largely,  in  the  cold  stage,  as  to  induce  its  secondary  sedative  effect, 
and  thus  add  to  the  prostration,  which  is  often  itself  very  alarming,  and 
not  unfrequently  fatal.  Admitting  then  that,  as  a  general  rule,  the  medi- 
cine should  be  given  only  in  the  intermission,  we  have  still  to  determine 
at  what  time,  during  this  period,  we  are  to  begin  with  it,  and  when  to 
suspend  it.  Without  referring  particularly  to  the  various  shades  of 
opinion  among  authors  on  this  point,  I  will  merely  state  my  own,  based 
upon  what  is  known  of  the  action  of  quinia,  and  upon  personal  observa- 
tion, that  the  best  plan  is  to  commence  immediately  after  the  cessation 
of  the  paroxysm,  and  to  continue,  with  repeated  doses,  until  within  about 
an  hour  of  its  expected  recurrence,  so  that,  at  the  time  referred  to,  the 
system  may  be  under  the  full  influence  of  the  medicine. 

I  prefer  the  exhibition  of  the  sulphate  of  quinia  in  small  doses,  repeated 
at  intervals  of  an  hour  or  two,  to  the  use  of  the  full  quantity,  required 
for  a  single  intermission,  in  one  or  a  very  few  doses.  We  thus  incur 
less  risk  of  irritating  the  stomach,  or  over-exciting  the  brain,  while  we 
have  it  in  our  power  to  modify  the  dose,  if  the  effects  should  be  unex- 
pectedly and  unnecessarily  severe.  The  absorption  is  probably  also 
more  complete,  and  the  whole  amount  necessary  for  the  required  effect 
diminished.  But  there  are  circumstances  which  justify,  and  even  demand 
a  departure  from  the  general  rule ;  as  when  the  intermission  is  very  short, 
or  when  it  occurs  at  night,  so  that  a  frequent  administration  might  inter- 
rupt sleep,  and  in  this  way  injure  the  patient.  In  such  cases,  the  whole 
quantity  may  be  given  in  one,  two,  or  three  doses ;  care  being  taken  to 
throw  the  medicine  mainly  into  the  earlier  period  of  the  apyrexia;  as, 
if  withheld  until  immediately  before  the  paroxysm,  time  is  not  allowed 
for  its  absorption  and  full  operation,  while,  even  if  confined  entirely  to 
the  earlier  period,  as  its  action  continues  for  many  hours,  this  may  be  in 
full  force  at  the  time  required. 

Used  in  the  method  above  pointed  out,  sulphate  of  quinia  is  capable 
of  interrupting  almost  any  case  of  intermittent  fever,  from  the  mildest  to 
the  most  violent.  But  different  quantities  are  required  in  different  varie- 
ties of  the  disease.  The  purely  irritative  intermittent,  occurring  inde- 


CHAP.  T.]  TONICS. — PERUVIAN    BARK.  253 

pondcntly  of  miasmatic  influence,  and  sometimes  ceasing  spontaneously 
after  a  few  paroxysms,  may  usually  be  checked  by  from  six  to  twelve 
grains,  given  in  each  intermission.  The  ordinary  miasmatic  intermittent, 
though  it  will  sometimes  yield  to  the  same  quantity,  is  much  more  effec- 
tively treated  with  from  twelve  to  twenty-four  grains  in  the  same  time. 
The  pernicious  form  of  the  same  affection  cannot  be  trusted  to  less  than 
from  twenty  to  sixty  grains.  The  great  rule,  in  the  administration  of 
the  medicine,  is  to  give  enough  to  produce  an  obvious  impression  on  the 
brain,  and  to  maintain  that  impression  until  every  vestige  of  a  paroxysm 
shall  have  ceased.  In  many  instances,  the  disease  is  at  once  arrested, 
and  there  is  no  return  of  the  paroxysm,  especially  if  the  required  im- 
pression has  been  produced  some  hours  before  the  period  for  its  recur- 
rence. More  frequently,  perhaps,  one  additional  paroxysm  occurs, 
though  with  mitigated  severity,  and  the  succession  is  arrested  at  the 
second.  Rarely  does  the  disease  pass  on  to  a  third.  Sometimes,  in- 
stead of  having  been  quite  set  aside,  the  paroxysm  returns  in  a  very  mild 
or  partial  form,  without  a  distinct  chill,  and  with  very  little  fever,  and 
altogether  so  slight  that,  in  itself,  it  would  scarcely  attract  attention.  It 
is  important,  however,  as  indicating  that  the  disease  is  not  yet  arrested, 
and  that,  unless  the  impression  of  the  medicine  is  maintained,  the  parox- 
ysms may  again  assume  their  original  severity.  It  is  not  impossible  that 
a  quotidian,  which  has  been  once  interrupted,  may  return  on  the  follow- 
ing day  as  a  tertian ;  and,  in  like  manner,  a  broken  tertian  may  assume 
the  quartan  type.  These  results  may  be  guarded  against  by  continuing 
the  quinia  beyond  the  period  for  the  tertian  or  quartan  paroxysm  ;  though 
they  are  so  rare  that  this  caution  may  generally  be  dispensed  with,  and 
the  plan  only  put  in  force  in  cases  presenting  this  peculiarity.  As  a 
general  rule,  therefore,  the  medicine  may  be  omitted  immediately  after 
the  complete  interruption  of  the  paroxysms.  It  is  of  no  advantage  to 
continue  with  it  regularly  afterwards,  with  a  view  to  prevent  the  sep- 
tenary or  bi-septenary  recurrence  of  the  paroxysms,  to  which  the  dis- 
ease is  liable;  for  a  smaller  daily  amount  than  that  originally  necessary 
for  arresting  the  disease,  cannot  be  depended  on  for  preventing  these  re- 
turns; and  to  persist  in  the  use  of  so  large  a  quantity  may  render  the 
system  at  length  insusceptible  to  its  operation.  The  best  plan  for  check- 
ing the  weekly  or  bi-weekly  returns,  the  latter  of  which  are  by  far  the 
most  common,  is,  I  think,  to  ascertain  at  what  period,  in  any  particular 
case,  the  paroxysm  is  disposed  to  recur,  and  to  anticipate  this  by  giving 
the  patient,  during  the  two  days  preceding  that  period,  as  much  as  was 
at  first  necessary  to  interrupt  the  disease ;  and  to  pursue  this  course 
every  week  afterwards  for  one  or  two  months,  or  longer  if  necessary. 
The  interrupted  use  of  the  medicine  prevents  the  system  from  becoming 
accustomed  to  it;  and,  after  a  time,  the  disposition  of  the  disease  to 
recur  ceases. 


254  GENERAL    STIMULANTS.  [PART  II. 

Writers  speak  of  latent  intermittent  fever,  in  which  the  disease  is 
masked  under  other  forms.  Thus,  there  may  be  a  chill  and  perspira- 
tion, without  fever,  or  a  headache  with  loss  of  appetite,  malaise,  etc., 
recurring  at  the  regular  day  and  hour;  or  the  effects  of  the  cause  may 
be  shown  in  an  attack -of  violent  periodical  neuralgia,  or  some  special 
local  affection,  as  diarrhoea  or  dysentery;  and  all  such  cases  will  yield 
to  the  antiperiodic  treatment  quite  as  readily  as  the  regular  disease. 
There  seems,  however,  to  be  no  necessity  for  considering  these  affec- 
tions as  masked  intermittent  fever.  They  are  simply  different  morbid 
results  of  the  same  cause,  and,  like  intermittent  fever  itself,  are  not  ex- 
clusively of  miasmatic  origin,  but  may  result  also  from  other  causes. 
But,  whatever  may  be  their  source,  they  are  equally  amenable  to  the 
antiperiodic  treatment. 

Intermittent  neuralgia  is  probably,  next  to  intermittent  fever,  the 
most  prevalent  form  of  regular  periodical  disease.  It  may  attack 
almost  any  part  of  the  body,  internal  or  external.  As  I  have  seen  it, 
however,  it  is  most  common  in  or  about  the  eye.  Sometimes  there  is 
reason  to  believe  that  it  is  the  effect  of  marsh  miasm ;  but  I  have  known 
it  much  more  frequently  quite  independent  of  this  cause.  It  is  often 
probably  of  a  rheumatic  or  gouty  character,  sometimes  apparently  the 
result  of  debility,  occurring  in  the  convalescence  from  other  diseases; 
but  quite  as  often,  its  source  cannot  be  satisfactorily  traced.  I  have 
never  witnessed  a  case  of  this  kind,  if  unconnected  with  organic  disease, 
which  has  not  yielded  to  sulphate  of  quinia.  The  ordinary  doses  of 
this  medicine  used  in  intermittent  fever  will  often  cure  it;  but  they  will 
often  also  fail.  Double  or  even  triple  the  quantity  may  be  necessary  to 
produce  the  desired  effect. 

Intermittent  headache,  especially  hemicrania,  may  be  considered  as 
closely  analogous  with  neuralgia,  and  is  treated  in  the  same  way.  But 
organic  lesions  of  the  brain  are  not  unfrequently  attended  with  severe 
pain  in  the  head,  assuming  a  somewhat  regular  periodical  character, 
and  liable,  without  caution,  to  be  mistaken  for  pure  functional  neuralgia. 
In  these  cases,  quinia  may  sometimes  afford  partial  relief;  but  it  is 
often  quite  powerless,  at  least  in  any  quantity  in  which  I  have  ventured 
to  prescribe  it ;  and,  I  believe,  may  do  harm  by  over-exciting  the  already 
irritated  nervous  centres. 

Rheumatism  and  gout  are  not  unfrequently  intermittent,  in  their 
nervous  forms,  whether  as  neuralgia,  or  painless  disorder  of  function; 
and  sometimes,  also,  in  their  inflammatory  state.  In  cither  case,  they 
yield  in  general  readily  to  quinia. 

The  various  neuroses  occasionally  assume  the  same  regularity  of 
recurrence.  Epileptic  convulsions,  in  general  so  intractable,  may  be 
treated  with  quinia  with  good  hope  of  success,  when  they  occur  regu- 
larly, for  any  length  of  time,  at  the  same  hour  daily,  or  every  other  day. 


CHAP.  I.]  TONICS. — PERUVIAN    BARK.  255 

The  same  may  be  said  of  hysteria.  Cramps,  internal  spasmodic  affec- 
tions, asthma,  nervous  cough,  and  amaurosis,  are  other  complaints 
occasionally  periodical  in  their  character,  and,  in  that  state,  curable  by 
the  great  antiperiodic  remedy. 

Hemorrhages  are  said  also  to  be  sometimes  regularly  intermittent, 
and  remediable  in  the  same  way. 

The  fact  is  undoubtedly  true  of  certain  complaints  of  an  apparently 
inflammatory  character.  Among  these,  ophthalmia  is  mentioned;  but, 
considering  the  frequency  of  neuralgia  of  the  eye,  I  am  disposed  to  think 
that  these  cases  of  apparent  inflammation  are  little  more  than  active 
congestion,  sustained  by  the  extreme  nervous  irritation,  and  subsiding 
when  that  ceases.  I  have  repeatedly  seen  diarrhoea  periodical,  and  in 
that  condition  yielding  to  quinia;  but  it  is  not  always  easy  to  determine 
whether  the  affection  is  inflammatory,  or  merely  irritative.  One  of  the 
most  apparently  violent  attacks  of  dysentery  which  I  ever  saw  proved 
to  be  regularly  periodical.  The  case  occurred  in  the  Pennsylvania 
Hospital.  At  my  first  visit,  the  man  was  seemingly  very  ill,  complained 
excessively  of  pain,  was  constantly  going  to  stool  with  the  characteristic 
dysenteric  discharges,  and  seemed  to  me  to  be  in  great  danger  of  his  life. 
Next  day  he  was  almost  well;  and  I  supposed  that  the  disease  had 
yielded  to  the  measures  employed.  On  the  following  day,  however,  it 
returned  with  all  its  former  violence,  and  subsided  again  as  before. 
There  were  several  similar  paroxysms.  Convinced  that  it  was  peri- 
odical, I  gave  sulphate  of  quinia  very  largely  in  the  intermission,  and 
almost  immediately  checked  the  disease.  But  the  probability,  I  think, 
is  that,  in  all  these  regularly  intermittent  inflammations,  the  nervous 
element  of  the  disease  is  predominant,  and  that  the  vascular  disturbance 
is  directly  dependent  upon  it.  In  many  cases,  however,  of  apparent 
intermittent  inflammation,  especially  of  the  lungs,  the  local  affection  is  a 
mere  appendage  of  a  miasmatic  fever,  being  lighted  up  by  the  general 
vascular  excitement  of  the  paroxysm,  acting  probably  upon  a  predis- 
position to  inflammation  in  the  organ  affected.  But,  whether  its  origin 
be  as  here  supposed  or  not,  it  yields  with  great  facility  to  quinia,  when 
there  is  proof  that  the  inflammation  is  quite  absent  during  the  period  of 
the  apparent  intermission. 

In  regular  remittent  diseases,  quinia  is  scarcely  less  efficient  than  in 
intermittents.  In  this  category,  however,  are  not  included  all  affections 
having  the  remittent  character.  In  consequence  of  the  varying  excita- 
bility of  the  system,  almost  all  complaints,  perhaps  it  may  be  said  all 
complaints  of  any  considerable  duration,  are  more  or  less  remittent,  even 
though  the  cause  may  be  constantly  operating.  But  to  constitute  a  reg- 
ular remittent,  in  the  sense  here  intended,  there  must  be  a  paroxysm  re- 
curring daily,  or  every  other  day,  at  regular  intervals;  and,  though  the 
morbid  action  may  continue,  in  a  moderated  degree,  throughout  the  inter- 
vening period,  yet  it  is  rather  a  prolongation  of  the  paroxysm,  than  a  con- 


256  GENERAL    STIMULANTS.  [PART  II. 

tinuous  and  sustained  effect  of  the  canse.  It  is  as  if  the  cause  oper- 
ated only  paroxysmally,  and  the  disturbance  of  system  produced  by  it 
did  not  subside  completely  before  the  period  arrived  for  the  recurrence  of 
its  action.  These  diseases,  then,  are  not  continuous  affections,  undergoing 
occasional  exacerbation  and  remission ;  but  consist  of  successive  parox- 
ysms, more  or  less  intercurrent  They  are  closely  analogous  to  inter- 
mittent disease,  and  are  submissive  to  the  same  antiperiodic  treatment. 

The  most  important  of  these  diseases  is  the  miasmatic  remittent,  or 
common  bilious  fever.  In  this  complaint,  sulphate  of  quinia  is  a  most 
efficient  remedy.  Whenever  a  decided  remission  is  observed,  after  due 
evacuation  of  the  bowels,  and  of  the  stomach  if  necessary,  it  may  be 
given  in  quantities  similar  to  those  administered  in  intermittent  fever, 
and  will  not  often  fail.  In  the  pernicious  variety  of  remittent  fever,  or 
when  pernicious  symptoms  supervene  in  a  case  before  simple,  it  is  all- 
important,  and,  indeed,  is  the  only  remedy  on  which  reliance  can  be 
placed.  As  in  the  pernicious  intermittent,  the  quantity  should  be  double, 
or  even  triple  that  given  in  the  milder  form  of  the  disease.  In  this 
affection,  it  is  of  vast  importance  that  no  time  should  be  lost.  The  next 
paroxysm  may  very  possibly  prove  fatal,  unless  prevented.  Nothing, 
therefore,  should  be  allowed  to  interfere  with  the  use  of  sulphate  of 
quinia,  upon  the  first  occurrence  of  signs  of  remission ;  and  sometimes 
it  might  be  advisable  not  to  wait  for  this  period,  but,  when  the  nature 
of  the  disease  is  well  ascertained,  to  have  recourse  to  the  antiperiodic, 
by  anticipation,  even  in  the  paroxysm ;  for  the  tendency  here  is  not  to 
active  congestion  or  inflammation,  but  rather  to  nervous  prostration  and 
passive  congestion,  and  there  is  little  probability  of  serious  injury  to  the 
brain,  or  other  vital  organ.  In  some  instances,  it  is  difficult  to  retain 
the  remedy,  on  account  of  great  irritability  of  stomach.  It  should  not 
be  omitted  on  this  account,  but  given  notwithstanding,  in  the  hope  that 
a  portion  at  least  may  be  retained;  and  its  retention  may  be  aided  by 
the  simultaneous  administration  of  opiates,  and  by  the  application  of  a 
sinapism  to  the  epigastrium.  The  remedy  should  also,  under  such  cir- 
cumstances, be  additionally  employed  as  an  enema  with  opium,  and  aa 
an  application  to  the  surface  of  the  body  by  the  endermic  method;  or, 
what  is  still  better,  by  injection  into  the  subcutaneous  areolar  tissue. 

In  regular  remittent  neuralgia,  also,  the  best  effects  may  be  expected 
from  sulphate  of  quinia,  given  in  the  same  manner  as  in  the  intermittent 
form  of  the  disease. 

Preventive  Influence.  Upon  the  same  principles  as  those  on  which 
periodical  diseases  may  be  cured,  they  may  also  be  prevented  by  sul- 
phate of  quinia.  There  is  no  prophylactic  measure  against  the  miasmatic 
fevers  at  all  comparable  in  efficacy  to  the  use  of  this  medicine.  It  seems 
reasonable  to  suppose  that  an  impression  on  the  system,  such  as  pre- 
vents the  return  of  the  paroxysms,  would  prevent  the  occurrence  of  the 
first.  Experience  has  established  the  correctness  of  this  inference.  All 


CHAP.  I.]  TONICS. — PERUVIAN    BARK.  257 

that  is  necessary  is  to  give,  twice  every  week,  in  divided  doses,  a  quan- 
tity equal  to  that  required  for  the  interruption  of  the  disease  when  formed. 
From  ten  to  fifteen  grains,  in  doses  of  two  grains  every  two  hours, 
will  probably  answer  the  purpose.  I  am  not  sure  that  the  same  amount 
taken  weekly  will  not  be  sufficient,  considering  the  tendency  to  septenary 
periods  which  characterizes  the  relapses  of  the  disease. 

In  the  irregular  intermittent  diseases,  such  as  hectic  fever,  for  exam- 
ple, sulphate  of  quinia,  given  in  the  same  manner  as  in  regular  intermit- 
tents,  will  often  check  the  paroxysms;  but  cannot  be  relied  on  even  for 
this  purpose,  and  is  generally  quite  inadequate  to  the  cure.  The  cause 
of  these  affections  is  generally  continuous  in  its  action,  and  is  always, 
therefore,  lying  in  wait  to  renew  its  assaults,  though  sometimes  tempo- 
rarily restrained.  In  hectic  fever,  the  nervous  centres,  through  which 
the  sources  of  irritation  operate  in  producing  the  paroxysm,  may  be 
rendered  insensible  for  a  time  to  their  influence;  but,  as  soon  as  the  pro- 
tective force  is  withdrawn,  the  cause  again  operates;  and,  if  the  quinia 
be  given  constantly,  the  system  at  length  becomes  insensible  to  its  effects, 
and  its  remedial  power  ceases. 

Nature  of  the  Antiperiodic  Action.  Various  theories  have  been 
broached  to  explain  the  antiperiodic  effect  of  Peruvian  bark.  Most  of 
them  are  scarcely  deserving  of  notice.  One  of  the  most  plausible,  in 
reference  to  the  miasmatic  intermittents  and  remittents,  is  that  the  alka- 
loids have  the  property  of  neutralizing  the  poison  in  the  system.  But 
this  is  not  tenable;  as  quinia  cures  the  irritative  intermittents  even 
more  readily  than  the  miasmatic ;  and,  if  there  be  any  disposed  to  deny 
the  existence  of  the  former  affection,  the  argument  will  still  hold;  for  in- 
termittent neuralgia,  which  often  occurs  where  there  can  be  no  possible 
suspicion  of  the  influence  of  marsh  miasms,  even  in  the  midst  of  cities 
the  air  of  which  serves  as  a  protection  against  these  miasms,  will  yet 
almost  invariably  yield  to  the  same  remedy. 

I  know  no  better  explanation  of  the  antiperiodic  property,  than  that 
which  supposes  it  to  depend  upon  the  powerful  influence  exercised  by 
the  remedy  upon  the  nervous  centres,  through  which  probably  the  parox- 
ysms are  produced.  Every  consideration,  in  connection  with  the  pecu- 
liarities of  regular  intermittent  diseases,  leads  to  the  conclusion,  that  the 
paroxysms  are  caused  by  an  influence  acting  through  the  cerebral  cen- 
tres, without  which  the  result  would  not  take  place.  Now,  if  these  cere- 
bral centres  can  be  preoccupied  by  a  strong  impression  from  some  other 
source,  they  may  be  rendered  insensible  to  the  morbid  influence,  and  the 
paroxysm,  therefore,  is  set  aside.  Quinia  is  characterized  by  its  dispo- 
sition to  act  energetically  upon  certain  nervous  centres,  which  are  prob- 
ably the  same  as  those  through  which  the  cause  of  the  disease  operates. 
Quinia,  therefore,  interrupts  the  succession  of  the  paroxysms;  and,  as 
they  are  probably  sustained,  in  part  at  least,  either  by  habit,  or  by  some 
VOL.  i. — 17 


258  r.I'XERAL    STIMULANTS.  [PART  II. 

chain  of  morbid  action  passing  insensibly  from  one  paroxysm  to  the 
succeeding1,  the  interruption  is  either  permanent,  or  continuous  until  the 
original  cause  may  reassume,  in  some  mysterious  way,  its  original 
activity,  and  produce  a  relapse  in  the  now  unguarded  system.  It  is 
obvious  that  this  explanation  of  the  antiperiodic  power  of  remedies  im- 
plies an  identity  with  that  next  to  be  considered;  namely,  the  property 
of  supersession;  but,  as  the  explanation  is  only  conjectural,  it  is  deemed 
best  to  treat  of  these  two  therapeutic  agencies  distinctly. 

3.  As  A  SUPERSEDENT.    What  has  been  stated  above  explains  the 
meaning  attached  to  this  term.     It  simply  implies  that  the  medicine  so 
named  has  the  power,  by  insinuating  an  action  of  its  own  in  any  part 
or  organ,  to  displace  disease  previously  existing  in  that  part  or  organ,  or 
to  exclude  it  if  not  already  established.     It  is  known  that  quinia  acts 
powerfully  on  the  cerebral  centres,  especially  those  of  the  organic  func- 
tions, and  produces  in  those  centres  an  impression  of  considerable  per- 
manence.    The  probable  influence  of  such  an  impression  in  preventing 
the  return  of  regular  periodical  paroxysms  has  been  referred  to.     It  is 
evinced  also,  though  much  less  certainly  and  strikingly,  in  the  preven- 
tion of  irregular  paroxysms  of  various  kinds,  and  even  in  the  relief  of 
existing  disease  occupying   especially  the  nervous  centres,   or  acting 
through  them,  though  not  necessarily  paroxysmal.      Upon  this  princi- 
ple, we  may  explain  the  occasional  efficiency  of  sulphate  of  quinia  in 
irregular  neuralgia,  when  given   very  freely.     In  chorea,  functional 

•  •/)«?/,  hysteria,  spasmodic  asthma,  and  the  advanced  stage  of  per- 
tussis, it  has  sometimes  been  used  advantageously;  and  it  is  said  to  have 
proved  efficacious,  in  large  doses,  even  in  tetanus.  Associated  with  in- 
fusion or  oil  of  valerian,  I  have  been  much  in  the  habit  of  using  it  in 
certain  forms  of  nervous  headache,  imitating  an  old  practice  taught  me 
by  the  late  Dr.  Jos.  Parrish,  in  which  Peruvian  bark  was  used  for  the 
same  purpose,  with  the  same  addition.  Much  efficacy  in  the  cure  of 
nervous  or  sick  headache  is  claimed,  by  MM.  Debout  and  Scrre,  for 
a  combination  of  sulphate  of  quinia  and  digitalis;  forty-five  grains  of  the 
former  and  twenty-two  of  the  latter,  being  made  with  syrup  into  thirty 
pills,  of  which  one  is  to  be  taken  every  night  for  at  least  three  months. 
(Bullet,  de  Therap.,  Iviii.  p.  311.) 

4.  As  A  SEDATIVE.  It  will  be  recollected  that  I  consider  the  sedative 
effect,  produced  by  large  doses  of  quinia,  as  essentially  secondary ;  being 
always  preceded  by  a  longer  or  shorter  period  of  excitement  in  certain 
cerebral  centres,  and  probably  dependent,  at  least  in  sonn-  degree,  on 
this  previous  excitement,  overwhelming,  and  us  it  were  paralysing  these 
centres,  and  disabling  them  from  extending  their  normal  influenee  to  the 
organic  functions  generally.     In  reference  to  this  sedative  property  of 
quinia,  it  would  seem  to  be  applicable  generally  to  diseases  of  over- 
excitement,  not  connected  with  active  congestion,  inflammation,  or  pecu- 


CHAP.  I.]  TONICS. PERUVIAN    BARK.  259 

liar  excitability  of  the  brain.  Some,  who  believe  in  the  direct  sedative 
power  of  the  medicine,  do  not  admit  even  this  exception.  By  these  it  is 
recommended  in  all  inflammatory  affections,  even  those  of  the  encepha- 
lon;  but  experience  has  shown  that  it  may  prove  very  injurious,  and 
even  fatal,  in  such  cases.  The  quantity  requisite  for  the  production  of 
the  secondary  depression  varies  from  fifteen  to  sixty  grains  daily.  From 
a  less  amount,  there  might  be  danger  of  obtaining  the  direct  stimulating 
effects  of  the  medicine.  The  following  are  the  complaints  in  which 
quinia  has  been  especially  recommended  as  a  sedative. 

Fevers.  There  can  be  no  doubt  that  large  doses  of  quinia  will  often 
control  febrile  phenomena,  reducing  the  frequency  and  force  of  the  pulse, 
diminishing  the  heat  and  dryness  of  the  surface,  and  sometimes  even 
relieving  headache  and  delirium.  Carried  far  enough,  it  will  suppress 
all  signs  of  over-excitement,  and  may  even  bring  on  great  prostration. 

In  remittent  miasmatic  fever  it  is  thus  employed,  especially  in  our 
Southern  and  South-Western  States,  very  soon  after  the  commence- 
ment of  the  disease,  before  a  remission  has  become  decidedly  established, 
and  even  in  the  height  of  the  paroxysm.  There  can  be  no  doubt,  from 
the  abundant  testimony  on  the  subject,  that,  thus  given,  it  will  often 
speedily  put  an  end  to  the  febrile  phenomena  by  its  sedative  operation ; 
while,  through  its  antiperiodic  powers,  it  prevents  a  return  of  the  par- 
oxysms, and  thus  cures  the  disease.  The  effects  are,  in  very  numerous 
cases,  so  prompt  and  happy,  and  the  injurious  results  comparatively  so 
few,  that  the  practice  has  become  very  popular,  and,  in  some  districts, 
almost  exclusive.  But,  if  my  views  of  the  action  of  quinia  in  these  cases 
are  correct,  it  is  not  without  its  dangers.  Should  active  congestion,  or 
positive  inflammation  of  the  brain,  complicate  the  disease,  it  might  be 
fatally  aggravated,  especially  if  it  should  happen  to  be  seated,  not  in  the 
lobes,  which  are  comparatively  little  affected  by  quinia,  but  near  the 
base  of  the  brain,  in  the  centres  of  vision  and  hearing,  and  of  the  great 
organic  functions,  which  it  powerfully  excites.  Even  without  the  posi- 
tive existence  of  high  vascular  irritation  or  inflammation,  a  simple  mor- 
bid tendency  to  these  conditions  might  be  goaded  into  dangerous  action. 
This  is  not  pure 'theory.  One  case  at  least  is  on  record,  in  which  fatal 
encephalitis,  in  an  attack  of  miasmatic  fever,  was  ascribed  to  the  exces- 
sive use  of  quinia  (Baldwin,  Am.  Journ.  of  Med.  Sci.,  N.  S.,  xiii.  293); 
and,  were  unfavourable  results  as  often  noted  as  the  favourable,  it  is  not 
improbable  that  others  might  be  adduced.  It  seems  to  me,  therefore,  a 
safer  practice,  in  these  fevers,  to  wait  for  a  decided  remission  before  pre- 
scribing quinia.  The  only  exceptions  I  would  make  to  this  rule  are 
cases,  either  originally  pernicious,  or  becoming  so  in  the  course  of  the 
disease.  In  these,  the  danger  of  a  fatal  issue  is  imminent,  and  there  is 
little  risk  of  inducing  active  cerebral  congestion  or  inflammation;  as  the 
tendencies  are  asthenic  rather  than  otherwise,  and  the  disposition  much 


2GO  GENERAL    STIMULANTS.  [PART  II. 

greater  to  nervous  prostration  and  passive  congestion,  than  to  inflam- 
matory action.  In  the  pernicious  remittent,  therefore,  or  congestive 
fever  of  the  South,  quinia  may  be  given  freely  after  reaction  has  taken 
place,  and  before  the  occurrence  of  a  distinct  remission ;  and  the  main 
error  to  be  guarded  against  is  the  exhibition  of  the  remedy,  in  over- 
whelming doses,  during  the  cold  stage,  or  that  of  prostration,  for  fear  of 
fatally  aggravating  the  existing  depression,  by  the  indirect  sedative 
influence  of  the  qninia. 

In  yellow  fever,  also,  quinia  has  been  largely  employed  in  this 
country,  upon  the  same  principle;  that,  namely,  of  suppressing  the 
fever  by  its  sedative  influence.  Given  in  doses  of  fifteen,  twenty,  or 
thirty  grains,  at  an  early  stage  of  this  complaint,  it  will  undoubtedly 
often  relieve  and  even  remove  the  febrile  phenomena;  and,  if  the  disease 
be  moderate,  and  spontaneously  curable,  the  patient  will  experience 
little  subsequent  inconvenience.  But  experience  has  shown  that,  though 
it  may  suppress  the  febrile  symptoms,  it  is  incapable  of  controlling  those 
deeper  derangements,  and  especially  that  depravation  of  the  blood,  in 
which  the  chief  danger  consists ;  and,  in  serious  cases,  the  patient  dies 
with  prostration,  hemorrhage,  black  vomit,  etc.,  quite  as  certainly  as 
though  no  quinia  had  been  given.  There  is  even  reason  for  believing 
that  the  great  secondary  depression,  resulting  from  the  overwhelming 
doses  sometimes  used,  may,  when  superadded  to  the  debility  of  the 
second  stage  of  the  disease,  produce  a  fatal  result  in  cases,  which,  if 
otherwise  treated,  might  end  in  recovery.  There  is,  moreover,  the  risk 
of  seriously  aggravating  any  inflammatory  condition  or  tendency  which 
may  exist  in  the  brain,  in  the  early  stage,  and  of  still  further  irritating 
the  mucous  membrane  of  the  stomach,  already  perhaps  the  seat  of  high 
vascular  irritation,  if  not  of  inflammation.  The  reader  will  perceive, 
therefore,  that  the  sedative  treatment  by  quinia  is  not  that  which  I  am 
disposed  to  recommend  in  yellow  fever;  though  it  is  proper  to  state, 
that  my  conclusions  have  been  deduced  from  d  priori  reasoning,  and 
the  recorded  .experience  of  others,  and  not  from  any  experience  of  my 
own  with  this  mode  of  treatment. 

Typhoid  or  enteric  fever  is  also  among  the  diseases  in  which  this 
method  of  treatment  has  been  employed.  Some  have  supposed  that, 
like  miasmatic  fever,  this  affection  could  be  promptly  arrested,  strangled 
as  it  were,  by  large  doses  of  quinia.  A  knowledge  of  its  pathology,  one 
would  imagine,  should  be  sufficient  to  guard  against  this  error ;  for  that 
it  is  an  error  has,  I  think,  been  abundantly  shown  by  experience.  Some- 
times, it  is  true,  the  disease  seems  to  be  mixed  with  remittent  fever, 
having  regular  paroxysms,  recurring  at  a  particular  hour  every  day, 
probably  owing  to  the  simultaneous  action  of  the  causes  of  the  two  com- 
plaints. In  such  cases,  as  I  know  from  observation,  quinia  will  check 


CHAP.  I.]  TONICS. — PERUVIAN    BARK.  261 

the  paroxysms,  and  remove  the  regular  remittent  character;  but  the  fe- 
brile affection  will  still  march  on,  with  its  characteristic  phenomena,  to 
its  regular  termination.  In  France,  sulphate  of  quinia  in  large  doses 
has  been  used,  not  with  a  view  to  the  prompt  suppression  of  the  disease, 
but  in  order  to  diminish  the  fever,  lessen  the  danger,  and  lead  to  a 
speedier  issue.  M.  Briquet,  who  employed  it  largely,  states,  as  the 
result  of  his  observation,  that  the  pulse  is  moderated  under  its  influence, 
the  heat  of  skin  diminished,  arid  the  cerebral  symptoms  very  much  alle- 
viated; and  on  the  whole,  believes  that  this  treatment  will  compare 
very  favourably  with  any  other  which  has  been  adopted.  An  appar- 
ently curious  point,  in  his  experience,  is  the  effect  of  the  medicine  in 
diminishing  stupor,  quieting  delirium,  and  otherwise  favourably  influ- 
encing the  head  affection.  But  the  cerebral  symptoms  in  this  complaint 
are  not  those  of  active  congestion  or  inflammation.  They  have  probably 
a  double  origin,  depending,  in  part,  upon  the  depressing  influence  of  the 
cause  upon  the  brain,  either  immediately,  or  through  the  instrumentality 
of  the  diseased  blood,  and  partly  upon  the  irritating  influence  of  the  dis- 
eased bowels  upon  the  cerebral  centres.  Now,  quinia  is  calculated  to 
obviate  both  these  effects.  By  its  excitant  influence,  it  may  counteract 
the  operation  of  the  depressing  cause,  and  thus  correct  in  some  degree 
the  characteristic  stupor;  while,  in  large  doses,  through  an  excess  of  the 
same  influence  on  the  organic  centres,  it  renders  them  less  impressible 
by  the  diseased  glands  of  Peyer.  We  might,  therefore,  expect  some 
favourable  effects  from  large  doses  of  quinia;  but,  though  I  have  given 
the  alkaloid  often  and  freely  in  this  complaint,  I  have  never  found  from 
it  any  other  advantage  than  a  moderate  supporting  effect  in  the  low 
states  of  the  disease ;  and  have  often  been  compelled  to  omit  it  by  an 
aggravation  of  the  symptoms.  I  have  certainly  never  seen  it  cure  a  case 
of  the  disease.  Nor  can  the  resxilts  obtained  by  M.  Briquet  be  considered 
remarkably  favourable,  when  judged  of  by  his  statistical  report.  Of 
forty-three  cases  of  a  serious  character,  including  all  that  came  under 
their  notice,  treated  by  himself  and  M.  Blache,  either  in' part  or  exclu- 
sively with  sulphate  of  quinia,  eight  terminated  fatally;  and,  of  these 
eight,  four,  on  post-mortem  examination,  exhibited  undoubted  signs  of 
meningitis.  (Trait.  Therap.  du  Quinq.,  pp.  383  and  385.)  Now,  the 
proportion  of  deaths  is  here  much  greater  than  we  habitually  meet  with 
in  the  Pennsylvania  Hospital  (see  my  work  on  the  Practice  of  Medicine, 
5th  ed.,  i.  354),  even  if  the  serious  cases  only  be  taken  into  account;  and 
the  number  of  cases,  four  out  of  eight,  in  which  signs  of  meningitis  were 
discovered,  is  far  beyond  the  usual  proportion,  under  any  ordinary  treat- 
ment. The  inference  is  fair,  that  the  general  result  of  the  heroic  treatment 
with  sulphate  of  quinia  is  unfavourable,  and  that  it  causes  death,  either 
by  directly  inducing  meningitis,  or  by  aggravating  a  tendency  to  that 


262  GENERAL    STIMULANTS.  [PART  II. 

affection  already  existing;  which  is  exactly  what  might  have  been  antici- 
pated, from  the  views  here  inculcated  of  the  action  of  quinia  on  the 
brain.* 

In  typhus  fever,  the  abortive  treatment  by  sulphate  of  quinia  has  been 
recommended  strongly  by  Robert  Dundas,  of  Liverpool ;  and  has  been 
tried  with  success  by  other  British  practitioners.  Among  those  who 
report  most  strongly  in  its  favour  is  Mr.  J.  O.  Fletcher,  who  found  it 
very  effectual  in  cases  of  pure  typhus,  but  not  in  those  complicated  with 
ulcerated  bowels,  in  other  words,  not  in  typhoid  fever.  (Land.  Med. 
Times  and  Gaz.,  vi.  422.)  As  a  tonic,  Peruvian  bark  has  long  been  an 
established  remedy  in  typhus  fever;  but  the  idea  of  employing  it  in  large 
doses,  with  the  view  of  speedily  arresting  the  disease,  is,  so  far  as  I 
know,  of  recent  origin.  Though  I  have  used  it  much  in  the  former  ca- 
pacity, I  have  no  experience  with  it  in  large  doses,  given  at  the  com- 
mencement of  the  fever,  with  a  view  to  a  direct  febrifuge  effect,  and  have 
no  right,  therefore,  to  speak  decidedly  on  this  point;  but,  if  the  humoral 
views  of  the  pathology  of  this  disease  now  prevailing  are  correct,  that  it 
depends,  namely,  on  a  poison  which  enters  the  circulation,  and  alters  the 
state  of  the  blood,  depraving  that  fluid,  and  causing  the  generation 
within  the  system,  and  elimination  from  it,  of  a  poisonous  matter  like 
itself,  we  know  of  no  properties  in  quinia  which  should  enable  it  to  cor- 
rect this  condition  of  things;  and,  though  by  its  secondary  sedative  in- 
fluence it  may  suppress  the  febrile  phenomena,  it  would  be  considered, 
with  these  views,  as  not  likely  to  eradicate  the  disease.  If  it  has  the 
power  of  arresting  that  quasi  zymotic  action  in  the  blood,  which  is  sup- 
posed to  characterize  contagious  diseases,  it  ought  to  be  competent  to 
the  interruption  of  the  course  of  smallpox,  measles,  and  scarlatina;  an 
influence  which  would  scarcely  be  claimed  for  it  by  the  most  sanguine. 
PcLechial  or  spoiled  fever,  or,  as  it  is  frequently  called,  malignant 
cerebro- spinal  meningitis,  is  one  of  the  low  forms  of  fever  in  which 
quinia  appears  to  act  most  favourably,  if  confidence  can  be  placed  in 
testimony.  Given  freely  in  the  initial  stage,  it  is  said  often  very  hap- 
pily to  dissipate  the  more  alarming  symptoms,  and  allow  the  disease  to 

*  A  case  has  fallen  under  my  notice,  strongly  illu-trative  of  the  dangerous  effects 
which  may  arise  from  very  large  quantities  of  sulphate  of  quinia  in  this  lever.  1 
was  called  in  consultation  to  a  case  of  fever,  which  the  attending  physician  con- 
sidered, and  wus  treating  as  an  ordinary  bilious  remittent.  I  thought  I  had  con- 
vinced him  that  it  was  euteric  or  typhoid  fever,  and  we  separated  after  agreeing  to 
a  course  of  treatment  consonant  with  this  view.  It  appeared,  however,  that  he  was 
not  really  convinced;  and,  determined  apparently  to  prove  me  in  the  wrong,  he  di- 
rected between  thirty  and  forty  grains  of  the  sulphate  of  quinia  to  be  administered 
during  the  day.  Theie  had  previously  been  no  alarming  symptoms  in  the  case; 
but,  on  the  repetition  of  my  vi.-it  next  day,  I  fum.d  the  patient  in  violent  convul- 
sions, and  within  twenty-four  hours  he  died  comatose.  (Note  to  the  second  edition.) 


CHAP.  I.]  TONICS. — PERUVIAN    BARK.  £68 

be  conducted  to  a  favourable  issue.  My  own  experience  with  it  is  con- 
6ned  to  a  single  case,  in  which,  in  connection  with  morphia,  it  appeared 
to  act  most  happily. 

In  puerperal  fever,  sulphate  of  quinia,  in  large  doses,  is  asserted  to 
have  been  employed  with  extraordinary  success;  and,  in  epidemics  of 
that  affection,  it  is  believed  to  have  been  used  advantageously  as  a  pre- 
ventive. M.  Beau,  of  Paris,  is  among  those  who  strenuously  advocate 
the  use  of  the  medicine  in  this  frightful  disease.  It  is  given  in  the 
quantity  of  from  fifteen  to  thirty  grains  in  the  day,  or  sufficient  to 
induce  the  decided  effects  of  quinia  on  the  system.  (Ann.  de  Therap., 
1858,  p.  178.) 

Acute  Rlieumatism.  Peruvian  bark  was  long  since  employed  as  a 
remedy  in  acute  rheumatism  in  Great  Britain  ;  but  the  practice  had  been 
abandoned,  and  only  came  again  into  general  notice  after  the  publica- 
tion of  the  results  obtained  by  M.  Briquet,  and  other  French  physicians, 
about  the  year  1842,  with  large  doses  of  sulphate  of  quinia  in  that  dis- 
ease. There  can  be  no  doubt  that,  under  the  use  of  this  salt,  in  the 
quantity  of  half  a  drachm,  more  or  less,  given  daily  in  divided  doses, 
cases  of  acute  rheumatism  have  often  yielded,  and  entered  into  conva- 
lescence, without  any  serious  inconvenience,  at  a  much  earlier  period 
than  they  ordinarily  do  if  left  alone.  Very  soon  after  the  system  has 
come  under  the  full  influence  of  the  remedy,  the  pains  and  swelling 
abate,  sleeplessness  is  relieved,  and  the  pulse  is  reduced  in  frequency 
and  force;  and  the  patient,  in  most  instances,  when  the  disease  is  un- 
complicated with  inflammation  of  the  internal  organs,  as  of  the  heart, 
will  become  convalescent  in  about  ten  or  twelve  days  from  the  com- 
mencement of  treatment.  Sometimes,  however,  as  under  every  other 
treatment,  the  complaint  is  much  more  prolonged,  and,  when  compli- 
cated with  pcricardial  or  endocardial  inflammation,  extends  to  an  aver- 
age period  of  sixteen  days  or  more;  though  it  is  asserted  that  these  in- 
flammations, especially  if  encountered  by  general  or  local  bleeding, 
afford  no  contraindication  to  the  use  of  quinia.  According  to  Briquet, 
the  cases  least  benefited  by  the  sulphate  of  quinia  are  those  of  a  ple- 
thoric character,  in  which  the  inflammatory  fever  is  intense,  and  the 
pulse  full,  hard,  and  frequent;  while  those  in  which  it  proves  most 
advantageous  are  lymphatic  subjects,  or  those  weakened  by  previous 
disease,  or  excessive  depletion,  with  pale  skin,  and  a  very  frequent  but 
not  well-developed  pulse.  This  is  exactly  what  might  have  been  ex- 
pected, from  the  views  of  the  action  of  sulphate  of  quinia  here  advocated, 
and  quite  contradictory  to  the  notion  of  its  direct  sedative  power.  The 
medicine  suppresses  the  morbid  phenomena  by  an  over-excitement,  and 
consequent  diminution  of  the  excitability  of  the  nervous  centres  through 
which  the  phenomena  are  induced,  and  not  by  a  direct  sedative  influence 
on  those  centres,  or  on  the  circulation.  But  in  this  very  circumstance  ex- 


264  GENERAL    STIMULANTS.  [PART  II. 

ists  the  danger  of  the  practice.  Should  there  happen  to  exist  already  in 
these  centres,  as  now  and  then  happens  in  acute  rheumatism,  a  vascular 
irritation  or  positive  inflammation,  or  a  strong  tendency  to  it.  then  the 
fear  is  that  quinia  may  aggravate  this  condition,  and  lead  to  fatal  inflam- 
mation within  the  eucephalon.  This  is  asserted  to  have  happened  in 
several  cases,  in  consequence  of  which,  the  practice  has  not  been  gener- 
ally adopted  by  the  profession ;  and  I  am  not  inclined  to  recommend  it. 
The  only  circumstances  under  which  I  should  think  it  advisable  to  ad- 
minister quinia,  in  acute  rheumatism,  not  complicated  with  miasmatic 
fever,  are  those  of  general  debility,  and  especially  as  indicated  by  pro- 
fuse sweats,  occurring  during  sleep,  and  not  at  other  times.  As  before 
stated,  I  have  for  a  long  time  been  in  the  habit  of  employing,  and  of 
recommending,  in  my  lectures,  the  use  of  quinia  freely  in  this  condition, 
and  have  almost  always  found  it  promptly  effectual  in  relieving  the  symp- 
toms, and  generally  curative. 

In  chronic  rheumatism,  the  remedy  is  less  efficient  than  in  the  acute; 
but,  when  carried  to  the  amount  of  thirty  or  forty  grains  daily,  it  has 
sometimes  proved  effectual,  especially  in  cases  in  which  the  inflamma- 
tion has  been  disposed  to  change  its  seat,  and  thus  approach  the  acute 
in  character. 

Gout  is  affected  by  quinia  in  a  manner  very  similar  to  its  mode  of  ac- 
tion in  rheumatism.  In  the  acute  form,  large  doses  of  it  will  some- 
times suppress  the  local  inflammation ;  but  the  disease  is  not  subdued, 
and  there  is  always  danger  of  its  appearance  in  some  other  of  its 
numerous  shapes.  The  practice,  therefore,  is  almost  never  resorted  to. 
But,  in  debilitated  states  of  the  disease,  the  medicine  may  be  used  ad- 
vantageously, as  a  tonic,  and,  in  the  nervous  forms,  is  not  uufrequently 
useful  as  an  anti periodic  or  superseding  remedy. 

In  the  phlegmasise,  or  local  inflammations  attended  with  symptomatic 
fever,  quinia  has  been  thought  by  some  to  have  a  curative  effect,  in 
large  doses,  through  its  sedative  influence.  But,  for  the  cure  of  inflam- 
mation, something  more  is  necessary  than  to  reduce  the  force  and  fre- 
quency of  the  pulse.  Otherwise  digitalis  would  be  among  the  most 
efficient  remedies  in  that  affection,  over  which,  indeed,  it  has  been  found 
to  have  little  influence.  An  important  indication,  in  the  phlegmasise,  is 
to  reduce  or  alter  the  quality  of  the  blood,  as  well  as  to  lessen  the 
quantity,  or  the  force  with  which  it  enters  the  inflamed  part.  Now 
quinia  has  no  effect  of  this  kind.  As  already  stated,  it  has  a  tendency 
rather  to  increase  than  to  diminish  the  proportion  of  fibrin  in  the  blood, 
the  augmentation  of  which  is  one  of  the  characteristics  of  severe  inflam- 
mation. It  is  true  that,  except  in  the  phlegmasiae  of  the  brain,  and  the 
alimentary  mucous  membrane,  and  probably  the  urinary  passages,  it  has 
little  if  any  direct  effect  in  increasing  inflammation ;  and  the  existence, 
therefore,  of  this  condition  does  not  positively  forbid  the  use  of  quinia 


CHAP.  I.]  TONICS. — PERUVIAN    BARK.  265 

when  decidedly  indicated  on  other  grounds ;  but,  in  simple  inflammation 
in  its  active  stage,  there  is  no  sufficient  ground  for  its  use;  and,  in  the 
large  quantities  which  would  be  required  to  suppress  the  febrile  phe- 
nomena, it  might  in  various  ways  do  harm. 

But  there  are  states  of  inflammation  in  which  it  is  highly  useful.  As 
before  mentioned,  it  may  be  employed,  often  with  the  greatest  benefit, 
in  miasmatic  intermittent  and  remittent  fever  complicated  with  this  con- 
dition ;  acting  as  an  antiperiodic  in  reference  to  the  general  disease,  and 
relieving  if  not  curing  the  local,  by  removing  the  injurious  influence  of 
the  paroxysmal  excitement  upon  it.  Moreover,  when  inflammation  is 
attended  with  a  low,  asthenic,  or  typhoid  state  of  system,  this  medicine 
is  highly  useful  as  a  tonic,  aiding  in  the  support  of  the  system  until  the 
inflammation  has  run  its  course.  Upon  the  same  principle,  it  is  useful 
in  the  suppurative  or  gangrenous  state  of  inflammation;  and,  in  these 
cases,  has  the  additional  advantage  that,  by  its  tonic  powers,  it  assists  in 
the  repair  of  the  local  injuries  inflicted  by  the  disease,  which  might  not 
be  carried  on  to  completion  without  this  or  equivalent  aid. 

5.  LOCAL  USE.  Peruvian  bark  is  slightly  irritant  to  the  parts  with 
which  it  is  brought  into  contact,  and  sulphate  of  quinia  more  so.  Hence, 
the  powdered  bark  was  formerly  sprinkled  over  indolent,  flabby,  and 
sloughing  ulcers ;  and  the  decoction  was  employed  as  a  gargle  in  gan- 
grenous ulceration  of  the  fauces.  The  remedy  was  supposed  to  be 
peculiarly  useful  in  mortifying  parts,  from  the  fact  that  bark  has  some 
influence  in  retarding  the  putrefaction  of  animal  matters ;  but  it  is  now 
well  understood  that  the  antiseptic  property,  though  it  may  tend  to  pre- 
vent the  decomposition  of  parts  already  dead,  and,  therefore,  to  correct 
fetor  in  sloughing  ulcers,  has  no  influence  whatever,  as  such,  on  the 
process  of  mortification;  and  consequently,  if  Peruvian  bark  is  useful  in 
such  cases,  it  is  by  supporting  the  vital  actions  through  its  tonic,  and 
not  through  its  antiseptic  powers. 

The  effect  of  the  medicine  in  giving  tone  to  the  stomach  may  be  con- 
sidered as,  in  some  degree,  the  direct  result  of  its  local  application  to 
the  gastric  mucous  membrane ;  and,  in  the  same  way,  it  may  do  good 
in  ulcerative  conditions  of  the  bowels,  in  which  a  local  stimulation  is 
desirable ;  as  in  some  cases  of  chronic  diarrhoea  and  dysentery,  and  the 
advanced  stages  of  enteric  or  typhoid  fever. 

As  quinia  passes  unchanged  through  the  kidneys,  and  is  thus  brought 
into  immediate  contact  with  the  urinary  passages,  it  must  exert  upon 
these  its  ordinary  local  stimulation,  and  may  thus  prove  useful  in  certain 
cases  of  chronic  inflammation  and  ulceration  of  the  pelvis  of  the  kidneys, 
the  ureter,  and  the  bladder,  and  in  retention  and  incontinence  of  urine 
dependent  on  debility  of  the  bladder  or  its  sphincter. 

Sulphate  of  quinia  may  be  used  locally  for  the  same  purposes  as  the 
bark,  but,  in  this  case,  should  be  much  diluted  with  some  unirritating 
material. 


266  GENERAL    STIMULANTS.  [PART  II. 


7.  Preparations,  and  Modes  of  Administration. 

Powdered  Bark.  The  powder  might  be  the  most  efficacious  form  for 
administration,  could  it  always  be  taken  in  sufficient  quantities,  and 
without  irritation  of  the  stomach.  But  its  taste  is  so  revolting  to  most 
patients,  and  it  is  so  apt  to  occasion  nausea,  if  not  vomiting,  that  it  is 
often  almost  impossible  to  employ  it  in  quantities  sufficiently  large  to 
produce  the  effects  required.  The  taste  may,  it  is  true,  to  a  considera- 
ble extent,  be  concealed  or  corrected  by  appropriate  management ;  but 
still  the  medicine  will  often  offend  the  stomach  by  its,directly  nauseating 
properties,  and,  if  in  no  other  way,  by  its  great  bulk  alone.  So  much  do 
these  disadvantages  impair  its  efficiency,  that  formerly,  when  the  bark 
in  substance  was  mainly  relied  on  in  the  treatment  of  periodical  fevers, 
it  was  not  unfrequently  difficult  to  break  them,  and  sometimes  almost 
impossible ;  and,  at  all  events,  the  treatment  was  much  more  prolonged 
than  at  present.  Trousseau,  indeed,  considers  the  powder  preferable  to 
the  sulphate  of  quinia,  being,  as  he  thinks,  less  apt  to  irritate  the  stom- 
ach, and,  if  properly  administered,  less  offensive  to  the  taste;  but  it 
seems  to  me  that  this  eminent  therapeutist  must  either  never  have  taken 
the  medicine  himself,  or  be  misled  by  personal  idiosyncrasy;  for  certainly 
the  general  experience  is  very  much  opposed  to  him.  Nevertheless, 
there  may  be  instances  in  which,  from  constitutional  peculiarity,  sul- 
phate of  quinia  may  fail  of  its  usual  effect ;  or  may  be  accidentally  un- 
attainable in  due  time;  and,  in  either  case,  recourse  may  be  had  to  the 
bark  in  substance 

The  variety  selected  for  internal  use  should  be  one  of  those  richest  in 
alkaloids ;  as  it  is  important  that  as  much  strength  should  be  concen- 
trated in  as  small  a  bulk  as  possible.  Hence,  either  the  Calisaya  bark, 
or  the  best  red  bark,  or  one  of  the  finest  varieties  of  the  Carthagena 
barks,  as  the  soft  or  hard  Pitaya,  should  be  preferred.  (See  U.  S.  Dis- 
pensatury,  12th  ed.)  Any  bark  containing  two  per  cent,  of  alkaloids 
may  be  ranked  among  the  efficient  varieties. 

The  dose  of  powdered  bark,  as  an  antiperiodic,  is  about  a  drachm, 
repeated  every  hour  or  two,  or  at  such  intervals  that  from  one  to  two 
ounces  may  be  taken  between  the  paroxysms.  In  reference  merely  to 
the  tonic  effect,  from  ten  to  thirty  grains  are  sufficient  to  commence  with. 

The  powder  should  be  given  diffused  in  water,  or  other  liquid  vehicle. 
It  is  not  the  best  plan  to  mix  each  dose  extemporaneously  when  admin- 
istered; for  the  dry  powder  is  not  readily  diffused  in  water,  and  the 
attempt  often  results  in  producing  an  offensive  dose,  sufficient,  by  its 
very  appearance,  to  produce  nausea  in  one  who  may  have  previously 
taken  the  medicine.  A  better  method  is  to  introduce  a  certain  quantity 
of  the  bark  and  of  the  vehicle,  say  two  ounces  of  the  former  and  two 


CHAP.  I.]  TONICS. —  PERUVIAN    BARK.  267 

pints  of  the  latter,  into  a  bottle,  allow  them  to  stand  until  the  powder 
has  become  wet  throughout,  and  then,  when  the  dose  is  to  be  taken,  to 
shake  them  well,  and  pour  out  a  wineglassful'  of  the  turbid  liquid.  The 
addition  of  a  fluidrachm  of  aromatic  sulphuric  acid,  for  each  ounce  of  the 
bark,  will  correct  in  some  degree  the  nauseous  taste,  and  increase  its 
efficiency  by  rendering  soluble  the  compounds  of  the  alkaloids  with  the 
colouring  matter.  Wine  was  formerly  much  employed  as  the  vehicle; 
but  it  would  be  too  stimulating  for  ordinary  use.  Trousseau  strongly 
recommends  hot  sweetened  coffee,  which  he  says  completely  corrects 
the  taste.  When  the  bark  purges,  it  should  be  conjoined  with  opium, 
when  it  constipates,  with  a  little  rhubarb. 

Infusions.  The  U.  S.  Pharmacopeia  recognizes  two  infusions,  one 
prepared  from  the  yellow  bark  (!NFUSUM  CINCHONJE  FLAV^E),  the  other 
from  the  red  (!NFUSUM  CINCHONA  RUBR^E).  These  are  not  simple  infu- 
sions, like  those  of  the  preceding  Pharmacopoeia;  but  are  made  in  ac- 
cordance with  the  old  formula  for  compound  infusion  (!NPUSUM  CIN- 
CHONA COMPOSITUM,  U.S.  1850),  by  the  addition  of  a  fluidrachm  of 
aromatic  sulphuric  acid  to  a  troyounce  of  the  powdered  bark.  The  acid 
is  first  mixed  with  a  pint  of  water,  and  this  mixture  is  then  used  in  per- 
colation, enough  water  being  poured  on,  at  the  end  of  the  process,  to 
make  the  infusion  measure  a  pint.  These  are  elegant  preparations,  and 
afford  one  of  the  most  efficient  methods  of  administering  cinchona.  All 
the  virtues  of  the  bark  are  extracted,  and  probably  in  a  condition  of 
greater  activity  than  in  the  powder  itself;  as,  by  means  of  the  acid,  the 
whole  of  the  active  matter  is  now  dissolved,  and  therefore  readily  ab- 
sorbable.  These  infusions  may  be  used  for  all  the  purposes  of  the  medi- 
cine. The  dose  is  two  fluidounces,  to  be  repeated  three  or  four  times  a 
day,  as  a  tonic,  in  chronic  debility ;  every  two  hours  in  low  fevers;  and 
in  such  a  manner  as  to  amount  to  one  or  two  piuts  between  the  parox- 
ysms, in  periodical  diseases.  For  use  in  the  typhous  state  of  fever,  they 
may  be  prepared  with  wine  as  the  menstruum  instead  of  water. 

The  officinal  infusions  above  described  are  expected  to  be  made  in  the 
shop.  For  a  simple  extemporaneous  infusion,  the  old  method  of  macerat- 
ing an  ounce  of  the  coarsely  powdered  or  bruised  bark  in  a  pint  of  boiling 
water,  may  be  resorted  to,  in  accordance  with  the  present  British  plan. 
The  simple  infusion  may  also  be  made  by  treating  the  coarsely  powdered 
bark  by  percolation  with  cold  water,  which  forms  a  more  elegant,  and  prob- 
ably stronger  preparation.  The  hot  infusion  is  somewhat  turbid ;  that  made 
with  cold  water,  perfectly  clear.  In  neither  is  the  bark  nearly  exhausted ; 
for  water  will  not  dissolve  that  portion  of  the  alkaloids  which  is  com- 
bined with  the  cinchonic  red.  Pale  bark  has  sometimes  been  preferred, 
in  consequence  of  its  less  disagreeable  taste ;  but  just  in  the  same  pro- 
portion is  it  less  efficient.  The  preparation  is  at  best  feeble,  and  is  used 
only  as  a  tonic.  The  dose  is  two  fluidounces,  three  or  four  times  a  day 
in  chronic  cases,  more  frequently  in  the  acute. 


268  GENERAL    STIMULANT?.  [PART  II. 

Decoctiona.  The  U.  S.  Pharmacopoeia  directs  separately  the  decoction 
of  the  yellow  bark  (DECOCTUM  CINCHONA  FLAVJE).  and  of  the  red  (DE- 
COCTUM  CINCHONA  RUBR.E).  These  are  made  by  boiling  an  ounce  of 
the  bruised  bark  in  a  pint  of  water,  for  fifteen  minutes,  straining  while 
hot,  and  adding  enough  water  through  the  strainer  to  make  the  decoction 
measure  a  pint.  At  the  end  of  the  boiling,  and  before  the  liquid  begins 
to  cool,  two  drachms  of  orange-peel  may  be  advantageously  added.  This 
mode  of  preparation  was  formerly  much  resorted  to,  when  it  was  deemed 
desirable  to  obtain  the  virtues  of  the  bark  speedily  in  a  liquid  form.  Its 
disadvantages  are  that  it  does  not  completely  exhaust  the  bark,  and  that 
on  cooling  the  decoction  becomes  turbid,  and  deposits  a  precipitate.  The 
turbidness  is  owing,  partly,  to  the  formation  of  tannate  of  starch,  which, 
though  dissolved  by  the  water  when  hot,  is  insoluble  in  cold  water,  and 
therefore  subsides  on  cooling ;  and,  partly,  to  the  deposition  of  a  com- 
pound of  the  alkaloids  with  the  colouring  matter,  previously  existing  in 
the  bark,  and  partially  taken  up  by  the  water  at  the  boiling  temperature. 
Hence  the  necessity  of  straining  while  hot,  so  that  a  portion  of  the  ac- 
tive matter  extracted  in  the  decoction  may  not  be  lost.  Of  course,  the 
precipitated  matter  should  be  again  mixed  with  the  water  by  stirring, 
when  the  decoction  is  administered.  It  would  be  a  great  improvement 
in  this  preparation  to  add  a  little  sulphuric,  muriatic,  or  citric  acid  to 
the  menstruum  before  boiling.  The  bark  would  then  be  exhausted,  and 
the  active  matter  retained  in  solution  upon  the  cooling  of  the  decoction. 
Wine  may  be  advantageously  substituted  for  water  in  the  preparation, 
when  there  is  an  indication  at  once  for  alcoholic  stimulation  and  the 
effects  of  the  bark,  as  often  happens  in  low  levers.  Indeed,  the  decoction 
of  bark  in  wine  was  formerly  much  used  in  the  prostrate  state  of  fevers 
of  a  typhoid  character,  and  with  great  advantage.  The  dose  of  the  de- 
coction is  two  fluidounces,  to  be  repeated  in  the  same  manner  as  the 
infusion. 

Tinctures.  Two  tinctures  are  directed  by  our  officinal  code,  one 
simple,  and  the  other  compound. 

The  simple  Tincture  (TiNCTDBA  CINCHONA,  U.  S.)  is  ordered  to  be 
made  with  the  officinal  yellow  or  Calisaya  bark.  This  is  in  order  to 
insure  efficiency;  for  this  variety  of  bark  is  more  uniformly  strong  with 
alkaloids  than  most  others;  but  any  variety  ascertained  to  be  of  equal 
strength  may  be  employed.  The  bark  is  probably  completely  exhausted 
when  the  process  is  properly  conducted,  especially  if  percolation  is  em- 
ployed. The  tincture  would,  therefore,  be  very  efficient,  were  it  not  that 
the  proportion  of  alcohol  to  the  active  matter  dissolved  by  it  is  so  great 
as  to  give  undue  prominence  to  its  effects,  and  thus  often  to  render  im- 
possible the  administration  of  a  sufficient  quantity  to  obtain  the  desired 
influence  of  the  bark.  Though  the  tincture  is  strong,  yet  a  fluidounce 
of  it  contains  the  virtues  of  only  a  drachm  and  a  half  of  the  bark.  In 


CHAP.  I.]  TONICS. — PERUVIAN    BARK.  269 

patients  of  intemperate  habits,  or  in  very  prostrate  states  of  fever,  this 
would  be  an  advantage ;  and,  in  such  cases,  the  tincture  may  be  used 
with  propriety.  But  it  is  more  prescribed  as  an  addition  to  the  infusion 
or  decoction,  or  in  connection  with  sulphate  of  quinia,  in  cases  requiring 
alcoholic  stimulation,  than  by  itself.  It  may  be  thus  employed  with 
propriety  in  cases  of  pernicious  fever,  attended  with  great  prostration, 
as  well  as  in  fevers  of  the  typhous  character.  In  consequence  of  the 
resin  it  contains,  it  becomes  turbid  on  dilution  with  water.  The  dose  is 
from  one  to  four  fluidrachms. 

The  Compound  Tincture  (TmcTURA  CINCHONA  COMPOSITA,  U.  £.)  is 
the  preparation  commonly  known  as  Huxhairi's  tincture.  It  differs  from 
the  preceding  in  containing  serpentaria  and  orange-peel  with  colouring 
matter,  and  in  being  prepared  with  red  instead  of  yellow  bark.  It  is 
made  with  a  much  smaller  proportion  of  bark  than  the  simple  tincture, 
and  is  less  suitable  as  an  antiperiodic,  or  in  cases  requiring  a  strong  im- 
pression from  the  medicine.  It  is,  however,  an  elegant  stomachic  cor- 
dial, useful  in  cases  of  feeble  digestion  and  general  debility.  The  dose  is 
a  fluidrachm. 

Extracts.  An  Extract  (ExTRACTUM  CINCHONA  FLAV^E,  U.  $.)is  pre- 
pared, according  to  our  officinal  code,  from  the  yellow  bark;  but  the 
preparation  would  be  equally  effectual  made  from  the  red,  if  carefully 
selected.  In  its  preparation,  the  bark  is  exhausted  first  by  alcohol  and 
afterwards  by  water;  the  tincture  and  infusion  are  separately  evaporated 
to  the  consistence  of  honey ;  and  the  two  are  then  mixed,  and  the  evapo- 
ration completed.  It  thus  appears  that  the  bark  is  deprived  of  all  its 
active  matter ;  and  the  extract  cannot  but  be  very  efficient,  if  due  care 
is  exercised  in  selecting  the  bark,  and  in  conducting  the  evaporation. 
But,  as  a  large  proportion  of  the  matter  dissolved  by  the  menstrua  is 
inert,  as  the  gum,  resin,  and  cinchonic  red,  the  preparation  is  much  less 
efficient  than  the  separated  alkaloids,  and  is  now  little  used.  As  found 
in  the  shops,  it  is  not  unfrequently  very  feeble,  from  the  want  of  at- 
tention to  the  points  above  referred  to.  The  dose  is  from  ten  to  thirty 
grains. 

The  Fluid  Extract  (EXTRACTUM  CINCHONA  FLUIDUM,  U.  S.)  is  a  new 
officinal  of  our  Pharmacopoeia.  It  is  a  highly  concentrated  tincture,  from 
which  a  considerable  proportion  of  the  alcohol  has  been  driven  off,  and 
its  place  as  a  preservative  agent  supplied  by  sugar.  It  is  much  pre- 
ferable to  the  Extractum  Cinchonse.  Flavse  Liquidum  of  the  British 
Pharmacopoeia,  which  is  simply  an  inspissated  infusion,  to  which  spirit 
is  added,  partly  for  its  preservation,  and  partly  for  the  solution  of  matter 
deposited  during  the  latter  part  of  the  process.  This  latter  preparation 
is  no  doubt  efficacious,  but  is  liable  to  the  same  objection  as  all  others  in 
which  water  alone  is  the  menstruum  ;  namely,  that  the  virtues  of  the  bark 
are  not  wholly  extracted.  The  dose  of  the  U.  S.  fluid  extract,  represent- 


270  GENERAL    STIMULANTS.  [PART  II. 

ing  a  drachm  of  the  hark,  is  two  fluidrachms.     For  antiperiodic  effect, 
at  least  two  fluidounccs  should  be  given  between  the  paroxysms. 

SULPHATE  OF  QUINIA.— QUININE  SULPHAS.  U.  S.,  Br. 

Preparation.  This  is,  beyond  all  comparison,  the  most  important  and 
most  extensively  used  of  the  preparations  of  bark,  and  may  be  consid- 
ered as  a  sufficient  representative  of  its  virtues,  on  all  ordinary  occasions. 
For  the  details  of  its  preparation,  the  reader  is  referred  to  the  U.  S.  Dis- 
pensatory. For  our  purposes  here,  it  is  sufficient  to  state  that  officinal 
yellow  or  Calisaya  bark,  which  is  usually  selected,  is  exhausted  by  boil- 
ing it  with  water  acidulated  with  muriatic  or  sulphuric  acid;  that,  from 
the  decoction  thus  obtained,  the  quinia  and  other  alkaloids  are  precipi- 
tated, together  with  impurities,  by  means  of  lime;  that  the  precipitate  is 
treated  with  alcohol,  which  dissolves  the  alkaloids;  that  the  alcoholic 
solution  is  then  evaporated ;  and,  finally,  that  from  the  residue,  consist- 
ing mainly  of  quinia,  the  sulphate  is  obtained  by  treating  it  with  boiling 
water  and  sulphuric  acid,  purifying  with  animal  charcoal,  and  crystal- 
lizing. 

Sensible  and  Chemical  Properties.  Sulphate  of  quinia  is  in  minute, 
white,  silky,  flexible,  needle-shaped  crystals,  in  tufts  or  interlaced,  in- 
odorous, intensely  bitter,  fusible  at  240°  F.,  soluble  in  740  parts  of  cold 
water,  30  of  boiling  water,  and  60  of  alcohol,  and  very  slightly  soluble 
in  ether.  It  is,  however,  very  readily  dissolved  by  water  acidulated 
with  almost  any  one  of  the  sour  acids.  It  is  also  soluble,  to  a  consider- 
able extent,  in  glycerin,  which,  if  slightly  heated,  is  said  to  take  up 
more  than  one-twelfth  of  its  weight.  (Lancet,  Am.  ed.,  ii.  262.)  Its 
aqueous  solution  exhibits  a  beautiful  bluish  colour  or  opalescence  on  its 
surface.  Two  views  are  taken  of  its  composition;  one,  that  it  is  a 
neutral  sulphate,  containing  one  eq.  of  acid  and  one  of  base ;  the  other, 
that  it  is  a  disulpkate,  containing  one  eq.  of  acid,  and  two  eqs.  of  base. 
The  former  opinion,  which  was  first  entertained,  subsequently  gave  way 
to  the  latter;  but  some  chemists  are  disposed  to  return  to  it,  and  the 
author  has  always  considered  it  as  most  probably  correct;  so  that  the 
ordinary  designation  of  the  salt  should,  in  his  view,  be  retained.  If  it 
be  considered  a  neutral  salt,  its  exact  composition  will  be  expressed  by 
the  formula;  one  eq.  of  sulphuric  acid  40,  one  of  quinia  324,  and  eight 
eqs.  of  water  72  =  436.  It  loses  part  of  its  water  of  crystallization  by 
exposure,  or  by  heat,  but  always  retains  about  4  per  cent,  or  two  eqs.  of 
water,  from  which  it  cannot  be  separated  without  decomposition. 

Bisulphate  of  Quinia.  By  an  additional  equivalent  of  sulphuric  acid, 
the  sulphate  is  converted  into  the  bisulphate,  by  some  considered  as  the 
neutral  salt.  This  is  much  more  soluble  in  water  than  the  ordinary  sul- 
phate, requiring  only  11  parts  of  cold  water  for  solution,  and  is  freely 
dissolved  by  alcohol.  It  is  formed  extemporaneously  in  solution,  with 
the  utmost  facility,  by  gradually  dropping  a  little  diluted  sulphuric  acid 


CHAP.   I.]  TONICS. SULPHATE    OP    QUINTA.  271 

into  a  mixture  of  the  ordinary  sulphate  with  water,  until  the  latter  is 
dissolved. 

Incompatibles.  The  substances  which  yield  precipitates  with  solutions 
of  sulphate  of  quinia,  and  should,  therefore,  not  be  administered,  as  a 
general  rule,  along  with  it,  are  the  alkalies  and  their  carbonates,  the 
alkaline  earths,  all  astringent  solutions  containing  tannic  acid,  and  the 
soluble  salts  of  lead  and  baryta.  The  soluble  salts  of  oxalic,  tartaric, 
and  gallic  acids  also  occasion  more  or  less  precipitation  with  solution  of 
sulphate  of  quinia,  without  excess  of  acid;  and  the  same  has  been  ascer- 
tained to  be  the  case,  by  Mr.  Maisch,  with  the  soluble  acetates  (Am. 
Jo  urn.  of  P/mrm.,  xxvii.  97);  but  the  precipitates  may  be  redissolved 
by  the  addition  of  an  acid. 

Adulteration.  Sulphate  of  quinia  is  liable  to  adulteration;  but  this 
can  generally  be  easily  detected  by  referring  to  its  peculiar  solubilities. 
The  presence  of  mineral  substances,  not  easily  volatilized  by  heat,  will 
be  evinced  by  a  residue  left  behind  when  a  small  portion  of  the  salt  is 
put  upon  red-hot  iron.  (See  U.  S.  Dispensatory,  llth  ed.,  p.  1239.) 

Effects.  The  properties  of  sulphate  of  quinia  as  a  therapeutic  agent 
have  already  been  sufficiently  considered.  In  reference  to  its  antiperi- 
odic  and  secondary  sedative  effects,  it  has  all  the  power  of  bark,  and 
more  indeed  than  can  always  be  exerted  by  the  crude  medicine.  As  a 
mere  tonic,  it  is  possible  that  the  compound  infusion,  or  some  other  pre- 
paration in  which  all  the  active  principles  of  bark  are  contained,  or  the 
bark  itself  in  substance,  may  be  more  efficacious;  but  I  do  not  think  that 
the  fact  has  been  rigidly  demonstrated.  The  peculiar  advantages  of  the 
salt  are  its  convenience  of  administration,  its  general  acceptability  to  the 
stomach,  the  rapidity  with  which  it  is  absorbed,  the  facility  of  ascer 
taining  its  purity  and  genuineness,  and  the  opportunity  which  it  af- 
fords, by  the  smallness  of  its  dose,  of  obtaining  the  peculiar  effects  of 
bark  in  a  degree  greater  than  can  be  obtained,  as  a  general  rule,  from 
the  bark  itself. 

Administration.  Sulphate  of  quinia  may  be  administered  in  substance 
or  solution.  In  my  own  experience,  I  have  been  able  to  discover  little 
difference,  in  therapeutic  results,  between  these  two  modes  of  exhibi- 
tion ;  though  it  is  asserted  by  M.  Briquet,  as  an  inference  from  his  ex- 
periments, that  the  solution  formed  by  the  addition  of  a  little  sulphuric 
acid,  and  containing,  therefore,  the  bisulphate,  will  produce  the  antiperi- 
odic  effect  more  quickly,  and  in  considerably  smaller  doses,  than  the 
ordinary  sulphate  given  in  substance.  There  can  be  no  doubt  that  the 
salt  in  solution  will  be  more  readily  absorbed  into  the  circulation  than 
the  undissolvcd  salt;  but  the  ordinary  sulphate  is  so  readily  dissolved 
by  water  slightly  acidulated  with  almost  any  acid,  that  the  instances 
must  be  very  few,  in  which  there  is  not  sufficient  acid  in  the  primaj  viae 
for  this  purpose.  It  is,  I  presume,  very  seldom  that  the  sulphate  of 


272  GENERAL   STIMULANTS.  [PART  II. 

quinia  passes  undissolved  through  the  stomach,  unless  secured  against 
the  action  of  the  gastric  acids  by  a  vicious  mode  of  exhibition.  The 
salt  in  substance  is  usually  given  in  pill,  or  suspended  in  water;  very 
rarely  in  the  form  of  powder. 

The  officinal  Pilla  of  Sulphate  of  Quinia  (PILULE  QUINIA  SUL- 
PHATIS,  U.  S. )  are  made  by  the  addition  of  gum  and  honey,  and  contain, 
each,  a  grain  of  the  salt.  They  answer  very  well  when  made  extempo- 
raneously ;  but,  if  kept  very  long,  there  is  danger  that  they  may  become 
so  hard  as  to  afford  a  mechanical  impediment  to  solution,  and  conse- 
quently to  pass  through  the  stomach  unchanged.  Nevertheless,  I  have 
used  very  old  officinal  pills,  with  prompt  and  powerful  effect,  as  an  anti- 
periodic.  A  method  of  preparing  them  suggested  by  Mr.  Edward  Par- 
rish  seems  to  offer  some  advantages.  This  plan  is  simply  to  triturate 
together  20  grains  of  the  salt  and  15  drops  of  aromatic  sulphuric  acid, 
until  a  pilular  mass  is  formed.  The  pills  are  thus  obtained  of  smaller 
bulk  and  more  soluble ;  and  a  pill  of  five  grains  is  not  inconveniently 
large. 

The  salt,  if  finely  powdered,  may  be  suspended  in  water  by  simple 
agitation ;  but  the  intervention  of  syrup  or  mucilage  is  preferable.  M. 
Trousseau  gives  it  stirred  up  in  hot  and  sweetened  coffee,  which  seems 
to  correct  its  taste.  The  probable  conversion  of  the  salt  into  an  insoluble 
tannate  may  be  urged  against  this  method  of  exhibition;  and  the  same 
objection  holds  against  the  plan  of  mixing  the  salt  with  tannic  acid,  as 
recommended  by  the  late  Dr.  Thomas,  of  Baltimore ;  but  when  it  is  very 
important,  as  in  some  infantile  cases,  to  destroy  the  taste,  either  method 
may  be  employed ;  as,  though  the  tannate  may  act  less  rapidly,  and  re- 
quire a  larger  quantity  for  a  given  effect,  than  the  sulphate,  yet  it  is  in 
fact  dissolved  in  the  stomach  whenever  acid  is  present,  and  experience 
has  proved  its  efficiency.  Dr.  W.  H.  Edwards,  of  Virginia,  has  found 
that,  by  enveloping  sulphate  of  quinia  in  a  spoonful  of  thick  mucilage  of 
slippery  elm,  without  allowing  it  to  touch  the  sides  of  the  spoon,  it  may 
be  taken  without  the  taste  being  in  the  least  degree  observed.  (Stetho- 
scope, iv.  338.) 

The  solution  of  sulphate  of  quinia,  which,  when  its  bitter  taste  is 
not  objectionable,  is  the  best  form  for  administration,  may  be  made  by 
adding  twelve  minims  of  aromatic  sulphuric  acid  to  eight  grains  of  the 
salt  in  a  fluidounce  of  water;  in  other  words,  a  minim  and  a  half  for 
each  grain. 

Twelve  grains  of  the  sulphate  may  be  considered  as  equivalent  to  one 
ounce  of  good  bark. 

The  doses  proper  under  different  circumstances  have  been  already 
stated.  It  may  be  repeated  that,  as  a  tonic,  the  dose  of  sulphate  of 
quinia  is  a  grain,  to  be  repeated  in  chronic  cases  three  or  four  times  a 
day,  in  acute  cases  every  two  or  three  hours ;  as  an  antiperiodic,  from 


CHAP.  I.]         TONICS. — SULPHATE  OF  QUINIA.  273 

twelve  to  twenty -four  grains  between  the  paroxysms,  in  ordinary  periodi- 
cal diseases,  which  may  be  increased,  in  pernicious  fever,  and  very  ob- 
stinate neuralgia,  to  from  thirty  to  sixty  grains,  these  amounts  being, 
as  a  general  rule,  divided  into  doses  of  from  one  to  five  grains  at  equal 
intervals;  and,  in  reference  to  the  secondary  sedative  effects,  not  less 
than  fifteen  or  twenty  grains  daily,  which  must  sometimes  be  consider- 
ably increased. 

A  Tincture  of  sulphate  of  quinia  is  directed  in  the  Br.  Pharmacopoeia 
under  the  name  of  TINCTURA  QUINIA  COMPOSITA,  being  made  by  dis- 
solving sulphate  of  quinia  in  tincture  of  orange-peel.  A  fluidrachm  of  it 
contains  a  grain  of  sulphate  of  quinia.  It  is  a  convenient  preparation  in 
some  cases  where  the  conjoint  use  of  quinia  and  alcohol  is  indicated. 

If  the  stomach  will  not  retain  the  salt,  it  may  be  given  by  the  rectum  ; 
from  six  to  twelve  grains,  in  ordinary  cases,  either  dissolved  by  means 
of  a  little  citric  acid,  or  suspended  in  two  fluidounces  of  mucilage  or 
solution  of  starch,  and  mixed  with  from  twenty  to  forty  drops  of  lauda- 
num, being  injected  into  the  rectum  every  six  hours.  In  urgent  cases, 
this  quantity  may  be  very  greatly  increased. 

The  endermic  method  is  sometimes  resorted  to;  but  the  application  of 
sulphate  of  quinia,  undiluted,  upon  a  surface  deprived  of  the  cuticle,  is  apt 
to  produce  superficial  sloughs;  and  its  employment  in  this  way  should  be 
restricted  to  cases  of  emergency.  It  should  also  be  mixed,  before  applica- 
tion, with  some  unirritating  substance,  as  powdered  gum  or  arrow-root. 
The  epigastrium,  and  insides  of  the  thighs  and  arms,  are  proper  positions 
for  its  endermic  use. 

The  hypodermic  method  has  come  into  considerable  use,  and  in  cer- 
tain cases  may  be  very  advantageously  employed.  Indeed,  sulphate  of 
quinia  is  peculiarly  adapted  for  subcutaneous  injection ;  being  readily 
absorbed  by  the  areolar  tissue,  and  producing  its  effects  in  quantities 
not  too  large  for  this  mode  of  application ;  but  it  is  liable  to  the  ob- 
jection, that  it  is  not  readily  dissolved,  while  the  success  of  the  plan 
depends  upon  the  perfect  fluidity  of  the  substance  injected.  This  ob- 
jection, however,  may  be  obviated  by  means  which  will  be  mentioned 
directly.  The  characteristic  effects  of  quinia  on  the  system  are  more 
rapidly  and  more  certainly  obtained  in  this  than  in  the  ordinary  modes 
of  administration ;  and,  in  the  same  dose,  the  medicine  will  produce 
greater  effects.  Besides,  the  patient  escapes  all  those  disturbances  of 
the  stomach  which  occasionally  follow  its  use  when  swallowed.  The 
hypodermic  method,  however,  is  liable  to  some  slight  inconveniences, 
which  will  prevent  its  general  substitution  for  the  usual  methods ;  but 
there  are  circumstances  which  decidedly  indicate,  and  some  which  im- 
peratively call  for  it.  1.  Whenever  there  is  an  obvious  indication  for  the 
use  of  quinia,  and,  after  a  fair  trial  by  the  mouth  and  rectum,  it  fails  to 
produce  the  desired  effect,  there  is  clearly  a  call  for  its  subcutaneous 

VOL.  I. — 18 


274  GENERAL    STIMULANTS.  [PART  II. 

use.  2.  A  still  stronger  demand  is  made  for  it  in  cases  where,  from  an 
irritable  state  of  the  stomach  or  bowels,  from  an  inability  or  refusal  to 
swallow  it,  as  in  some  low  cases  of  disease,  and  with  maniacs  or  infants, 
or  from  idiosyncrasies  of  the  patient,  it  is  either  very  difficult  or  alto- 
gether inexpedient  to  give  it  by  the  mouth.  3.  There  are,  besides, 
affections  so  exceedingly  painful,  and  others  so  imminently  dangerous  to 
life,  that  it  is  imperatively  necessary  to  have  recourse  to  the  most  prompt 
and  most  effectual  means  of  relief  and  safety.  This  condition  of  things 
is  presented  in  certain  cases  of  neuralgia,  and  in  all  cases  of  the  per- 
nicious form  of  miasmatic  fever,  especially  in  the  latter,  when,  as  often 
happens,  the  stomach  is  excessively  irritable. 

For  the  method  of  effecting  subcutaneous  injection,  and  the  instru- 
ments employed,  the  reader  is  referred  to  page  81  of  this  volume.  To 
obtain  the  salt  of  quinia  in  the  liquid  form,  it  is  necessary  either  to 
use  the  bisulphate,  which  is  much  more  soluble  than  the  sulphate,  or, 
what  is  still  better,  to  add  just  as  much  of  the  diluted  sulphuric  acid, 
or  of  one  of  the  vegetable  acids,  as  the  acetic,  citric,  or  tartaric,  as  may 
be  necessary  for  the  solution  of  the  sulphate  in  the  admissible  quantity  of 
water,  which  for  one  dose  should  not  exceed  twenty  or  thirty  minims. 
It  is  important  not  to  use  more  acid  for  the  purpose  than  is  necessary  to 
solution,  because  in  excess  it  acts  as  an  irritant  to  the  tissues.  The  dose 
of  the  sulphate  of  quinia  may  be  from  one-third  to  one-half  that  given  by 
the  mouth  for  the  same  purpose.  For  antiperiodic  effect,  four  or  five 
grains  may  be  given  two  or  three  hours  before  the  expected  paroxysm; 
and  if  postponed  still  later,  even  to  within  an  hour  or  three-quarters  of 
the  chill,  some  effect  may  be  expected.  The  solution  may  be  injected  in 
either  of  the  extremities,  or  in  the  trunk  along  the  spine.  On  the  whole 
the  arm  is  the  most  convenient. 

Friction  upon  the  surface  with  sulphate  of  quinia,  in  the  form  of 
liniment  or  ointment,  has  also  been  recommended.  For  this  purpose, 
a  drachm  of  the  sulphate,  finely  powdered,  may  be  incorporated  with 
two  drachms  of  lard;  but  it  would  be  better  that  the  salt  should  be 
preliminarily  dissolved,  as  it  is  more  readily  absorbed  in  this  state. 
The  following  formula  is  essentially  that  of  M.  Boudin.  Dissolve  a 
drachm  of  sulphate  of  quinia  in  the  least  possible  quantity  of  alcohol, 
with  the  aid  of  a  little  aromatic  sulphuric  acid,  and  incorporate  the  solu- 
tion with  four  drachms  of  melted  lard.  The  salt  being  soluble  in  oleic 
acid,  or  pure  lard  oil,  M.  Lhermite  recommends  to  dissolve  one  part  of 
it  in  ten  parts  of  the  oil,  with  the  aid  of  a  gentle  heat ;  the  oil  being  pre- 
viously scented  with  an  agreeable  volatile  oil,  as  that  of  bcrgamot,  for 
example.  Kit  her  of  these  preparations  may  be  rubbed,  ad  libitum,  upon 
the  inside  of  the  upper  or  lower  extremities,  or  in  the  axilla. 

The   idea  of  bringing  young  infants  under  the  influence  of  quinia 
through  the  milk  of  the  mother,  by  administering  the  medicine  to  the 


CHAP.  I.]  TONICS. — SULPHATE    OF   QUINIA.  275 

latter,  has  suggested  itself  to  practitioners;  but  the  alkaloid  is  probably 
not  thrown  off  with  this  secretion;  at  least  numerous  attempts  to  detect. 
it  in  the  milk  of  women  under  its  influence  have  failed.  This  plan, 
therefore,  should  never  be  relied  on,  and  is  the  less  necessary,  as  it  is 
very  easy  to  give  the  remedy  to  the  child  directly,  by  resorting  to  some 
expedient  for  covering  the  taste. 

Other  Sails  of  Quinia.  Numerous  other  salts  of  quinia  have  been 
recommended,  on  various  grounds,  as  substitutes  for  the  sulphate.  The 
acetate,  an/imoniate,  arsenite,  and  arseniate,  citrate,  fcrrocyanate,  lac- 
tate,  muriate,  tannate,  and  valerianate,  have  severally  had  their  peculiar 
advocates;  but  the  insolubility  of  most  of  them  is  one  objection;  and. 
though  this  may  be  overcome  by  the  acid  of  the  stomach,  or  the  addition 
of  an  acid  previously  to  administration,  yet  there  exists  another  objec- 
tion ;  that,  namely,  as  they  act  through  the  quinia  they  contain,  and  all 
of  them  have  a  less  proportion  of  this  than  the  sulphate,  in  consequence 
of  the  higher  combining  number  of  their  acid,  they  must  be  proportiona- 
bly  less  efficient,  even  when  dissolved.  Besides,  experience  has  failed 
to  establish  any  superiority  of  any  one  of  them  over  the  sulphate,  except 
as  regards  the  taste ;  and,  in  relation  to  the  salts  with  arsenious  and 
arsenic  acids,  they  cannot  be  given  in  quantities  sufficient  to  obtain  the 
influence  of  quinia  over  the  system,  without  incurring  the  risk  of  danger 
from  the  arsenical  ingredient.  Of  the  above  named  salts,  the  valerianate 
of  quinia  (QUININE  YALERIANAS,  U.  S.)  is  officinal;  and  directions  for  its 
preparation  are  given  in  the  U.  S.  Pharmacopoeia.  It  is  soluble  in  110 
parts  of  cold  and  40  of  boiling  water,  in  6  parts  of  cold  and  an  equal 
weight  of  boiling  alcohol.  It  has  a  strong  disagreeable  odour  of  valeri- 
anic  acid.  It  is  peculiarly  applicable  to  debility  combined  with  nervous 
disorder,  and  may  be  found  useful  in  some  cases  of  neuralgia,  and  hemi- 
crania.  The  dose  is  one  or  two  grains,  three  or  four  times  a  day. 

CRUDE  QUINIA.  In  the  process  for  preparing  sulphate  of  quinia, 
after  the  evaporation  of  the  alcoholic  solution,  and  before  the  addition  of 
sulphuric  acid,  a  semiliquid  -substance  is  obtained,  which,  being  dried, 
constitutes  the  substance  here  referred  to,  under  the  name  of  crude  quinia. 
It  has  a  resinous  aspect,  and  a  brownish-fawn  colour  more  or  less  deep, 
is  softened  by  heat  so  as  easily  to  be  formed  into  pills,  is  much  less  bitter 
than  the  sulphate,  and  consists,  as  procured  from  Calisaya  bark,  mainly 
of  quinia,  which  is  mixed  with  whatever  other  alkaloids  may  exist  in 
the  bark,  and  more  or  less  colouring  and  perhaps  resinous  matter.  It 
has  all  the  effects  of  sulphate  of  quinia,  and  may  be  employed  for  the 
same  purposes.  Though  but  very  slightly  soluble  in  water,  it  is  readily 
dissolved  by  the  addition  of  an  acid,  and  is  consequently  soluble  in  the 
gastric  liquor.  From  its  comparative  want  of  taste,  it  is  applicable  to 
infantile  cases.  The  only  objection  to  it  is  that,  from  its  want  of  a  pre- 
cisely definite  composition,  it  cannot  be  so  readily  guarded  against 


276  GENERAL   STIMULANTS.  [PART  II. 

adulteration.  It  may  be  given  in  the  same  doses  as  sulphate  of  quinia, 
either  in  pill,  or  suspended  in  water.  Dissolved  by  means  of  an  acid,  it 
acquires  the  bitter  taste  of  the  sulphate. 

QUINOIDIN. — AMORPHOUS  QUINIA — QUINICIA  and  CINCHONICIA. 
After  the  crystallization  of  all  the  sulphate  of  quinia  that  can  be  obtained 
in  that  form,  in  the  process  for  preparing  the  salt,  there  is  left  behind  a 
mother  liquor,  by  the  evaporation  of  which  a  dark  amorphous  substance 
is  obtained,  which  was  formerly  recognized  by  our  Pharmacopoeia  under 
the  name  of  impure  sulphate  of  quinia.  This  had  been  used,  before 
being  thus  officinally  recognized,  by  the  late  Dr.  Samuel  Emlen,  of  Phila- 
delphia, and  by  the  author,  with  all  the  effects  of  the  pure  sulphate  in 
the  case  of  intermittents,  though  requiring  to  be  given  in  about  double 
the  dose.  It  was  supposed  to  consist  of  sulphate  of  quinia  with  a  little 
sulphate  of  cinchonia,  and  colouring  impurities.  From  the  want  of  pre- 
cise characters  by  which  it  could  be  recognized,  it  has  been  abandoned 
in  the  recent  revisions  of  the  Pharmacopoeia. 

Serturner  supposed  that,  in  this  residuary  matter,  he  had  found  a  new 
alkaloid,  which  was  named  quinoidin  from  its  resemblance  to  quinia. 
According  to  Liebig  this  new  alkaloid  has  the  same  composition  as 
quinia,  from  which  it  differs  only  in  being  uncrystallizable,  and  impart- 
ing this  same  property  to  its  salts.  He  therefore  named  it  amorphous 
quinia.  Pasteur  ascertained  that  what  was  called  quinoidin  by  Ser- 
tiirncr,  and  amorphous  quinia  by  Liebig,  consists  usually  of  two  alka- 
loids, one  called  by  him  quinicia,  because  derived  from  quinia,  the  other 
cinchonicia,  from  the  same  relation  to  cinchonia.  They  are  probably 
mainly  the  result  of  the  process  for  extracting  the  alkaloids;  the  heat 
employed  having  the  effect  of  modifying  the  state  of  quinia  and  cinchonia, 
as  the  same  agency  converts  crystallizable  into  uncrystallizable  sugar. 

The  substance  called  quinoidin  in  commerce,  containing  the  amor- 
phous quinia  of  Liebig,  is  obtained  by  precipitating  the  mother  liquor 
of  sulphate  of  quinia  above  referred  to,  by  means  of  an  alkaline  car- 
bonate, which  decomposes  the  sulphates  contained  in  it,  and  throws 
down  the  uncombined  alkaloids.  By  repeated  solution  and  precipita- 
tion, the  alkaline  matter  may  be  obtained  quite  pure,  and,  in  this  state, 
consists  of  the  two  alkaloids  quinicia  and  cinchonicia,  together  with 
whatever  other  organic  alkali  may  have  existed  in  the  bark,  as  cin- 
chonia, and  possibly  sometimes  quinia,  quinidia,  and  cinchonidia.  When 
pure,  it  is  an  excellent  preparation,  and  may  be  employed,  in  all  cases, 
as  a  substitute  for  sulphate  of  quinia,  in  about  the  same  dose. 

SULPHATE  OP  CINCHONIA.  —  CINCHONAS  SULPHAS.  U.  S. 
This  was  first  recognized  as  officinal  in  the  present  U.  S.  Pharmacopoeia. 
It  may  be  made  by  directly  combining  its  ingredients,  or  by  crystallization 
from  the  mother  waters  of  sulphate  of  quinia,  after  this  salt  has  been 
wholly  separated  from  them.  It  is  in  short,  oblique,  shining,  prismatic 


CHAP.  I.]  TONICS. — SULPHATE    OF   CINCHONIDIA.  277 

crystals,  with  dihedral  summits,  which  melt  at  212°  P.,  are  soluble  in 
54  parts  of  cold,  and  a  much  smaller  proportion  of  boiling  water,  are 
readily  dissolved  by  alcohol,  and  scarcely  soluble  in  ether,  and  have  a 
very  bitter  taste.  The  salt  is  either  a  sulphate  or  disulphate,  according 
to  the  opinion  which  may  be  adopted  as  to  the  equivalent  of  cinchonia; 
and,  like  the  sulphate  of  quinia,  may  be  converted  into  a  more  soluble 
salt  by  combination  with  an  additional  equivalent  of  acid.  It  has  been 
abundantly  proved  to  have  the  therapeutic  virtues  of  sulphate  of  quinia, 
though  somewhat  feebler.  A  general  result  of  observation  has  been 
that  it  is  less  apt  than  sulphate  of  quinia  to  occasion  buzzing  in  the  ears, 
deafness,  and  disturbance  of  vision,  at  least  in  the  same  dose ;  though, 
according  to  Bouchardat,  it  produces,  even  in  smaller  doses  and  more 
certainly  than  that  salt,  a  peculiar  headache,  rather  severe,  which  is 
seated  specially  in  the  anterior  part  of  the  head,  and  is  attended  with  a 
remarkable  feeling  of  compression.  (Ann.  de  Thcrap.,  1857,  p.  126.) 
To  obtain  the  same  effects  from  it,  the  dose  should  be  about  one-third, 
or  at  least  one-quarter,  greater  than  that  of  the  salt  of  quinia. 

SULPHATE  OF  CINCHONIDIA. — CINCHONIDIA  SULPHAS.  This 
is  the  salt  which  a  few  years  since  first  came  into  notice  under  the  name 
of  sulphate  of  quinidia,  which  name  is  commercially  still  applied  to  it. 
The  fact  is  that,  as  sold,  it  is  usually  complex,  consisting  of  the  two  sul- 
phates of  cinchonidia  and  quinidia,  though  with  a  great  predominance 
of  the  former.  It  is  obtained  for  use  from  the  barks  which  most  abound 
in  cinchonidia,  by  the  same  process  as  that  employed  in  the  preparation 
of  sulphate  of  quinia  from  Calisaya  bark.  Like  the  analogous  salt  of 
quinia,  this  is  considered  by  some  as  a  neutral,  by  others  as  a  subsalt, 
and  by  the  latter  would  be  called  a  disidphale.  It  is  in  long,  silky, 
acicular  crystals,  soluble  in  130  parts  of  cold  and  16  of  boiling  water, 
readily  soluble  in  alcohol,  but  nearly  insoluble  in  ether;  and  by  these 
properties  may  be  distinguished  from  the  corresponding  salt  of  quinia. 
It  has  the  same  effects  as  the  sulphates  of  quiiiia  and  cinchonia,  and  may 
be  employed  in  the  same  doses  as  the  latter  salt.  That  it  is  little  if  at 
all  inferior,  in  the  treatment  of  intermittent  fever,  has  been  abundantly 
proved  by  the  trials  made  with  it  by  Dr.  J.  S.  Dorsey  Cullen,  in  the 
Almshouse  Hospital  of  Philadelphia  (Am.  Journ.  of  Med.  Sci.,  N.  S., 
xxix.  81);  and  those  of  Dr.  Geo.  L.  Upshur,  surgeon  to  the  U.  S.  Ma- 
rine Hospital  at  Norfolk  (Med.  Examiner,  N.  S.,  x.  740).  From  fifteen 
to  thirty  grains  were  employed  between  the  paroxysms. 

I  am  not  aware  that  the  proper  sulphate  of  quinidia  is  used  as  a  dis- 
tinct preparation.  It  is  contained  occasionally  in  the  sulphates  of  the 
other  cinchona  alkaloids,  and  is  probably  identical  in  therapeutic  influ- 
ence with  sulphate  of  quinia,  or  so  nearly  so  as  to  render  its  presence,  in 
small  proportions,  of  no  practical  importance. 


278  GENERAL    STIMULANTS.  [PART  II. 

Peruvian  bark  owes  its  special  virtues  to  the  peculiarity  of  its  active 
tonic  principles.  Besides  nectandra  or  bebeeru  bark,  recently  admitted 
into  the  officinal  catalogues,  there  are  several  substances  of  minor  import- 
ance, supposed  to  possess  peculiar  virtues,  which,  if  the  claim  be  admitted, 
must  rank  in  the  same  category.  Among  these  are  the  dogwood  and  wil- 
low barks.  It  is  true  that  these  have  a  portion  of  tannic  acid  associated 
with  the  bitter  principle;  but  it  is  not  to  this  that  the  remedial  effects  as- 
cribed to  them,  and  to  which  they  mainly  owe  what  reputation  they  possess, 
can  be  attributed,  any  more  than  the  characteristic  remedial  properties  of 
Peruvian  bark  can  be  attributed  to  the  tannic  acid  which  it  also  contains. 
If  they  have  special  virtues,  these  reside,  in  all  probability,  in  their  bitter 
principle;  and  the  medicines,  therefore,  may  be  appropriately  considered 
here. 

1.  NECTANDRA.  U.  S.,  Br.—Syn.  Bebeeru  Bark. 

This  bark,  which  is  the  product  of  Nectandra  Rodicei,  or  bebeeru-tree, 
a  lofty  tree  inhabiting  Guiana  and  neighbouring  parts  of  South  America, 
was  introduced  into  the  Pharmacopoeias  mainly  as  the  source  of  a  peculiar 
alkaloid,  having  virtues  analogous  to  those  of  the  cinchona  alkaloids. 
The  bark  is  in  large  flat  pieces,  a  foot  or  two  long,  from  two  to  six  inches 
broad,  and  three  or  four  lines  in  thickness ;  grayish-brown  on  the  outer, 
and  deep-cinnamon  on  the  inner  surface;  of  a  rough  fracture,  and  of  a 
somewhat  astringent,  extremely  bitter  taste.  Two  alkaloids  are  said  to 
have  been  obtained  from  it,  called  respectively  bebee.rin  (bebeeria)  and 
sipeerin  (sipeeria) ;  but  as  the  two  are  extracted  by  the  same  process, 
Dr.  Maclagan,  of  Edinburgh,  who  analyzed  the  bark,  is  inclined  to  believe 
that  the  latter  is  merely  the  result  of  an  oxidation  of  the  former.  Like 
cinchona,  nectandra  also  contains  tannic  acid,  of  the  variety  which  forms 
a  green  precipitate  with  the  salts  of  iron.  Bebeeria  is  amorphous,  and 
forms  uncrystallizable  salts  with  the  acids.  It  is  pale-yellow,  of  a 
resinous  appearance,  fusible  and  inflammable,  without  smell,  very  bitter, 
slightly  soluble  in  water,  and  freely  soluble  in  alcohol  and  in  ether.  It 
consists  of  carbon,  hydrogen,  nitrogen,  and  oxygen;  but  its  formula  has 
not  been  precisely  determined.  Sipeeria  is  also  amorphous  ;  but  differs 
from  the  preceding  alkaloid,  in  being  insoluble  in  ether;  so  that,  when 
it  is  desirable  to  separate  the  two,  the  object  may  be  readily  effected  by 
means  of  ether,  which  removes  the  bebecria,  leaving  the  sipeeria  behind. 

Nectandra  is  tonic  and  astringent,  with  febrifuge  virtues  analogous, 
though  inferior  to  those  of  cinchona.  It  is  seldom  used  in  any  other 
form  than  that  of  sulphate  of  bebeeria,  either  impure,  as  generally  found 
in  commerce,  or  pure,  as  directed  to  be  prepared  in  the  British  Pharma- 
copoeia. 

Sulphate  of  Bebeeria  (BEBEKLE  SULPHAS,  Br.)  is  prepared  by  treating 
the  bark  with  water  diluted  with  sulphuric  acid,  adding  lime  to  the  infu- 
sion thus  obtained,  but  so  as  still  to  leave  an  acid  reaction,  then  precipi- 


CHAP.  I.]  TOXICS. — NKCTANDRA. — DOGWOOD.  279 

tating  with  ammonia,  treating  the  precipitate  with  alcohol  so  as  to  dis- 
solve the  alkaloid,  concentrating1  the  alcoholic  solution,  neutralizing  with 
sulphuric  acid,  and  evaporating  to  dry  ness.  For  the  details  of  the  pro- 
cess, as  well  as  for  the  method  in  which  the  impure  sulphate  of  com- 
merce is  obtained,  the  reader  is  referred  to  U.  S.  Dispensatory  (12th  ed., 
pp.  1023  for  the  former,  and  501  for  the  latter). 

The  impure  sulphate  is  in  thin,  shining,  brownish  scales,  becoming 
yellow  when  powdered,  sparingly  soluble  in  pure,  but  freely  in  acidulated 
water,  and  freely  soluble  also  in  alcohol.  It  has  all  the  remedial  effects 
of  the  bark,  and  may  be  given  either  in  pill,  or  dissolved  in  water  by  the 
addition  of  a  drop  of  diluted  or  aromatic  sulphuric  acid  for  each  grain  of 
the  impure  sulphate. 

The  sulphate  of  the  British  Pharmacopffiia  has  the  same  sensible  prop- 
erties and  probably  differs  little  in  any  respect.  The  test  of  sufficient 
purity,  given  in  the  Pharmacopoeia,  is  that  "it  is  entirely  destructible 
by  heat;  water  forms  with  it  a  clear-brown  solution;  its  watery  solution 
gives  with  caustic  soda  a  yellowish-white  precipitate,  which  is  dissolved 
by  agitating  the  mixture  with  twice  its  volume  of  ether ;  and  the  ethereal 
solution  separated  by  a  p'pette,  and  evaporated,  leaves  a  yellow  trans- 
lucent residue,  entirely  soluble  in  dilute  acids."  Anything  left  undissolved 
by  the  ether  is  probably  sipeeria. 

The  medical  virtues  of  ncctandra  were  first  announced  so  early  as 
1834,  by  Dr.  Rodie,  after  whom  the  specific  name  of  the  tree  was 
adopted.  But  Dr.  Douglas  Maclagan  was  still  more  instrumental  in 
giving  it  credit.  It  was  for  a  time  supposed  that  a  substitute  had 
been  found  for  quiuia  in  the  alkaloid  of  this  bark ;  and  there  can  be  no 
doubt  that  it  will  often  prove  efficacious  in  remittent  and  intermittent 
fevers;  but  experience  has  subsequently  shown  that  it  cannot  be  relied 
on ;  and  its  chief  importance  at  present  consists  in  the  fact  that,  in  the 
absence  of  the  cinchona  alkaloids,  or  where  circumstances  render  their  ad- 
ministration impossible,  or  when  they  have  failed  after  trial,  recourse  may 
be  had  to  sulphate  of  bebecria,  with  good  hopes  of  advantage.  The  dose 
is  from  two  to  five  grains;  and  from  a  scruple  to  a  drachm  maybe  given 
between  the  paroxysms  of  an  intermittent.  The  medicine  may  be  given 
in  pill  or  in  slightly  acidulated  solution. 

2.  DOGWOOD.— CORNUS  FLORIDA.  U.  8. 

This  is  the  bark  of  Cornus  Florida,  or  common  dogwood,  a  small 
indigenous  tree,  remarkable  for  its  conspicuous  white  flowers,  which  ren- 
der it  one  of  the  finest  ornaments  of  our  forests  in  the  spring,  as  it.- 
glossy-red  fruit,  and  leaves  beautifully  tinted  by  the  frost,  do  in  the  au- 
tumn. The  bark  is  taken  indiscriminately  from  the  root,  stem,  and 
branches;  but  that  of  the  root  is  preferred.  It  is  in  pieces  of  various 
size,  partially  or  completely  rolled,  sometimes  with  and  sometimes  with- 
out epidermis,  of  a  reddish-gray  colour,  a  feeble  odour,  and  a  bitter, 


280  GENERAL   STIMULANTS.  [PART  II. 

astringent,  slightly  aromatic  taste.  It  is  brittle,  and  yields  a  gray, 
slightly  reddish  powder.  Either  water  or  alcohol  will  extract  its  vir- 
tues. These  probably  reside  in  a  peculiar  bitter  principle,  which,  how- 
ever, has  not  yet  been  isolated ;  for  neither  the  cornin  of  Mr.  Carpenter, 
nor  the  substance  used,  under  the  same  name,  by  the  eclectic  physicians, 
so  called,  can  be  admitted  ta  this  rank.  The  bark  contains  also  tannic 
acid,  but  not  in  sufficient  proportion  to  give  it  any  considerable  medicinal 
activity. 

The  effects  of  dogwood  on  the  system,  so  far  as  they  can  be  traced, 
are  those  of  a  mild  tonic  and  feeble  astringent.  It  is  said  to  increase 
the  strength  and  frequency  of  the  pulse,  and  the  heat  of  the  body;  but, 
so  far  as  known,  it  produces  none  of  those  effects  upon  the  brain  which 
characterize  the  action  of  Peruvian  bark.  In  the  recent  state,  it  is  said 
to  act  unkindly  on  the  stomach  and  bowels ;  but,  in  this  respect,  it  resem- 
bles most  other  tonics,  when  too  freely  administered. 

Dogwood  has  been  used  almost  exclusively,  as  a  substitute  for  Peru- 
vian bark,  in  the  treatment  of  intermittent  and  remittent  fevers ;  and, 
from  the  amount  of  testimony  in  its  favour,  there  can  be  no  doubt  that 
it  often  has  proved  efficacious  in  the  former  of  these  complaints.  But  it 
has  often  also  failed ;  and,  since  the  introduction  of  sulphate  of  quinia 
into  use,  has  been  little  employed  by  regular  practitioners. 

It  may  be  used  in  powder  or  decoction.  The  dose  of  the  powder  in 
intermittents  is  stated  at  a  drachm,  so  repeated  as  to  amount  to  one  or 
two  ounces  between  the  paroxysms.  The  U.  S.  Pharmacopoeia  directs 
a  decoction  (DECOCTUM  CORNUS  FLORIDA,  U.  S.)  to  be  made  by  boiling 
an  ounce,  in  a  pint  of  water,  for  fifteen  minutes,  then  straining,  and  add- 
ing enough  water,  through  the  strainer,  to  make  the  decoction  measure 
a  pint.  The  whole  pint  may  be  taken  in  one  intermission,  in  doses  of 
two  fluidounces.  An  extract,  prepared  with  water  or  alcohol,  might  be 
substituted  for  either  of  the  above  forms  with  advantage.  The  profes- 
sion is  indebted  chiefly  to  Dr.  John  M.  Walker,  who  published  a  thesis 
on  dogwood,  in  Philadelphia,  in  the  year  1803,  for  what  is  known  upon 
the  subject. 

The  bark  of  two  other  indigenous  species  of  Cornus,  C.  circinata  or 
round-leaved  dogwood,  and  C.  sericea  or  swamp  dogwood,  have  similar 
sensible  properties,  and  are  supposed  to  have  the  same  medical  virtues 
as  that  of  C.  Florida. 

3.  WILLOW  BARK.— SALIX.  U.  S. 

The  barks  of  all  the  species  of  willow,  possessing  a  very  bitter  taste, 
may  be  considered  as  designated  by  the  title  above  given ;  for  all  proba- 
bly have  identical  properties;  but  only  that  of  Salix  alba  has  been 
recognized  by  our  national  standard.  This  is  the  common  European  or 
white  willow,  and  has  been  introduced  into  this  country,  where  it  grows 
extensively. 


CHAP.  I.]  TONICS. — WILLOW   BARK.  281 

When  dried,  willow  bark  taken  from  the  branches  rolls  into  close  quills, 
which  are  fibrous,  flexible,  and  difficult  to  powder.  It  has  a  feeble,  some- 
what aromatic  odour,  and  a  peculiar  bitter,  astringent  taste.  Water  and 
alcohol  extract  its  virtues.  The  active  ingredients  are  a  peculiar  princi- 
ple called  salicin  and  tannic  acid,  the  latter  of  which,  however,  though 
in  considerable  proportion,  is  scarcely  sufficient  to  entitle  the  medicine  to 
rank  among  the  proper  astringents. 

The  effects  of  willow  bark  upon  the  system,  so  far  as  they  are  obvious, 
are  those  of  a  mild  tonic  and  astringent ;  but  it  probably  has  also  an  an- 
tiperiodic  action ;  as  it  has  been  used  with  some  success  as  a  substitute 
for  Peruvian  bark  in  intermittents.  This,  indeed,  has  been  its  chief  em- 
ployment ;  though  it  is  not  without  efficacy  in  relaxed  and  debilitated 
states  of  the  system,  as  in  the  weakness  of  convalescence,  certain  con- 
ditions of  scrofula,  passive  hemorrhages,  etc.,  in  which  a  slight  astrin- 
gency  is  indicated  along  with  a  tonic  influence.  Like  many  other  bitters, 
it  has  been  used  as  an  anthelmintic.  The  states  of  preparation  in  which 
it  may  be  used  are  those  of  powder,  infusion  or  decoction,  and  of  salicin. 

The  powder  is  better  borne  by  the  stomach  than  cinchona  and  many 
other  tonics.  The  dose  of  it  for  other  purposes  than  those  of  an  anti- 
periodic  is  half  a  drachm,  repeated  three  times  a  day.  As  a  substitute 
for  Peruvian  bark,  in  intermittents,  it  must  be  given,  during  a  single  in- 
termission, in  the  quantity  of  one  or  two  ounces,  which  may  be  distrib- 
uted into  doses  of  a  drachm,  repeated  as  often  as  may  be  necessary. 

The  infusion  or  decoction  is  made  in  the  proportion  of  an  ounce  to 
the  pint  of  water ;  and  the  dose  is  one  or  two  fluidounces.  From  one 
to  two  pints  must  be  given  between  the  paroxysms  of  an  intermittent. 
The  decoction  has  been  used  as  a  topical  application  in  indolent,  flabby, 
or  foul  ulcers. 

Salicin  is  by  far  the  most  efficient  preparation  in  reference  to  the  anti- 
periodic  effect.  Several  processes  have  been  suggested  for  its  prepara- 
tion. Among  the  best  is  that  of  Merck.  The  boiling  concentrated 
decoction  is  treated  with  litharge,  in  order  to  precipitate  various  sub- 
stances that  tend  to  prevent  the  crystallization  of  the  salicin.  This 
principle  remains  in  solution,  probably  holding  a  portion  of  the  oxide  of 
lead  in  combination.  The  lead  is  thrown  down  by  the  addition  first  of 
sulphuric  acid,  and  then  of  sulphuret  of  barium  ;  and  the  remaining 
liquid,  being  evaporated  and  allowed  to  cool,  deposits  the  salicin,  which 
is  purified  by  repeated  solution  and  crystallization.  When  pure,  it  is 
beautifully  white,  in  minute,  soft,  shining,  slender  crystals,  inodorous, 
and  very  bitter,  with  the  peculiar  flavour  of  the  bark.  It  melts  at  230°, 
and  is  inflammable  at  a  higher  temperature.  It  is  soluble  in  water, 
much  more  so  in  hot  than  cold,  is  soluble  also  in  alcohol,  but  not  in 
ether,  or  the  volatile  oils.  It  is  neuter  in  relation  to  acids  and  alkalies, 
and  is  not  thrown  down  by  any  reagent.  Sulphuric  acid  gives  it  a  blood- 


282  GENERAL    STIMULANTS.  [PART  II. 

red  colour;  but  a  more  certain  test  is  the  odour  of  meadow-sweet  (Spiraea 
ulmoria),  which  it  yields  when  heated  in  solution  with  chromic  acid; 
salicin  being  resolved  by  that  acid  into  the  oil  of  meadow-sweet  or  sali- 
cylous  acid,  among  other  products.  Having  been  employed  to  adulterate 
sulphate  of  quinia,  it  is  important  that  there  should  be  some  method  of 
detecting  it.  When  taken  internally,  it  gives  to  the  urine  the  odour  of 
salicylous  acid,  into  which  it  is  probably  converted  in  its  passage  through 
the  system. 

Since  the  discovery  of  salicin,  this  preparation  has  been  almost  ex- 
clusively used  for  obtaining  the  effects  of  willow  bark.  At  one  time,  so 
favourable  were  the  reports  of  its  efficacy  in  intcrmittents,  that  the  hope 
was  indulged  that  it  might  supersede  quinia.  Hut  further  experience  has 
shown  that,  though  it  will  often  cure  intermittent  s,  it  cannot  be  relied 
on  with  certainty  ;  and  the  best  that  can  be  said  of  it  is  that,  when  quinia 
cannot  be  obtained,  it  is  among  the  best  substitutes  of  vegetable  origin. 
The  dose  as  an  antiperiodic  is  from  two  to  eight  grains,  repeated  so  as 
to  amount  to  from  twenty  to  forty  grains  during  the  intermission.  It  is 
less  apt  to  oppress  the  stomach  than  quinia. 

4.  HYDRASTIS.— HYDRASTIS.  U.  S. 

Yellow-root,  oranye-root,  and  yellow  pitccoon  are  the  common  names 
by  which  this  medicine,  as  well  as  the  plant  producing  it,  have  been 
Jong  known  in  this  country,  and  which  have  been  officinally  superseded 
by  the  title,  both  English  and  Latin,  which  has  been  adopted  in  the 
U.  S.  Pharmacopoeia.  Already  it  is  probably  better  known,  among  the 
profession,  by  the  name  of  hydrastis  than  by  any  of  its  vernacular  titles. 
It  is  the  product  of  Hydrasiis  Canadensis,  an  indigenous  plant,  widely 
distributed  throughout  most  of  the  United  States,  especially  the  North 
and  West.  It  is  a  perennial  herb,  with  a  thick,  fleshy,  yellow  root-stalk, 
which  sends  out  numerous  radical  fibres,  and  from  which  rises  annually 
an  erect  pubescent  stem,  from  six  to  twelve  inches  high,  bearing  near  the 
top  two  unequal,  generally  five-lobed,  pubescent  leaves,  and  a  solitary 
rose  coloured  or  purplish  flower.  The  fruit  resembles  the  raspberry,  but 
should  not  be  eaten.  It  prefers  moist  and  rich  woodlands.  The  root 
has  long  been  known  as  a  domestic  remedy,  and  has  been  much  used  by 
irregular  practitioners;  but  did  not  become  officinal  untjl  the  late  re- 
vision of  the  Pharmacopoeia,  when  it  was  introduced  ii .to  the  secondary 
list  of  that  work.  It  merits,  however,  a  place  in  the  primary  catalogue, 
and  will  probably  receive  it  at  the  next  revision. 

The  dried  root,  which  has  shrunk  much  in  desiccation,  is  irregularly 
contorted,  rough  and  wrinkled,  one,  two,  or  three  inches  long  by  two  or 
three  lines  in  thickness,  with  numerous  slender  rootlets,  or  the  marks 
where  they  have  been  broken  off.  It  is  externally  of  a  yellowish  colour 
becoming  dark-brown  by  age,  is  internally  yellow,  and  yields  a  yellowish 


CHAP.  I.]  TONICS. — HYDRASTIS.  283 

powder.  The  odour  is  strong,  sweetish,  and  somewhat  narcotic,  the  taste 
peculiar  but  bitter.  Water  and  alcohol  extract  its  virtues.  These  prob- 
ably reside  partly  in  a  volatile  oil,  but  much  more  in  two  alkaloids, 
hydraxlia  or  hydrastin,  originally  discovered  by  Mr.  Alfred  A.  B.  Du- 
rand,  of  Philadelphia,  and  berberina,  a  principle  long  known  as  existing 
in  the  root  of  Berberis  vulgaris,  but  first  recognized  by  Mr.  F.  Mahla  as 
being  the  second  alkaloid  of  hydrastis.  This  latter  alkaloid  has  since  been 
detected  in  other  vegetable  remedies,  especially  columbo;  and  the  large 
proportion  in  which  it  exists  in  hydrastis  proves  that  this  medicine 
must  have  virtues  analogous  to  those  of  the  African  root. 

For  the  modes  of  preparing,  and  for  the  characteristic  properties  of 
these  two  alkaloids,  I  must  be  content  with  referring  to  the  12th  edi- 
tion of  the  U.  S.  Dispensatory.  It  is  sufficient  here  to  state  that  hy- 
drastia  crystallizes  in  shining  four- sided  prisms,  which  are  white  or 
colourless  when  pure,  inodorous,  nearly  tasteless  in  consequence  of  dif- 
ficult solubility  in  the  saliva,  nearly  insoluble  in  water,  but  readily  dis- 
solved by  alcohol  and  ether;  while  berberina  is  in  minute  acicular 
crystals,  having  in  mass  a  yellow  colour,  soluble  in  100  parts  of  cold 
water,  less  soluble  in  alcohol,  and  insoluble  in  ether,  of  a  decidedly  bitter 
taste,  and  characterized  by  the  property  of  forming  with  muriatic  acid  a 
yellow  salt,  of  very  difficult  solubility. 

Medical  Properties.  Hydrastis  is  decidedly  tonic,  as  might  be  in- 
ferred from  its  partial  resemblance  to  columbo  in  composition.  It  is  also 
aperient ;  and  this  property  may  be  ascribed  to  the  berberina,  which  is  the 
characteristic  ingredient  of  a  root  long  used  for  its  aperient  properties, 
that,  namely,  of  Berberis  vulgaris.  But  it  is  asserted  also  to  be  chola- 
gogue,  deobstruent  in  its  influence  on  enlarged  glands,  diuretic,  altera- 
tive, etc.  There  can,  I  think,  be  little  doubt  .that  the  alkaloid  hydrastia 
has  special  remedial  powers;  and,  if  further  experience  should  confirm 
the  opinion,  that  it  peculiarly  promotes  the  hepatic  secretory  function, 
it  will  be  an  invaluable  addition  to  the  materia  medica,  enabling  us  to 
dispense  in  many  instances  with  the  use  of  mercury,  otherwise  indis- 
pensable. The  affections  in  which  it  has  been  specially  employed  are 
dyspepsia,  particularly  when  attended  with  deficient  action  of  the  liver, 
jaundice  and  other  functional  diseases  of  the  liver  attended  with  de- 
ficient secretion,  constipation  with  or  without  piles,  and  generally  chronic 
inflammation  of  the  mucous  membranes,  in  which  it  is  supposed  to  act 
as  an  alterative  like  the  mercurials.  But  much  more  experience,  and  a 
careful  comparison  of  detailed  reports  from  regular  practitioners,  above 
the  suspicion  of  interested  motives,  are  necessary,  in  order  to  justify  a 
positive  determination  as  to  the  merits  of  this  very  promising  medicine. 


284  GENERAL    STIMULANTS.  [PART  II. 

5.  BARBERRY.— BERBERIS.  U.  S. 

The  bark  of  the  root  of  Berberis  vulgaris  is  the  part  designated  in 
the  U.  S.  Pharmacopeia  as  officinal.  The  plant  is  a  shrub,  sometimes 
attaining  the  size  of  a  small  tree,  indigenous  in  Europe,  but  growing 
wild  in  various  parts  of  our  own  country,  as  in  New  England  and  on  the 
banks  of  the  Hudson.  A  species  of  the  genus,  designated  by  Pursh  as 
Berberis  Ganadensis,  grows  in  our  country  from  its  northern  boundaries 
to  the  Carolinas.  Hooker,  however,  considers  it  as  merely  a  variety  of  B. 
vulgaris;  and,  whatever  may  be  the  fact  on  this  point,  there  can  be  little 
doubt  that  it  possesses  the  same  medical  virtues. 

The  bark  of  the  root  is  grayish  on  the  outer,  and  yellow  on  the  inner 
surface;  is  very  bitter,  staining  the  saliva  yellow  when  chewed;  and 
yields  its  virtues  and  colouring  properties  to  water  and  alcohol.  Long 
employed  in  medicine,  it  never  enjoyed  a  very  high  reputation,  and 
seems  to  have  fallen  into  almost  entire  neglect;  but,  when  it  was 
ascertained  to  contain  a  peculiar  alkaloid,  and  that  alkaloid  found  to 
be  diffused  among  various  other  medicines,  some  of  them  very  greatly 
esteemed,  as  columbo,  xanthorrhiza,  xanthoxylum,  hydrastis,  etc.,  atten- 
tion was  again  forcibly  drawn  to  it,  with  the  result  of  introducing  it  into 
the  present  edition  of  our  Pharmacopeia,  though  in  the  secondary  cata- 
logue. For  the  method  of  extracting  berberina  from  the  bark,  I  must 
refer  to  the  U.  S.  Dispensatory  (12th  ed.,  p.  168).  Of  the  alkaloid  itself, 
the  most  important  and  characteristic  properties  may  be  given  in  a  few 
words.  When  obtained  by  crystallization  from  the  hot  solution,  resulting 
from  the  decomposition  of  its  sulphate  by  means  of  oxide  of  load,  added 
to  a  heated  solution  of  that  salt,  it  is  in  the  form  of  a  yellow  powder, 
shown  by  the  microscope  to  consist  of  groups  of  minute  acicular  crystals. 
It  is  inodorous,  bitter,  soluble  in  100  parts  of  cold  water,  and  requiring 
still  more  of  cold  alcohol,  but  freely  dissolved  by  both  these  liquids  with 
the  aid  of  heat,  and  insoluble  in  ether.  Its  most  characteristic  property 
is  probably  that  of  being  copiously  precipitated  by  muriatic  acid  from  its 
solution  in  cold  water,  owing  to  the  very  difficult  solubility  of  the  result- 
ing muriate.  This  property,  taken  in  connection  with  the  bright-yel- 
low colour  of  the  muriate,  is  sufficient  to  distinguish  berberina  from  all 
other  alkaloids.  Notwithstanding  the  very  difficult  solubility  of  the 
muriate  in  cold  water,  yet  enough  is  dissolved  to  produce  a  deep-yellow 
colour.  Another  alkaloid  has  also  been  found  in  the  root  for  which  the 
name  of  vinelina  has  been  proposed.  But  little  is  known  of  its  phys- 
iological properties.  Both  alkaloids  consist  of  carbon,  hydrogen,  nitrogen 
and  oxygen  ;  but  their  precise  atomic  composition  can  scarcely  In-  said  to 
have  been  yet  determined,  though  that  of  berberina  has  been  given  as 
C^HjjNO,,,  of  vinetina  CMHMNOn. 

Barberry  is  tonic,  and  when  freely  given,  cathartic,  with  a  supposed 
action  on  the  liver.  It  has  been  used  in  intermittent  fever,  dyspeptic  af- 


CHAP.  I.]  TONICS. — HOPS.  285 

fections  with  constipation,  and  in  jaundice.  Whether  it  has  any  real  in- 
fluence on  the  liver  is  not  yet  determined,  and  would  form  a  good  subject 
for  careful  inquiry.  It  was  probably  first  introduced  into  the  treatment  of 
jaundice  on  the  doctrine  of  signatures,  which  implies  a  certain  relation 
between  the  sensible  properties  of  the  medicine  and  those  of  the  part  dis- 
eased, or  some  product  of  the  disease ;  as,  in  this  case,  between  the  yellow- 
ness of  the  bark  and  that  of  bile.  But,  baseless  as  this  principle  is,  some 
medicines  introduced  into  use  on  the  grounds  of  it,  have  retained  their 
place  from  their  real  virtues ;  and  the  same  may  possibly  be  the  case 
with  barberry. 

The  substances  which  follow,  belonging  to  the  subdivision  of  bitter 
tonics  of  peculiar  properties,  owe  their  peculiarity  in  general  to  the  as- 
sociation of  some  other  active  constituent  with  their  bitter  principle. 
This  associated  constituent  is,  with  one  or  two  exceptions,  a  stimulant 
volatile  oil.  The  most  decided  exception  to  this  general  rule  is  afforded 
by  the  wild-cherry  bark,  in  which,  though  a  somewhat  stimulating  vola- 
tile oil  is  always  generated  when  it  is  exposed  to  the  action  of  water, 
whether  within  the  stomach  or  out  of  it,  yet,  in  connection  with  this  oil, 
a  powerful  sedative  is  also  produced,  hydrocyanic  acid,  namely,  to  which 
the  medicine  is  mainly  indebted  for  its  peculiar  and  characteristic  effects. 


II.  HOPS. 

HUMULTJS.  U.S.— LUPULUS.  Br. 

Origin.  Hops  are  the  fruit  or  strobiles  of  Humulus  Lupulus,  a  climb- 
ing perennial  plant,  growing  wild  in  Europe  and  North  America,  and 
largely  cultivated  in  both  continents.  The  fruit  is  picked  when  ripe, 
dried  by  artificial  heat,  packed  in  bales,  and  thus  sent  into  market. 

Sensible  Properties.  Each  strobile  has  the  shape  of  a  cone  flattened 
by  pressure,  and  consists  of  a  number  of  thin,  translucent,  leaf-like  scales, 
one  overlapping  another,  of  a  pale  yellowish-green  colour,  with  two  small 
black  seeds  near  the  base  of  each,  and  minute  yellowish  granules  upon 
their  surface,  easily  separable  when  the  fruit  is  quite  dry.  Hops  are  of 
difficult  pulverization,  of  a  strong,  peculiar,  narcotic,  yet  fragrant  odour, 
and  of  an  extremely  bitter,  aromatic,  somewhat  astringent  taste.  They 
impart  their  sensible  and  medicinal  properties  to  alcohol  and  water. 

Active  Constituents.  The  virtues  of  hops  depend  probably,  in  chief, 
upon  a  peculiar  bitter  principle  called  lupulite  or  lupuline,  but  to  which 
the  name  of  humulin  would  be  more  appropriate,  as  more  distinct  from 
lupulin,  which  had  been  introduced  into  use,  with  another  meaning,  be- 


286  GENERAL   STIMULANTS.  [PART  II. 

fore  the  discovery  of  the  principle  referred  to.  They  contain  also  a  vol- 
ntile,  oil,  which  is  the  source  of  their  aroma,  and  a  small  proportion  of 
tannic  acid.  According  to  Mr.  W.  Jauncey,  the  oil  is  formed  in  the 
hops  during  desiccation,  as  he  has  failed  to  discover  it  in  fresh  stro- 
biles. (Edin.  Med.  Joum.,  iii.  (599.)  Their  other  constituents  have  no 
special  interest  for  the  physician. 

The  active  principles  of  hops  are  diffused,  in  some  degree,  throughout 
their  whole  substance,  but  are  mainly  concentrated  in  the  yellowish  gran- 
ules upon  the  surface  of  the  scales.  These  granules  are  separated  for 
use,  and  constitute  a  distinct  medicine,  recognized  in  our  Pharmacopoeia 
by  the  name  of  lupulin,  proposed  for  it  by  the  late  Dr.  A.  W.  Ivcs,  of 
New  York,  who  first  brought  it  into  notice. 

LUPULIN  (Lupulina,  U.S.)  is  prepared  by  rubbing  or  threshing  the 
hops,  and  then  sifting  the  coarse  powder  obtained.  It  consists  of  yel- 
lowish granules,  almost  always  interspersed  with  minute  fragments  of 
the  scales  themselves,  from  which  it  is  impossible  entirely  to  separate 
them,  as  ordinarily  procured.  Lupulin  has  the  odour  and  taste  of  hops, 
and  contains  the  volatile  oil  and  bitter  principle  above  mentioned,  with 
mere  traces  of  the  tannic  acid.  As  it  possesses  all  the  virtues  of  hops, 
in  a  more  concentrated  and  convenient  form,  it  is  generally  preferred  for 
internal  use. 

Effects  on  the  System.  Notwithstanding  the  vast  consumption  of  hops 
in  malt  liquors,  their  effects  on  the  system,  and  mode  of  operation,  have 
not  yet  been  thoroughly  investigated,  or  satisfactorily  determined.  That 
they  are  tonic  to  the  digestive  function  is  generally  admitted,  and  might 
be  inferred  from  their  intense  bitterness.  Almost  universal  experience 
would  seem  to  have  determined  that  they  have  the  additional  property 
of  inducing  heaviness,  drowsiness,  and  even  sleep ;  and  by  most  they 
are  believed  to  have  that  also,  in  some  degree,  of  relieving  pain.  Never- 
theless, Magendie  was  disposed  to  reject  their  claim  to  be  considered 
narcotic,  having  given  lupulin  to  the  lower  animals  without  any  such 
effect;  and  others  are  not  wanting  who  maintain  the  same  opinion.  Dr. 
Muton,  however,  found  them  to  allay  pain,  produce  sleep,  and  lower  the 
pulse  in  twenty-four  hours  from  93  to  60  in  the  minute.  (Pereira,  Mat. 
Med.,  3d  ed.,  p.  1247.)  Dr.  William  Byrd  Page,  of  this  city,  in  Feb- 
ruary, 1849,  stated  to  the  College  of  Physicians  of  Philadelphia,  that  he 
had  found  lupulin  to  possess  extraordinary  powers  in  allaying  irritation 
of  the  genital  organs,  and  had  been  in  the  habit  of  using  it  for  that  pur- 
pose for  two  years.  The  same  fact  has  since  been  confirmed,  on  the  con- 
tinent of  Europe,  by  Xambuco,  who  was  ind'uced  to  make  experiments* 
with  it  by  an  observation  of  Debout,  in  relation  to  its  favourable  influ- 
ence in  relieving  painful  erections,  lie  gave  from  one  to  sixteen  scruples, 
without  producing  disturbance  of  the  nervous  system,  but  with  decided 
effects,  of  the  nature  referred  to,  on  the  genital  organs.  (See  Lond.  Med. 


CHAP.  I.]  TONICS. — HOPS.  287 

Times  and  Gaz.,  Feb.  1855,  p.  118.)  With  their  tonic,  soporific,  and 
anodyne  properties,  hops  may,  therefore,  be  considered  antaplirodisiac. 
That  they  possess  the  power  of  stimulating  the  cerebral  functious  is  ex- 
tremely doubtful ;  and  I  am  not,  therefore,  disposed  to  class  them  in  the 
same  category  with  opium  and  alcohol.  From  the  large  quantities  taken 
with  impunity,  it  is  probable  that  their  influence  over  the  brain  is  feeble, 
and.  from  the  symptoms  evinced,  that  it  is  rather  sedative  than  stimulant. 
In  this  uncertainty  as  to  the  precise  position  they  ought  to  occupy,  in 
reference  to  their  influence  over  the  nervous  system,  1  have  thought  it 
best  to  rank  them  with  the  division  of  bitter  tonics  having  peculiar  prop- 
erties, to  which  they  undoubtedly  belong,  whatever  claim  they  may  have 
to  a  position  elsewhere. 

Opinion  is  not  more  settled  as  to  the  special  influence  of  the  several 
active  principles  of  hops.  It  has  been  a  prevalent  impression  that  the 
odorous  and  volatile  principle  is  that  to  which  they  owe  their  narcotic 
properties.  The  effect  of  a  pillow  cf  hops  in  producing  sleep  may  be 
said  to  be  almost  notorious ;  and  it  is  asserted  that  stupor  has  sometimes 
occurred  in  persons  who  have  remained  long  in  warehouses  containing 
hops;  but,  in  the  former  case,  much  allowance  must  be  made  for  the 
operation  of  the  patient's  imagination;  and,  in  the  latter,  it  might  be 
suggested  that  the  experience  of  such  an  effect,  if  real,  should  be  more 
than  occasional,  and  that  there  might  have  been  some  other  cause  for 
the  stupor  when  observed.  Besides,  Dr.  Wagner  states  that  he  gave 
twenty  drops  of  the  volatile  oil  to  a  rabbit  without  observable  effect. 
(Chem.  Gaz.,  July  15,  1853.)  In  reference  to  the  bitter  principle,  there 
is  little  more  certainty,  except  as  to  its  tonic  action  on  the  digestive 
organs.  Dr.  ChristisoD  is  disposed  to  think,  that  whatever  soporific 
virtues  may  be  possessed  by  hops  reside  in  the  volatile  oil,  and  conse- 
quently that  the  bitter  principle  is  destitute  entirely  of  narcotic  prop- 
erties. (Dispensatory.)  Mr.  Walter  Jauncey,  as  the  result  of  his  experi- 
ments, found  the  oil  to  relieve  pain,  without  necessarily  producing  sleep, 
and,  in  large  doses,  to  reduce  the  frequency  of  the  pulse  considerably,  and 
induce  headache,  anorexia,  and  nausea;  and  it  acts  in  this  way  whether 
taken  into  the  stomach,  or  inhaled.  He  also  found  it  to  act  as  a  diu- 
retic, and  to  allay  the  venereal  appetite.  His  general  conclusion  was, 
that  the  oil  is  sedative  and  anodyne,  and  that  humulin,  or  the  bitter  prin- 
ciple, is  merely  tonic.  (Ed.  Hied.  Journ.,  Feb.  1858,  p.  701.)  Like  all 
other  bitters,  hops  are  ofl'ensive  to  the  stomach  in  over-doses. 

Tltt-rapeutic  Application.  Hops  may  lie  used  as  a  tonic  in  dyspeptic 
or  debilitated  states  of  the  digestive  organs,  and  are  specially  indicated 
in  cases  attended  with  nervous  restlessness  and  want  of  sleep.  This 
condition  not  (infrequently  exists  in  the  convalescence  from  acute  dis- 
eases, and  in  persons  of  a  nervous  temperament,  who  have  been  exposed 
to  the  influence  uf  other  debilitating  causes.  On  any  occasion  of  obsti- 


288  GENERAL    STIMULANTS.  [PART  II. 

nate  wakefulness,  dependent  on  mere  nervous  disturbance,  hops  may  be 
tried  among  other  means  of  relief,  and  especially  when  some  objection 
may  exist  to  the  use  of  opiates.  They  are  supposed  sometimes  to  have 
operated  usefully  in  the  morbid  vigilance  of  insanity.  In  all  these  ca- 
a  dose  of  the  infusion  of  hops,  of  lupulin,  or,  when  stimulation  is  also 
indicated,  of  one  of  the  tinctures,  may  be  given  three  or  four  times  a  day. 

But  the  case  to  which  hops  are  probably  most  appropriate  is  that  of 
the  inebriate,  suffering  under  the  want  of  his  accustomed  stimulus.  The 
medicine  appears  sometimes  to  operate  most  happily  in  such  cases,  in 
supporting  the  digestive  function,  controlling  nervous  tremors,  obviating 
hallucinations,  and  disposing  to  sleep.  Unassisted  by  stimulants,  it  is 
not  adequate  to  supply  the  want  of  alcoholic  drinks  altogether;  but,  in 
the  form  of  malt  liquors,  or  that  of  the  tincture  of  hops  or  of  lupulin,  it 
will,  I  believe,  often  enable  the  patient  to  escape  the  horrors  of  delirium 
tremens,  with  a  smaller  amount  of  alcoholic  stimulus  than  would  other- 
wise be  necessary.  In  delirium  tremens  itself,  the  tincture  is  often  an 
admirable  adjuvant  to  opium ;  and  I  feel  confident  that  I  have  seen  sleep 
induced  by  it,  in  cases  of  this  kind,  which  resisted  the  opiate  treatment, 
without  any  reason  for  ascribing  the  result  merely  to  the  alcoholic  in- 
gredient. In  convalescence,  moreover,  from  that  disease,  it  is  one  of  our 
best  remedies  for  sustaining  a  moderate  tonic  and  soporific  influence  over 
the  patient,  until  nature  shall  have  recovered  her  powers.  In  these  con- 
ditions, the  tincture  of  lupulin  may  be  given  in  the  dose  of  half  a  fluid- 
ounce  every  two  or  three  hours  in  the  beginning,  to  be  gradually  dimin- 
ished, and  with  lengthened  intervals,  as  it  may  cease  to  be  requisite,  either 
for  supporting  strength,  or  producing  sleep. 

Dr.  Maton  found  the  medicine  useful  in  allaying  the  pains  of  acute 
rheumatism ;  but  it  is  vastly  inferior  to  opium  for  this  purpose. 

It  has  occasionally  been  used  in  intermittent  fever  without  very  en- 
couraging success;  but  has  recently  been  recommended  in  that  com- 
plaint by  Dr.  W.  Y.  Godberry,  of  Benton,  Miss.,  as  equal  to  any  other 
article  of  the  Materia  Medica  except  quinia  ;  and  he  has  often  succeeded 
in  arresting  the  disease  by  means  of  it,  after  that  medicine  had  failed. 
He  prefers  the  infusion,  which  should  be  made  with  an  ounce  to  a  pint 
of  boiling  water;  the  whole  to  be  taken  during  the  intermission.  (Am. 
Journ.  of  Med.  Sci.,  N.  S.,  xxvi.  283,  from  Went.  Journ.  of  Med.  and 
Surg.,  March,  1853.) 

From  the  statements  of  Dr.  Page  before  referred  to,  lupulin  would  ap- 
pear to  be  one  of  the  best  remedies  in  our  possession  for  relieving  irri- 
tations of  the  genital  organs  in  men.  In  the  painful  erections  occurring 
in  gonorrhoea,  he  gives  it  in  doses  of  from  five  to  ten  grains,  and  has  never 
known  an  instance  in  which  the  second  dose  did  not  afford  relief.  He 
has  also  found  it  useful  in  spermatorrhoea;  preventing  the  discharges 
while  the  patient  is  under  its  influence,  though  inadequate  to  the  cure. 


CHAP.  I.]  TONICS. — WILD-CHERRY   BARK.  289 

These  statements  of  Dr.  Page  have  been  confirmed  by  subsequent  ob- 
servers. I  have  myself  witnessed,  in  irritation  of  the  urinary  organs, 
very  beneficial  effects  resulting  apparently  from  the  use  of  lupulin. 

Administration.  Hops  are  seldom  if  ever  given  in  substance.  The 
Infusion  (!NFUSUM  HUMULI,  U.  S.),  which  is  made  in  the  proportion  of 
half  an  ounce  to  a  pint  of  boiling  water,  may  be  given  in  the  dose  of  a 
wincglassful.  Decoction  is  an  unsuitable  mode  of  preparation,  as  boiling 
dissipates  the  volatile  principle,  on  which  probably  the  virtues  of  the 
hops  partly  depend. 

The  Extract  (EXTRACTUM  LUPULI,  Br.)  is  liable  to  the  same  objec- 
tion as  the  decoction.  It  has  the  bitterness  without  the  aroma  of  the 
hops.  Nevertheless,  it  is  said  to  have  acted  as  an  anodyne  and  soporific; 
but  it  has  been  almost  entirely  superseded  by  lupulin,  which  has  all  its 
advantages  without  its  defect.  The  dose  of  the  extract  is  from  ten  to 
thirty  grains. 

A  Fluid  Extract  and  an  Oleoresin  of  Lupulin  (EXTRACTUM  LUPU- 
LIN^E  FLUIDUM,  U.  S.,  and  OLEORESINA  LUPULIN.E,  U.  S.)  were  introduced 
into  the  present  edition  of  our  national  code.  The  former  is  a  very  con- 
centrated tincture  of  lupulin,  the  latter  a  semiliquid  ethereal  extract. 
Both  of  these  preparations  may  be  considered  as  representing  the  vir- 
tues of  hops.  The  dose  of  the  former  is  ten  or  fifteen  minims,  of  the  lat- 
ter from  two  to  five  grains.  The  oleorcsin  is  most  conveniently  given 
in  the  form  of  pill,  made  up  with  powdered  liquorice  root. 

Lupulin  is  now  probably  most  used  when,  the  influence  of  hops  is 
wanted.  The  dose  is  from  six  to  twelve  grains ;  but  may  be  much  in- 
creased, if  thought  advisable.  It  is  most  conveniently  given  in  pill, 
which  may  be  made  by  rubbing  the  powder,  in  a  warm  mortar,  till  it 
acquires  a  plastic  consistence. 

The  Tincture  of  Hops  (TINCTURA  HUMULI,  U.  S.,  TINCTURA  LUPULI, 
Br.)  is  not  an  eligible  preparation,  being  too  feeble  and  uncertain  to  be 
relied  on.  The  usual  dose  is  from  one  to  three  fluidrachms. 

The  Tincture  of  Lupulin  (TIVCTURA  LUPULIN^E,  U.S.)  is  more  effi- 
cient, and  is  an  excellent  preparation  when  the  alcoholic  ingredient  is 
not  objectionable.  The  dose  for  ordinary  purposes  is  one  or  two  flui- 
drachms. 


III.  WILD-CHERRY  BARK. 
PRUNUS  VIRGINIANA.  U.  S. 

Origin.  This  is  the  inner  bark  of  Cerasus  serolina,  or  wild-cherry,  a 

large  indigenous  tree,  growing  abundantly  in  the  Middle  and  Western 

States.     The  officinal  name  originated  in  the  mistaken  supposition,  that 

the  Prunus  Virginiana  of  Linnaeus  was  the  tree  in  question ;  whereas, 

VOL.  i. — 19 


290  GENERAL   STIMULANTS.  [PART  II. 

according  to  Torrey  and  Gray,  that  title  really  Jbel on gs  to  the  choke- 
cherry  (Cerasus  Virginiana  of  the  N.  American  Flora),  a  small  tree  or 
shrub,  inhabiting  the  Northern  States.  The  bark  is  obtaiaed  from  the 
root,  stem,  and  branches  of  the  tree ;  but  that  from  the  root  is  preferred. 
It  should  be  collected  in  the  autumn,  when  it  is  strongest.  The  recently 
dried  bark  is  more  efficacious  than  that  which  has  been  long  kept. 

Sensible  Properties.  Wild-cherry  bark,  as  found  in  the  shops,  is 
usually  destitute  of  epidermis,  of  a  reddish-yellow  colour,  brittle,  and 
easily  pulverized,  yielding  a  fawn-coloured  powder.  When  fresh,  or 
treated  with  water,  it  has  the  odour  of  peach-leaves.  The  taste  is  agree- 
ably bitter,  astringent,  and  somewhat  aromatic.  It  yields  its  bitterness 
to  water,  to  which  it  imparts  a  reddish-brown  colour  like  that  of  Madeira 
wine. 

Active  Constituents.  Among  the  active  principles  existing  in  the  bark 
arc  amygdalin  and  lannic  acid.  There  is  probably  also  some  emulsin, 
a  kind  of  nitrogenous  or  albuminous  matter,  found  in  the  bitter  almond, 
where  it  plays  an  essential  part  in  changes,  analogous  if  not  identical 
with  those  which  are  now  to  be  noticed  as  occurring  in  wild-cherry  bark. 
When  this  bark  comes  in  contact  with  water,  a  reaction  takes  place, 
under  the  influence  of  the  emulsin  operating  as  a  ferment,  between  the 
water  and  the  amygdalin  of  the  bark,  whereby  the  latter  is  converted 
into  a  peculiar  volatile  oil  and  hydrocyanic  acid,  which  may  be  obtained 
together  by  distillation,  constituting  a  product  which  is  probably  iden- 
tical with  the  volatile  oil  of  bitter  almonds.  When,  therefore,  wild- 
cherry  bark  is  used  in  the  form  of  infusion,  it  is  not  merely  the  amygda- 
lin and  tannic  acid  which  act,  but  the  new  product  also,  which  is 
essentially,  in  relation  to  its  effects  on  the  system,  the  hydrocyanic  acid ; 
for  the  volatile  oil  which  attends  it  has  little  effect.  When  the  medicine 
is  taken  in  the  form  of  powder,  it  is  highly  probable  that  the  same 
change  takes  place  in  the  stomach,  under  the  reagency  of  the  water 
there.  It  is  a  question  whether  the  bark  does  or  does  not  contain  a  bit- 
ter principle  distinct  from  amygdaliu.  I  believe  that  it  does  so,  not  only 
from-  its  tonic  effects,  which  cannot  be  ascribed  either  to  the  volatile  oil 
or  hydrocyanic  acid,  but  from  an  experiment  made  at  my  request  by 
Professor  Procter,  which  appears  to  determine  the  question.*  Though 

*  A  portion  of  the  bark  was  exhausted  by  alcohol,  and  the  tincture  evaporated  to 
an  extract.  This  contained  the  amygdalin,  and  whatever  bitter  matter  and  tannic 
acid  existed  in  the  bark.  The  extract  was  triturated  with  water,  and  with  gelatin 
to  remove  the  tannic  acid.  The  liquor  being  then  filtered,  was  mixed  with  an  excess 
of  the  emulsion  of  sweet  almonds,  containing  of  course  the  emulsin  necessary  for 
causing  reaction  between  the  amygdalin  and  water.  A  strong  odour  of  hydrocy- 
anic acid  was  produced,  which  had  not  previously  existed  in  the  solution  of  the 
alcoholic  extract.  AH  the  emulsin  was  in  excess,  the  whole  of  the  amygdalin  must 
have  been  destroyed.  The  liquid  was  evaporated  to  a  soft  extract,  and  mixed  with 
water.  Sweet  almond  emulsion  now  added  generated  no  more  hydrocyanic  acid. 


CHAP.  I.]  TONICS. — WILD-CHERRY   BARK.  291 

boiling  water  will  extract  the  active  matters  existing  in  the  bark,  yet 
cold  water  is  medicinally  the  best  solvent;  for  the  emulsin  is  coagulated 
and  rendered  inert  at  a  high  temperature,  and  the  formation  of  hydrocy- 
anic acid  consequently  prevented. 

Effects  on  the  System.  Wild-cherry  bark  is,  through  its  bitter  princi- 
ple, a  gentle  stimulant  to  the  digestive  and  probably  to  the  nutritive  func- 
tion ;  while  the  hydrocyanic  acid,  evolved  by  the  reaction  of  water  with 
the  amygdalin,  renders  it  sedative  to  the  nervous  system,  and,  when 
freely  taken,  to  the  general  circulation.  Dr.  Eberle  states  that,  in  his 
own  person,  he  has  "several  times  reduced  his  pulse  from  seventy-five  to 
fifty  strokes  in  the  minute  by  copious  draughts  of  the  cold  infusion,  taken 
several  times  a  day,  and  continued  for  twelve  or  fourteen  days."  (Mat. 
Med,  and  Therap.,  4th  ed.,  i.  301.) 

Therapeutic  Application.  The  joint  tonic  and. sedative  properties  of 
this  bark  admirably  adapt  it  to  the  treatment  of  cases  of  general  debility, 
with  enfeebled  digestion,  an  irritable  state  of  the  nervous  system,  and 
excessive  frequency  of  pulse.  Long  before  its  chemical  peculiarities 
were  discovered,  experience  had  established  this  application  of  the  rem- 
edy. In  the  treatment  of  pulmonary  consumption,  it  has  for  many  years 
been  a  favourite  in  this  country,  and,  before  cod-liver  oil  came  into  no- 
tice, was  probably  more  relied  on  than  any  other  single  medicine.  It 
was  employed  not  only  in  the  advanced  stages  when  hectic  fever  had  set 
in,  but  from  the  beginning,  and  often  as  a  preventive,  in  cases  in  which 
a  strong  tendency  to  the  disease  seemed  to  be  displayed.  It  was  given 
with  the  view  of  imparting  tone  to  the  digestive  organs  and  system  gen- 
erally, and  thereby  modifying  the  tuberculous  diathesis,  and  was  pre- 
ferred to  other  tonics,  because  it  was  thought  to  produce  these  effects 
with  less  danger  of  undue  excitement.  Now  that  it  is  known  to  be  posi- 
tively sedative  to  the  heart,  and  to  the  nervous  system,  we  can  better 
understand  its  usefulness  in  that  complaint.  In  other  forms  of  scrofu- 
lous disease,  presenting  a  similar  complication  of  debility  of  the  digestive 
and  nutritive  functions  with  frequency  of  the  pulse,  it  is  equally  indicated. 
Few  remedies  are  better  adapted  to  hectic  fever,  from  whatever  source 
it  may  proceed.  In  the  debility  of  convalescence  from  fevers,  and  other 
severe  acute  diseases,  when  attended,  as  it  often  is,  with  night-sweats,  a 
frequent  pulse,  and  sleeplessness,  restlessness,  or  other  functional  nervous 
disorder,  the  wild- cherry  bark  is  also  an  excellent  remedy.  Perhaps  the 
tannic  acid  it  contains  may  contribute  to  its  usefulness  in  correcting  the 
excessive  sweating  in  these  cases;  but  I  am  not  inclined  to  attribute 
much  to  that  principle  in  estimating  the  virtues  of  the  bark. 

It  has  been  recommended  also  in  simple  dyspepsia,  and  as  an  anti- 

and  there  was  none  of  the  peculiar  odour  of  that  product;  yet  the  taste  was 
decidedly  bitter,  proving  the  existence  in  the  bark  of  a  bitter  principle  distinct 
from  amygdalin. 


292  GENERAL    STIMULANTS.  [PART  II. 

periodic  in  intermittents :  but  in  the  former  it  is  much  inferior  to  the  pure 
bitters,  and  in  the  latter,  though  sometimes  successful,  it  very  often  also 
fails,  and  is  not  comparable  in  efficacy  with  Peruvian  bark.  It  may  be 
emploved,  however,  in  cases  of  convalescence  from  miasmatic  fevers,  in 
which  there  is  a  strong  tendency  to  relapse,  and  in  which  a  long  con- 
tinuance of  the  preventive  influence  may  be  necessary  for  the  eradication 
of  the  predisposition.  In  such  cases,  though  less  effectual  than  sulphate 
of  quinia,  it  may  perhaps  be  safer. 

I  have  employed  the  remedy  much  in  functional  and  organic  disease 
of  the  heart,  attended  with  a  frequent,  perhaps  irregular,  but  rather  feeble 
pulse,  with  an  anemic  or  otherwise  debilitated  state  of  system ;  and  con- 
sider it  one  of  our  best  remedies  in  such  cases,  combined,  if  anemia  exist, 
with  the  use  of  the  chalybeates.  As  the  infusion,  however,  contains  tan- 
nic  acid,  it  is  better  not  to  add  the  preparation  of  iron  to  it,  but  to  ad- 
minister the  two  separately. 

Administration.  The  bark  may  be  given  in  the  form  of  powder,  infu- 
sion, or  syrup.  The  powder  is  seldom  used,  because  less  convenient,  more 
apt  to  oppress  the  stomach,  and  less  likely  to  undergo  those  chemical 
changes  which  are  essential  to  the  characteristic  effects  of  the  remedy. 
The  dose  is  from  thirty  grains  to  a  drachm,  which  may  be  repeated  three 
or  four  times  daily. 

The  Infusion  made  with  cold  water  (INFUSUM  PRUNI  VIRGINIANS, 
U.  S.)  is  the  most  appropriate  form.  It  is  made  in  the  proportion  of  half 
an  ounce  to  the  pint  of  water,  and  is  best  prepared  by  the  process  of 
percolation.  Any  one  can  perform  this  process.  Introduce  an  ounce 
of  the  bark,  in  the  state  of  powder,  into  a  common  funnel,  pack  it  some- 
what closely,  and  pour  upon  it  a  quart  of  cold  water;  the  point  of  the 
funnel  being  inserted  into  the  mouth  of  a  glass  decanter.  When  the 
water  has  all  passed,  pour  it  back  into  the  funnel,  and  repeat  this  measure 
until  the  liquid  acquires  the  colour  of  Madeira  wine.  Two  fluidounces  of 
the  infusion,  thus  prepared,  may  be  given  three  or  four  times  a  day,  or 
more  frequently  when  a  strong  impression  is  desired. 

A  Syrup  (SYRUPUS  PRUNI  VIRGINIANS,  U.  S.)  is  directed  by  our 
Pharmacopeia.  It  is  an  elegant  preparation,  and,  where  there  is  no 
contraindication,  from  delicacy  of  stomach  or  other  cause,  to  the  use  of 
so  much  saccharine  matter,  may  be  substituted  without  disadvantage  for 
the  infusion.  The  dose  is  half  a  fluidounce,  to  be  repeated  as  directed  for 
the  other  forms. 

A  Fluid  Extract  (EXTRACTUM  PRUNI  VIRGINIANS  FLUIDUM,  U.  S.) 
was  introduced  into  the  last  edition  of  the  Pharmacopoeia.  It  is  pre- 
pared ^according  to  a  very  ingenious  process  suggested  by  Professor 
Procter,  by  which  the  virtues  of  the  bark  are  obtained  in  a  very  con- 
centrated form.  The  dose  is  one  or  two  fluidrachms,  equivalent  to  half 
a  drachm  or  a  drachm  of  the  bark  in  substance.  (See  U.  S.  Dispensatory, 
llth  ed.,  p.  628.) 


CHAP.  I.]  TONICS. — CHAMOMILE.  293 

Wild-cherry  bark  should  not  be  prepared  in  the  form  of  tincture,  ex- 
tract, or  decoction.  In  reference  to  the  two  latter,  independently  of  the 
chemical  objection  above  stated,  there  is  another  in  the  volatile  character 
of  the  hydrocyanic  acid,  which,  if  formed,  would  be  driven  off,  to  a  greater 
or  less  extent,  in  the  processes  for  their  preparation. 


IV.  CHAMOMILE. 

ANTHEMIS.  U.  S.,  Br. 

Origin.  The  chamomile  of  the  shops  consists  of  the  flowers  of  Anthe- 
mis  nobilis,  a  perennial,  herbaceous  plant,  growing  wild  in  Europe,  where 
it  is  also  cultivated  for  use.  Though  it  has  been  introduced  into  our 
gardens,  none  of  the  chamomile  of  the  shops  is  produced  in  this  country. 
All  parts  of  the  plant  have  medicinal  properties ;  but  it  is  only  the  flowers 
that  are  officinal.  They  are  imported  from  Germany  and  England. 

Varieties.  The  flowers  of  chamomile  are  compound,  consisting,  in  their 
perfect  state,  of  a  central  yellow  disk,  with  a  circle  of  white  ray  florets 
around  it.  There  are  two  varieties,  distinguished  as  the  single  and 
double ;  the  former  retaining  their  yellow  central  disk  florets,  the  latter 
having  had  these  converted  by  cultivation  into  white  ray  florets.  But  the 
distinction  is  not  precise ;  for  there  is  a  large  proportion  of  the  flowers  in 
which  this  conversion  is  incomplete ;  and,  as  found  in  the  shops,  there  is 
generally  a  mixture  of  the  single  and  double  flowers,  and  others  in  the 
intermediate  state.  In  most  parcels,  as  brought  to  this  country,  the 
double  or  white  flowers  greatly  predominate.  The  single  or  yellow,  how- 
ever, are  more  odorous,  and  more  stimulant  to  the  stomach,  because  the 
volatile  oil,  upon  which  these  properties  depend,  is  much  more  abundant 
in  the  central  or  yellow  florets. 

Sensible  Properties.  The  odour  of  chamomile  is  fragrant  and  peculiar, 
the  taste  bitter,  warm,  and  somewhat  aromatic.  It  yields  these  properties, 
and  its  medical  virtues,  to  water  and  alcohol. 

Active  Constituents.  With  a  minute  proportion  of  tannic  acid,  which 
is  therapeutically  of  no  account,  the  flowers  contain  a  bitter  principle 
and  volatile  oil,  upon  which  their  medical  virtues  depend.  It  is  said 
that  they  yield  also,  on  distillation,  in  very  small  proportion,  a  substance 
resembling  valerianic  acid. 

Effects  on  the  System.  In  small  doses  frequently  repeated,  chamomile 
is  a  mild  tonic,  operating  like  the  simple  bitters,  but  with  a  somewhat 
more  excitant  influence  on  the  stomach,  owing  to  its  volatile  oil.  In 
large  doses  it  is  apt  to  prove  emetic,  more  so  probably  than  the  simple 
bitters,  which  it  resembles  in  its  tonic  effects. 

Therapeutic  Application.  Chamomile  has  been  employed  as  a  medi- 
cine from  the  earliest  times.  On  the  continent  of  Europe,  it  is  distin- 


294  GENERAL   STIMULANTS.  [PART  II. 

guished  by  the  name  of  Roman  chamomile.  It  is  particularly  adapted 
to  cases  of  general  debility,  in  which  the  stomach  participates  in  a  greater 
degree  than  other  organs.  The  gentle  stimulant  influence  of  its  volatile 
oil  on  the  stomach  renders  it  peculiarly  applicable  under  such  circum- 
stances. Hence,  it  is  much  used  in  the  convalescence  from  acute  febrile 
diseases.  In  mild  d}rspepsia,  with  defective  appetite,  flatulent  eructa- 
tions, or  slight  colicky  pains  from  wind  in  the  stomach  or  bowels,  it  may 
often  be  given  with  advantage.  Its  general  mildness  and  harmlessness 
adapt  it  to  those  slight  cases  of  debility,  frequently  occurring,  especially 
in  sedentary  females,  in  which  stronger  medicines  are  scarcely  required, 
and  might  prove  hurtful. 

By  the  ancients  it  was  used  in  the  treatment  of  intermittent  fever, 
and  continued  to  be  esteemed  among  the  most  valuable  remedies  in  that 
complaint,  down  to  the  period  of  the  discovery  of  Peruvian  bark.  Eveii 
after  that  period,  it  long  continued  to  retain  some  reputation  as  a  febri- 
fuge, being  employed  in  cases  which  resisted  the  bark,  and  especially  in 
the  remission  of  remittent  fevers,  before  the  febrile  phenomena  of  the 
paroxysms  had  sufficiently  subsided  to  justify  the  use  of  the  more  pow- 
erful antiperiodic.  But,  since  the  introduction  of  sulphate  of  quinia  into 
use,  this  application  of  chamomile  has  been  generally  abandoned ;  as  it 
is  now  understood  that,  in  miasmatic  remittents,  when  there  is  a  sufficient 
abatement  of  the  fever  to  justify  a  resort  to  the  bitter  tonics,  quinia  may 
almost  always  be  used,  with  equal  safety,  and  vastly  greater  effect.  In 
cases,  however,  of  intermittent  and  remittent  fever,  distinctly  paroxys- 
mal, in  which  circumstances  may  prevent  the  employment  of  cinchona 
or  its  preparations,  large  draughts  of  warm  chamomile  tea,  given  imme- 
diately before  the  paroxysm,  the  patient  being  kept  warm  in  bed,  will 
sometimes  prevent  the  recurrence  of  the  fever,  either  by  operating  as  an 
emetic,  or  by  a  joint  tonic  and  diaphoretic  action. 

It  has  already  been  stated  that,  in  large  doses,  chamomile  is  apt  to 
vomit.  To  produce  this  effect,  however,  it  should  be  given  in  the  form 
of  warm  infusion,  and  in  large  draughts,  so  as  to  aid  the  medicine  by  the 
nauseating  effects  of  tepid  water.  It  may  frequently  be  employed  with 
advantage,  in  this  way,  incases  of  gastric  spasm  arising  from  undigested 
food  or  other  irritating  matters  in  the  stomach,  and  attended  with  sensa- 
tions of  nausea,  or  ineffectual  efforts  to  vomit.  Indeed,  in  any  case  of 
irritable  stomach,  when  that  organ  seems  unable  wholly  to  free  itself 
from  its  contents,  it  may  very  properly  be  aided  by  large  draughts  of 
warm  chamomile  tea.  In  febrile  and  bilious  diseases,  there  is  often  a 
good  deal  of  retching  from  the  presence  of  acrid  bile  in  the  stomach, 
which  may  thus  be  promptly  relieved.  The  tea  is  often  also  adminis- 
tered along  with  other  emetics,  or  shortly  afterwards  when  they  are 
tardy,  in  order  to  promote  their  action,  or  to  render  it  more  easy  to  the 
patient,  by  giving  the  stomach  a  greater  bulk  to  act  upon. 


CHAP.  I.]  TONICS. — CHAMOMILE.  295 

The  flowers  were  formerly  much  used  externally  with  hot  water,  in  the 
way  of  fomentation,  or  as  a  sort  of  cataplasm  inclosed  in  a  flannel  bag. 
They  add  nothing  to  the  virtues  of  the  hot  water;  but,  in  the  latter  case, 
may  be  useful  by  absorbing  the  liquid. 

Administration.  Chamomile  is  given  in  powder,  infusion,  or  extract ; 
and  the  volatile  oil  is  sometimes  separately  administered. 

The  powder  was  formerly  given  occasionally,  with  the  view  to  the  an- 
tiperiodic  effect,  in  doses  of  from  half  a  drachm  to  a  drachm,  repeated  three 
or  four  times  a  day,  or  oftener  if  required.  As  a  mere  tonic,  its  dose 
may  be  stated  at  from  ten  to  thirty  grains ;  but  it  is  almost  never  admin- 
istered in  this  way.  The  flowers  themselves  are  sometimes  chewed  by 
dyspeptic  persons,  and  by  those  who  wish  to  break  themselves  of  the 
habit  of  chewing  tobacco,  by  substituting  a  more  innocent  substance. 

The  Infusion  (!NFUSUM  ANTHEMIDIS,  U.S.)  is  made  in  the  proportion 
of  half  an  ounce  to  a  pint  of  water.  When  time  is  allowed  for  a  suffi- 
cient maceration,  cold  water  is  preferable  to  hot  as  the  menstruum,  as  it 
yields  an  infusion  more  acceptable  at  once  to  the  palate  and  the  stomach  ; 
but  in  case  of  haste,  boiling  water  maybe  used  ;  and,  with  a  view  to  its 
emetic  operation,  the  latter  is  decidedly  preferable,  and  the  infusion 
should  be  taken  warm.  The  dose  as  a  tonic  is  a  vvineglassful,  three  or 
four  times  a  day.  When  given  to  aid  emetics,  a  small  bowlful,  containing 
from  six  to  twelve  fluidounces,  may  be  given  at  once,  and  repeated  if 
required. 

The  Extract  (EXTRACTUM  ANTHEMIDIS,  Br.),  directed  by  the  British 
Pharmacopoeia,  is  not  an  ineligible  preparation  ;  as  the  volatile  oil,  which 
was  driven  off  in  the  old  Edinburgh  process  during  the  evaporation,  or 
rather  an  equivalent  quantity  of  it,  is  added  at  the  close  of  the  concentra- 
tion. As  now  prepared,  the  extract  represents  the  virtues  of  the  flowers, 
and  may  be  given  whenever  these  are  indicated.  It  is  occasionally  used  as 
an  addition  to  laxatives  or  metallic  tonics,  and  as  a  vehicle  for  other  med- 
icines, given  in  the  pilular  form.  The  dose  is  from  five  to  thirty  grains, 
the  strength  being  about  double  that  of  the  flowers. 

The  decoction  was  formerly  used  as  an  external  fomentation,  as  an 
enema,  or  as  a  local  application  to  flabby  or  indolent  ulcers;  but  has  been 
abandoned,  because  in  no  respect  preferable  to  the  infusion,  and  inferior 
from  the  circumstance,  that  a  portion  of  the  volatile  oil  must  be  driven 
off  in  its  preparation. 

The  Volatile  Oil  (OLEUM  ANTHEMIDIS,  Br.)  is  occasionally  prescribed. 
It  is  obtained  by  distillation  with  water  from  the  flowers.  As  first  pro- 
cured, it  has  a  sky-blue  colour,  which  is  changed  by  time  to  yellow  or 
brown.  Its  odour  is  that  of  chamomile,  its  taste  pungent  and  aromatic. 
It  is  stimulant  to  the  stomach,  and  may  be  given  in  gastric  pains  of  a 
purely  functional  character,  and  in  flatulence,  in  the  dose  of  five  or  six 
drops.  It  is  sometimes  associated  with  purgatives  to  prevent  griping. 


296  GENERAL    STIMULANTS.  [PART  II. 

Other  species  of  Anthemis  have  been  used.  A.  Cotula,  may-weed,  or 
wild  chamomile,  which  grows  abundantly  in  this  country,  and  is  one  of 
the  most  common  weeds  in  our  public  roads,  has  virtues  analogous  to 
those  of  A.  nobilis,  but,  in  consequence  of  its  very  unpleasant  odour,  is 
little  if  at  all  used  with  us.  In  Europe  it  is  said  to  be  occasionally  em- 
ployed as  an  antispasrnodic  and  emmenagogue.  Our  national  Pharma- 
copoeia recognizes  it,  in  the  secondary  list,  under  the  name  of  Cotula. 

GERMAN  CHAMOMILE.— MATRIOARIA.  U.  S. 

This  medicine  is  considered  here  in  a  subordinate  position  to  Anthe- 
mis, because,  though  closely  similar  to  the  common  or  Roman  chamomile, 
and  largely  used  on  the  continent  of  Europe,  and  especially  in  Germany, 
for  the  same  purposes,  it  is  probably  inferior  in  strength,  and  is  little  used 
in  this  country  unless  among  German  practitioners.  The  plant  is  an  annual 
syngenesious  herb,  of  which  the  flowers  only  are  officinal.  As  found  in 
our  shops  they  are  imported  from  Germany.  They  are  smaller  than  the 
common  chamomile,  and  the  yellow  disk  or  central  florets,  which  are 
deep-yellow,  are  proportionably  more  numerous  than  those  of  the  ray. 
They  owe  their  virtues  to  a  volatile  oil  and  bitter  principle,  both  of  which 
are  readily  imparted  to  water  and  alcohol.  Their  effects  are  essentially 
the  same  as  those  of  common  chamomile,  and  they  are  given  for  the 
same  purposes,  and  in  the  same  way. 


V.  THOROUGHWORT,  OR  BONESET. 
EUPATORIUM.  U.  S. 

Origin.  This  consists  of  the  leaves  and  flowering  tops  of  Eupalorium 
perfolialum,  an  indigenous,  perennial,  herbaceous  plant,  growing  abund- 
antly, usually  in  clusters,  in  low  moist  grounds,  in  most  parts  of  the 
United  States.  All  portions  of  the  plant  are  medicinal.  It  is  in  flower 
from  July  to  October,  and  should  be  collected  during  that  period. 

Sensible  Properties.  Boneset  is  sometimes  kept  in  the  shops  in  bunches, 
sometimes  in  small  oblong  packages,  in  which  it  is  much  broken  up.  In 
the  former  state,  it  may  be  known  by  its  perfoliate  and  decussating 
leaves,  and  by  its  flattish,  dense  summit  of  white,  almost  feathery 
flowers.  The  leaves  may  be  considered  as  consisting  of  two,  join  id 
at  their  base,  where  they  are  perforated  by  the  stem.  Each  leaf  is 
broadest  at  the  base,  long,  narrow,  and  gradually  tapering  to  a  point, 
serrate  on  the  edges,  wrinkled,  whitish  below  and  green  above,  and 
hairy.  The  pairs  are  so  placed  on  the  stem,  that  each  one  is  at  right 
angles  with  the  one  above  and  below  it.  The  odour  is  feeble,  yet  dis- 
tinct, and  the  taste  strongly  bitter  and  peculiar.  It  yields  its  sensible 
and  medicinal  properties  to  water  and  alcohol. 


CHAP.  I.]  TONICS. — EUPATORIUM.  297 

Active  Constituents.  Little  is  known,  positively,  on  this  point.  There 
is  little  doubt  that  the  bitterness  resides  in  one  or  more  proximate 
principles;  but  they  have  not  yet  been  satisfactorily  isolated.  From 
the  smell,  it  may  be  inferred  to  contain  a  small  proportion  of  volatile 
oil,  and  the  fact  seems  to  have  been  established  by  the  examination 
of  Mr.  Bickley.  (Am.  Journ.  of  Pharm.,  xxvi.  495.)  The  medicine  is 
placed  next  to  chamomile,  more  from  its  analogy  to  that  medicine  in 
effects,  than  from  any  known  resemblance  in  composition. 

Effects  on  the  System.  Eupatorium,  in  moderate  doses,  produces  on 
the  system  effects  like  those  of  the  simple  bitters ;  but  superadds  to  these, 
especially  when  taken  in  warm  infusion,  and  somewhat  freely,  a  decided 
diaphoretic  action.  It  is  said,  also,  sometimes  to  be  diuretic,  and,  in 
large  doses,  proves  emetic  and  laxative.  It  is  among  the  remedies  de- 
rived from  the  aborigines,  from  whom  it  passed  into  popular  use,  and 
thence  into  the  hands  of  the  profession. 

Therapeutic  Application.  Eupatorium  may  be  given,  like  the  simple 
bitters,  in  pure  dyspepsia  or  general  debility;  but,  being  more  liable 
than  they  to  irritate  the  stomach,  and  probably  less  efficient  as  a  mere 
tonic,  should  not  be  allowed  to  supersede  them,  unless  under  peculiar 
circumstances  of  idiosyncrasy  or  prejudice.  Dr.  Burgon,  of  Bucks 
County,  Pennsylvania,  preferred  it  to  all  other  tonics,  in  the  loss  of  ap- 
petite incident  to  the  abuse  of  alcoholic  drinks.  (Am.  Med.  Record.,  iii. 
331.)  Dr.  Eborle  found  it  peculiarly  useful  in  the  indigestion  of  old 
people,  in  whom,  while  it  restored  tone  to  the  stomach,  it  rendered  the 
skin  soft  and  comfortable.  (Mat.  Med.  and  Therap.,  4th  ed.,  ii.  219.) 

But  its  highest  reputation  has  been  as  a  febrifuge.  From  the  inau- 
gural dissertation  of  Dr.  Anderson  (New  York,  1813),  it  would  appear 
to  have  been  employed  with  very  great  success,  in  the  treatment  of  in- 
termittents,  in  one  of  the  New  York  hospitals.  Subsequen/  observation 
of  its  effects  has  proved  less  favourable ;  and,  employed  as  a  mere  anti- 
periodic,  in  the  ordinary  mode  of  prescribing  bark  or  quinia  in  the  inter- 
missions, it  cannot  be  relied  on.  But  I  have  known  it  to  supersede  the 
paroxysms  of  intermittent  fever,  when  given  in  emetic  doses,  in  the  state 
of  strong  tepid  infusion,  shortly  before  the  period  for  the  return  of  the 
chills ;  and  if,  jointly  with  this  method  of  exhibition,  it  be  administered 
in  moderate  doses,  at  short  intervals,  during  the  apyrexia,  there  is  little 
doubt  that  it  will  often  prove  successful.  Still,  it  is  greatly  inferior  to 
sulphate  of  quinia  in  certainty,  while,  in  its  effects  as  thus  used,  it  is 
much  more  disagreeable.  It  may  be  very  appropriately  tried  in  obsti- 
nate and  frequently  recurring  attacks  of  intermittent  fever,  in  which 
quinia  has  become  offensive  to  the  patient,  or  inoperative  from  repetition. 
The  same  remarks  are  applicable  to  its  comparative  efficacy  in  remittents; 
in  which,  however,  its  tendency  to  produce  perspiration  is  somewhat  in 
its  favour. 


298  GENERAL    STIMULANTS.  [PART  II. 

It  was  recommended,  by  Drs.  Bard  and  Hosack,  in  yellow  fever  (Eb- 
erle,  loc.  cit.);  and  has  been  used  as  a  tonic  and  diaphoretic  in  low  fevers, 
and  typhoid  pneumonia;  but  its  special  merits  iu  these  affections  are  at 
best  equivocal,  and  it  is  now  seldom  employed. 

Perhaps  its  best  application  is  to  the  treatment  of  catarrahal  affec- 
tions, more  particularly  the  epidemic  catarrh  or  influenza,  which  is  fre- 
quently attended  with  an  asthenic  state  of  system,  calling  for  supporting 
measures.  The  most  effectual  method  of  employing  it,  in  these  cases, 
is,  very  soon  after  the  attack  of  the  disease,  to  administer  it  freely  at 
bedtime,  in  the  form  of  hot  infusion,  the  patient  being  well  covered,  so 
as  to  provoke  copious  and  lasting  perspiration;  and  if  vomiting  should 
take  place  the  effect  would  be  more  certain.  In  the  morning,  the  disease 
will  often  be  found  to  have  been  arrested,  or  very  much  moderated ;  and 
afterwards  the  medicine  may  be  given  in  small  and  repeated  doses,  so  as 
not  to  nauseate.  Dr.  Chapman,  in  his  Therapeutics  (2d  ed.,  i.  388),  speak- 
ing of  its  employment  in  a  species  of  influenza  which  had  prevailed 
many  years  previously  in  the  United  States,  and  which,  in  consequence 
of  the  pain  attending  it,  was  commonly  denominated  break-bone  fever, 
states  that,  from  its  prompt  success  in  relieving  this  symptom,  it  acquired 
the  popular  name  of  boneset,  by  which  it  is  still  known.  The  probability 
is,  that  the  epidemic  alluded  to  by  Dr.  Chapman  was  that  described  by 
Dr.  Rush  as  having  occurred  in  Philadelphia,  in  the  summer  and 
autumn  of  1780,  called  break-bone  fever,  from  the  violence  of  its  pains, 
but  which,  there  is  every  reason  to  suppose,  was  the  disease  since  better 
known  under  the  name  of  dengue.  This  fact  would  suggest  a  trial  of 
eupatorium  in  that  very  painful  epidemic  disease. 

In  acute  rheumatism,  the  medicine  is  said  to  have  proved  useful ;  and, 
in  the  atonic  variety,  occurring  in  feeble  constitutions,  without  plethora, 
it  might  !><•  very  properly  tried,  with  a  view  to  its  conjoined  tonic  and 
diaphoretic  effects. 

Though  said  to  have  been  advantageously  employed  in  obstinate  cuta- 
neous diseases,  I  have  no  faith  whatever  in  its  efficacy,  except  in  so  far 
as  it  may  operate,  like  any  other  tonic,  in  promoting  the  general  health. 
The  same  may  be  said  of  its  remedial  powers  in  dropsy,  in  which  it  has 
been  recommended. 

Administration.  As  an  antiperiodic  or  tonic,  the  medicine  m;iy  he 
given  in  powder,  in  doses  of  twenty  or  thirty  grains,  or  more;  but  it  is 
very  little  used  in  this  form. 

The  Infusion  (!NFUSUM  EUPATORII,  U.  /S.)  is  a  more  eligible  prepara- 
tion. It  is  made  in  the  proportion  of  an  ounce  to  a  pint  of  water,  and  given 
in  the  dose  of  one  or  two  fluidounces,  repeated  more  or  less  frequently, 
according  to  circumstances;  three  or  four  times  a  day,  as  a  tonic,  in 
chronic  cases;  and  every  hour,  two,  or  three  hours,  as  an  antiperiodic, 
or  joint  tonic  and  diaphoretic,  in  those  more  acute.  When  its  emetic 


CHAP.  I.]  TONICS. — SERPENTARIA.  299 

effect  is  wanted,  six  or  eight  ounces  of  the  hot  infusion  may  be  given  at 
a  draught. 

A  watery  extract  has  been  used  in  the  dose  of  four  or  five  grains. 

Several  other  species  of  Eupatorium  have  been  employed.  Among 
our  indigenous  species,  E.  purpureum,  or  gravel  root,  has  tonic  and 
astringent  properties,  and  is  said  to  be  diuretic.  E.  teucrifolium,  or 
wild  horehound,  corresponds  with  the  officinal  species  in  properties, 
though  less  powerful ;  and  E.  aromaticum  is  considered,  among  the  so- 
called  eclectic  physicians,  as  a  valuable  remedy  in  a  number  of  diseases. 
The  root  of  E.  Cannabinum  was  formerly  used  in  Europe  as  a  purga- 
tive ;  and  E.  Aya-pana,  of  Brazil,  resembles  the  boneset,  but  is  weaker. 


VI.  SERPENTARIA.  U.S. 

SERPENTARIA.  U.S.,  Br.— Syn.  Virginia  Snakeroot. 

Origin.  This  consists  of  the  roots  of  Aristolochia  Serpentaria,  Aris- 
tolochia  reticulata,  and  probably  several  other  analogous  species  of  the 
same  genus,  all  of  them  small,  indigenous,  herbaceous  perennials,  grow- 
ing in  the  woods  in  the  Middle,  Southern,  and  Western  States;  A. 
Serpentaria  abounding  in  western  Pennsylvania,  Virginia,  Ohio,  Ken- 
tucky, etc.;  A.  reticulata  in  Louisiana,  Arkansas,  and  the  neighbouring 
regions. 

Sensible  Properties.  The  root  consists  of  a  short,  contorted,  knotty 
head,  with  numerous  long,  slender  fibres  or  rootlets  proceeding  from  it, 
which  are  often  more  or  less  interlaced,  as  the  medicine  is  found  in  the 
shops.  The  roots  of  A.  reticulata  are  straighter,  thicker,  and  less  flexible 
than  the  others,  and  consequently  much  less  interlaced.  The  colour  is 
at  first  yellowish,  but  becomes  brownish  by  time ;  the  odour  is  strong, 
aromatic,  and  agreeable ;  the  taste  very  bitter,  aromatic,  and  somewhat 
camphorous.  The  root  yields  its  sensible  properties  and  medical  virtues 
to  water  and  alcohol. 

Active  Constituents.  These  are  a  peculiar  bitter  principle,  and  a  pecu- 
liar volatile  oil,  which  may  be  separated  by  distillation. 

Adulterations.  Occasionally  the  roots  of  Spigelia  Marilandica,  and 
the  young  roots  of  Polygala  Senega,  are  mixed  with  serpentaria,  but 
probably  not  by  design.  They  are  distinguishable  by  the  total  want  of 
the  odour  and  taste  of  the  genuine  root. 

Effects  on  the  System.  Serpentaria  is  a  stimulating,  diaphoretic  tonic; 
owing  its  tonic  properties,  which  are  probably  identical  with  those  of  the 
simple  bitters,  to  its  bitter  principle,  and  its  stimulant  and  diaphoretic  in- 
fluence mainly  to  its  volatile  oil.  Taken  internally,  it  sharpens  the  appe- 
tite, hastens  the  digestive  process,  increases  the  frequency  of  pulse  and 


300  GENERAL    STIMULANTS.  [PART  II. 

warmth  of  skin,  and  occasions,  not  unfrequently,  either  diaphoresis  or 
diuresis ;  being  disposed  to  produce  the  former  effect,  if  given  in  warm 
infusion  while  the  patient  is  well  covered  in  bed,  and  the  latter,  if  in 
powder,  or  cold  infusion,  while  he  is  walking  about  and  exposed  to  the 
air.  When  taken  in  over-doses,  it  may  produce  nausea,  griping  pain  in 
the  bowels,  even  vomiting  or  tenesmus,  and  will  sometimes  cause  pain 
or  a  sense  of  weight  in  the  head,  with  disturbed  sleep. 

Therapeutic  Application.  Virginia  snakeroot  has  been  known  as  a 
medicine  from  an  early  period  of  the  settlement  of  this  country.  Like 
others  of  our  valuable  indigenous  remedies,  it  originally  attracted  notice 
as  an  antidote  to  the  bite  of  serpents;  and,  as  such,  is  alluded  to  in  a 
work  by  Dr.  J.  Cornutus,  published  at  Paris  in  1635  (W.  P.  C.  Bar- 
ton, Veg.  Mat.  Med.  of  the  U.  S.,  ii.  48) ;  but  the  first  known  mention 
of  it  was  by  Thomas  Johnson,  an  apothecary  of  London,  in  an  edition 
of  Gerarde's  Herbal,  published  in  1633  (Pereira,  Mat.  Med.,  ii.  1299). 
Its  supposed  efficacy  in  the  poison  of  serpents  led  naturally  to  its  use  in 
low  and  malignant  febrile  diseases,  in  which  the  blood  was  believed  to 
be  poisoned ;  and,  by  an  easy  transition,  it  came  to  be  employed  in  other 
fevers,  in  which  this  malignant  type  was  not  presented.  Sydenham  re- 
commended it  in  vernal  intermittents  (Sydenham's  Works,  edited  by  Dr. 
Rush,  p.  460);  and  it  is  favourably  spoken  of  by  many  of  the  medical 
writers  of  the  last  century.  Its  real  value  is  now  probably  better  known 
than  formerly.  It  is  simply  tonic  and  stimulant  to  the  circulation,  with 
a  tendency  to  produce  perspiration,  generally  acceptable  to  the  stomach 
in  moderate  doses,  and  probably  without  special  influence  on  the  brain 
or  nervous  system. 

It  may  be  employed  in  pure  dyspepsia,  attended  with  a  degree  of  de- 
bility calling  for  something  more  stimulating  than  the  simple  bitters,  and 
especially  wl^ere  there  is  a  disposition  to  dryness  of  the  surface ;  but  its 
most  appropriate  application  continues  to  be  that  for  which  it  was  early 
recommended,  to  the  treatment,  namely,  of  fevers  of  a  low  or  typhoid 
character,  or  disposed  to  take  on  that  character.  Whenever  any  febrile 
disease  begins  to  exhibit  this  tendency,  and  stimulation  is  demanded, 
serpentaria  is  one  of  the  first  medicines  to  which  we  may  have  recourse, 
provided  the  stomach  be  wholly  free  from  inflammation,  or  vascular  irri- 
tation. It  may  be  used,  therefore,  with  the  condition  of  stomach  men- 
tioned, in  typhus  or  typhoid  fever  when  passing  from  the  first  stage  of 
excitement  into  that  of  debility,  in  protracted  remittent  fever  a.-suminga 
low  character,  in  typhoid  pneumonia,  and  in  smallpox,  scarlatina,  malig- 
nant sore-throat,  and  erysipelas,  under  similar  circumstances.  But  it 
should  be  understood  that,  in  none  of  these  affections,  does  it  possess 
any  specific  curative  powers,  that  it  can  act  merely  as  a  tonic  and  gentle 
stimulant,  and  that  it  should  be  used  only  as  an  adjuvant  in  very  serious 
cases,  being  alone  wholly  incompetent  to  the  support  of  the  system  under 


CHAP.  I.]  TONICS. — ARNICA.  301 

powerful  depressing  influences.  In  many  of  these  cases,  it  may  be  very 
properly  associated  with  Peruvian  bark  or  quinia. 

From  my  own  observation,  I  should  infer  that  serpentaria  possesses 
no  peculiar  antiperiodic  power,  and  that  it  cannot,  therefore,  be  relied 
on  for  breaking  the  course  of  an  intermittent  or  remittent  fever;  but  in 
either,  it  may  be  conjoined  with  sulphate  of  quinia  when  the  system  is 
feeble,  and  the  stomach  somewhat  insusceptible.  The  association  of  ser- 
pentaria with  Peruvian  bark  has  long-  been  a  habit  among  practitioners. 
It  exists  in  the  compound  tincture  of  Peruvian  bark  of  the  British  and 
American  Pharmacopoeias,  better  known  under  the  name  of  Huxham's 
tincture  of  bark. 

Dr.  Chapman  says  of  serpentaria  "that  it  is  admirably  suited  to  check 
vomiting,  and  to  tranquilize  the  stomach,  especially  in  bilious  cases." 
(Elem.  of  Therap.,  etc.,  2d  cd.,  ii.  434.) 

Administration.  The  medicine  is  sometimes,  but  rarely,  given  in  pow- 
der. The  Infusion  (!NFUSUM  SERPENTARIA,  U.S.),  made  in  the  pro- 
portion of  half  an  ounce  to  a  pint  of  boiling  Avater,  is  the  preparation 
ordinarily  used.  In  the  present  Pharmacopcoia  the  infusion,  though 
prepared  also  in  this  way,  is  preferably  made  by  percolation  with  cold 
water,  essentially  the  same  proportions  being  used.  There  is  an  officinal 
Tincture  (TINCTURA  SERPENTARIA,  U.  S.),  which  is  rendered  turbid  by 
water. 

The  dose  of  the  powder  is  from  ten  to  thirty  grains ;  that  of  the  infu- 
sion, one  or  two  fluidounces,  to  be  repeated  three  or  four  times  a  day  in 
chronic  cases,  every  hour,  two,  or  three  hours,  in  acute.  Of  the  tincture, 
which  is  employed  chiefly  as  a  stimulant  and  stomachic  addition  to  other 
medicines,  the  dose  is  one  or  two  fluidrachms. 

A  Fluid  Extract  (EXTRACTUM  SERPENTARIA  FLUIDUM,  U.  S.)  is 
directed  in  the  present  Pharmacopoeia,  and  is  a  good  preparation,  con- 
taining all  the  virtues  of  the  root  in  a  very  small  space.  It  is,  indeed, 
a  concentrated  tincture ;  but  the  proportion  of  alcohol  is  almost  insig- 
nificant, and,  in  view  of  the  stimulant  effect  the  fluid  extract  is  intended 
to  produce,  wholly  so.  The  dose  is  twenty  or  thirty  minims,  to  be  fre- 
quently repeated. 

ARNICA.  U.  S.,  Br. 

On  comparing  arnica  with  other  medicines,  I  find  none  to  which  it 
appears  to  me  to  approach  more  closely  than  serpentaria;  though  it 
must  be  acknowledged  that  there  is  considerable  difference  between 
them.  I  have  accordingly  concluded  to  give  it  this  subordinate  position 
to  serpentaria  provisionally,  until  a  better  place  can  be  found  for  it  in 
the  classification. 

The  name  of  arnica  is  given,  in  the  U.  S.  Pharmacopoeia,  to  the 
flowers,  in  the  British,  to  the  root  of  Arnica  montana  or  Leopard1  s-bane, 


302  GENERAL   STIMULANTS.  [PART  II. 

a  perennial  herbaceous  plant,  growing  in  the  mountainous  regions  of 
Europe  and  Siberia,  and,  according  to  Nuttall,  in  the  North-western 
parts  of  this  continent.  The  entire  plant  has,  when  fresh,  a  strong  dis- 
agreeable odour,  which  diminishes  in  drying,  and  an  acrid,  bitter,  last- 
ing taste.  The  flowers  are  most  used  in  this  country.  Among  other 
ingredients  they  were  found  by  MM.  Chevallier  and  Lassaigne  to  contain 
a  peculiar  principle,  analogous  if  not  identical  with  cytisin,  previously 
discovered  in  the  laburnum-tree.  This  is  a  powerful  agent,  acting  ener- 
getically in  the  dose  of  five  grains  as  an  emeto-cathartic,  and  probably 
capable  in  excessive  doses  of  producing  poisonous  effects.  It  is  no 
doubt  one  of  the  active  ingredients  of  the  flowers ;  but  certainly  not  the 
only  one ;  as,  besides  a  small  proportion  of  volatile  oil  and  acrid  resin,  a 
peculiar  alkaloid  has  been  obtained  from  them,  which  is  not  without 
influence  upon  the  system.  Our  information,  however,  as  to  the  relation 
between  these  two  substances,  the  cytisiu  and  arnicina  (or  preferably 
arnicia)  as  the  alkaloid  has  been  named,  and  as  to  the  effects  of  both  on 
the  system,  is  yet  too  indefinite  to  admit  of  positive  conclusions.  It 
seems  certain,  however,  that  they  are  not  identical ;  for,  according  to  its 
discoverers,  cytisin  is  readily  dissolved  by  water,  with  difficulty  by 
strong  alcohol,  and  not  at  all  by  ether;  while  arnicia  is  but  slightly 
soluble  in  water,  and  freely  soluble  in  alcohol  and  ether.  The  root 
probably  has  essentially  the  same  virtues  as  the  flowers. 

As  a  medicine,  arnica  has  long  been  used  on  the  continent  of  Europe, 
particularly  in  Germany,  where  it  is  highly  esteemed.  In  the  United 
States,  it  was  almost  unknown  as  a  remedy  until  of  late ;  but  within  a 
few  years  it  has  risen  greatly  in  reputation,  probably  in  part  through  the 
many  German  practitioners  who  are  pursuing  their  profession  in  this 
country.  So  decided  is  the  change  in  this  respect  that,  in  the  present 
edition  of  the  U.  S.  Pharmacopeia,  it  takes  a  place  in  the  primary  cata- 
logue, having  been  transferred  from  the  secondary,  where  it  previously 
held  a  somewhat  doubtful  place.  Arnica  appears  to  be  a  general  stimu- 
lant and  tonic,  analogous  in  this  respect  to  serpentaria,  but  directed  espe- 
cially to  the  nervous  system,  and  acting  as  a  diaphoretic,  diuretic,  and 
emmenagogue.  It  is  apt  to  nauseate,  and  in  large  doses  operates  as  an 
emetic  and  cathartic.  Very  freely  taken,  it  causes  burning  in  the  stom- 
ach, violent  abdominal  pain,  excessive  headache,  muscular  spasms,  and 
other  evidence  of  nervous  disturbance.  It  is  no  doubt  capable  of  acting 
as  a  poison.  A  case  is  recorded  in  the  London  Lancet  (Nov.  18,  1864, 
p.  571),  in  which  the  patient  was  apparently  saved  only  by  the  use  of 
remedies  from  threatened  death,  consequent  on  the  swallowing  by  mis- 
take of  an  ounce  of  tincture  of  arnica.  When  first  seen  by  the  physician, 
he  was  in  a  state  of  approaching  collapse,  with  sunken  and  glassy  eyes, 
dilated  pupils  unaffected  by  light,  voice  low  and  muttering,  pulse  over  a 
hundred,  feeble  and  fluttering,  great  pain  in  the  epigastrium,  and  a  cold, 


CHAP.  I.]  TONICS. — ARNICA.  303 

dry  skin.  Intelligence,  however,  was  not  lost ;  and,  from  his  account  of 
himself,  it  appeared  that  little  effect  had  been  experienced  for  the  first 
eight  hours  after  the  swallowing  of  the  poison,  except  dryness  of  the 
mouth,  that  at  the  end  of  that  time  he  was  awakened  from  sleep  by  vio- 
lent pain  in  the  stomach,  and  that  on  rising  he  felt  sick  and  feeble.  The 
treatment  consisted  in  the  exhibition  of  an  ounce  of  brandy  and  twenty 
minims  of  laudanum,  which  were  repeated  in  two  hours,  and  the  exter- 
nal application  of  heat.  He  gradually  recovered.  An  emetic  would 
have  been  the  appropriate  remedy  at  an  earlier  stage,  but  was  out  of  the 
question  under  the  circumstances  of  the  present  case. 

Arnica  appears  to  be  adapted  to  febrile  diseases  with  a  low  or  typhoid 
tendency,  also  to  various  phlegmasiae  offering  a  similar  condition.  It 
has  been  used  in  rheumatism  and  gout,  diarrhoea  and  dysentery,  chronic 
catarrh  and  nephritis,  passive  hemorrhage,  dropsy,  and  amenorrhoea,  and 
certain  paralytic  affections,  especially  amaurosis.  Having  been  found 
useful  in  the  nervous  disturbance  following  accidents  of  various  kinds,  it 
got  a  reputation  as  a  special  cure  for  wounds,  sprains,  bruises,  and  the 
swellings  consequent  on  dislocation,  and  is  much  employed  in  domestic 
practice  as  a  local  application  in  these  affections,  for  which  the  tincture 
is  deemed  especially  useful.  The  powder  is  sometimes  used  to  excite 
sneezing. 

Arnica  may  be  given  in  powder  or  infusion ;  the  dose  of  the  former 
being  from  five  to  twenty  grains ;  of  the  latter,  made  in  the  proportion 
of  an  ounce  to  the  pint,  half  a  fluidounce  to  a  fluidounce  every  two 
hours. 

A  Tincture  of  the  Flowers  (TINCTURA  ARNIOE,  U.  S.)  and  a  Tincture 
of  the  'Root  (TINCTURA  ARNICA,  Br.)  are  officinal,  the  former  in  the  U.  S., 
the  latter  in  the  Br.  Pharmacopoeia.  It  is  this  preparation  either  undiluted, 
or  mixed  with  water  or  soap  liniment,  that  is  so  much  used  in  the  local 
affections  above  referred  to.  From  some  observations  made  by  Dr.  Garrod, 
of  London,  there  is  reason  to  believe  that  the  effects  of  the  tincture  in 
these  cases  is  little  more  than  that  of  the  alcoholic  menstruum.  The  dose 
for  internal  use  is  from  thirty  minims  to  two  fluidrachins. 

An  Extract  (EXTRACTUM  ARNICA  ALCOHOLICUM,  U.  S.)  is  prepared 
from  the  flowers  by  percolation  with  alcohol  and  subsequent  evaporation. 
The  dose  is  from  five  to  ten  grains.  But  is  more  used  in  the  prepara- 
tion of  the  plaster  than  for  any  other  purpose. 

The  Plaster  of  Arnica  (EMPLASTRUM  ARNICA,  U.  S.)  is  made  by  in- 
corporating the  extract  with  the  melted  resin  plaster.  This  is  another 
preparation  very  popular,  outside  of  the  profession,  as  a  remedy  for 
sprains,  bruises,  etc. 


304  GENERAL   STIMULANTS.  [PART  II. 

VII.  MYRRH. 

MYRRHA.  U.  S.,  Br. 

Origin.  Myrrh  is  a  concrete  exudation  from  Balsamodendron  Myrrha, 
a  shrub  or  small  tree,  growing  in  the  deserts  of  Arabia  and  North-eastern 
Africa,  Two  commercial  varieties  were  formerly  brought  into  market, 
one  from  the  ports  of  Egypt  in  the  Mediterranean,  the  other  from  the 
ports  of  India;  both,  however,  being  originally  obtained  from  the  same 
neighbourhood.  They  were  distinguished  by  the  names  of  Turkey  and 
India  myrrh.  The  former  was  much  purer  and  finer  than  the  latter, 
because  selected  with  greater  care,  in  reference  to  its  more  expensive 
carriage.  At  present  both  kinds  are  imported  from  India,  whither  they 
are  taken  by  Arab  vessels  from  the  Red  Sea. 

Sensible  Properties.  Myrrh  is  in  small  fragments,  irregular  or  rounded, 
like  tears,  or  in  larger  masses,  as  if  consisting  of  the  smaller  agglutinated 
together.  The  best  specimens,  formerly  called  Turkey  myrrh,  are  of  a 
pale  reddish-yellow,  or  reddish-brown  colour,  often  powdery  on  the  sur- 
face, and  translucent.  The  larger  agglutinated  pieces  exhibit  various 
shades  of  colour.  The  inferior  kinds,  formerly  known  as  India  rnyrrh, 
are  in  very  irregular  lumps,  of  a  dark  colour,  opaque,  and  full  of  im- 
purities. Myrrh  is  brittle,  with  a  shining  fracture.  The  powder  of  the 
best  kinds  is  whitish  or  yellowish-white,  of  the  inferior  darker,  with  a 
somewhat  reddish  hue.  It  is  not  fusible  by  heat,  but  is  inflammable. 
The  odour  is  strong,  peculiar,  and  fragrant;  the  taste  bitter,  somewhat 
acrid  or  pungent,  and  aromatic. 

Composition,  and  Relation  to  Solvents.  The  active  principles  of 
myrrh  are  &  peculiar  bitter  resin,  which  has  been  called  myrrhin,  and 
a  volatile  oil.  In  composition  it  is  a  gum-resin,  containing  volatile  oil, 
and  other  ingredients  of  little  or  no  practical  importance.  Water  dis- 
solves the  gum  and  a  very  small  proportion  of  the  volatile  oil ;  alcohol 
the  resin  and  the  whole  of  the  oil ;  and,  as  these  two  are  the  active 
principles,  alcohol  would  seem  to  be  the  best  menstruum.  But  when 
the  gum-resin  is  rubbed  with  water,  it  readily  forms  a  white  or  yellowish- 
white  opaque  emulsion,  in  which  the  resin  and  oil  are  held  in  suspension 
by  the  gummy  matter  dissolved  in  the  water;  and,  though  a  portion  of 
the  resin  soon  subsides,  the  mixture  is  sufficiently  permanent,  or  so  easily 
rendered  uniform  by  shaking,  that  this  form  is  usually  preferred  for  the 
administration  of  the  medicine.  Alkalies  unite  with  the  resin,  and  ren- 
der it  much  more  soluble  in  water;  so  that,  by  the  addition  of  a  portion 
of  an  alkaline  carbonate  in  forming  the  emulsion,  this  is  rendered  of  easier 
preparation,  and  more  permanent.  The  volatile  oil  may  be  separated 
from  the  gum-resin  by  distillation. 


CHAP.  I.]  TONICS. — MYRRH.  305 

Effects  on  the  System.  Myrrh  acts  on  the  system  probably  as  a  simple 
bitter  tonic  through  its  resin,  and  as  a  stimulant  to  the  circulation 
through  its  volatile  oil.  It  has  no  special  influence  on  the  brain  or 
nervous  system  generally;  but  is  supposed  to  have  a  peculiar  tendency 
to  the  lungs  and  uterus,  stimulating  their  functions  respectively,  and 
consequently  acting  as  an  expectorant  and  emmenagogue.  When  swal- 
lowed in  small  doses,  it  increases  the  appetite,  produces  a  feeling  of 
warmth  in  the  stomach,  and  invigorates  digestion,  as  well  probably  as 
the  vital  functions  generally.  In  larger  quantities,  it  increases  the 
pulse,  produces  a  glow  over  the  system,  and  operates  generally  as  a  mild 
arterial  stimulant.  In  over-doses,  it  irritates,  or  may  even  inflame  the 
stomach,  and  gives  rise  to  general  febrile  phenomena. 

Therapeutic  Application.  Myrrh  has  been  known  as  a  medicine  from 
the  earliest  records  of  our  science.  It  is  now  probably  less  esteemed 
than  formerly,  but  is  still  much  employed,  and  is  not  without  valuable 
powers.  As  a  tonic  simply,  it  is  not  often  used;  being  too  stimulating, 
and  too  apt  to  irritate  the  stomach,  if  this  be  at  all  disposed  to  be  so 
affected,  or  to  augment  any  existing  irritation  or  inflammation.  But  in 
a  perfectly  sound,  though  weakened  state  of  the  stomach,  with  a  languid 
condition  of  the  functions  generally,  it  may  be  given  advantageously; 
and  especially  when,  with  this  debilitated  state  of  the  system,  there 
coexists  either  arnenorrhcea,  or  a  chronic  bronchial  inflammation,  with 
profuse  expectoration,  or  both  these  conditions  jointly.  The  particular 
affections,  therefore,  to  which  it  is  best  adapted,  are  chlorosis  in  females 
with  amenorrhoea,  and  chronic  bronchitis  in  the  old  or  debilitated,  with 
or  without  hectic  fever,  but  with  copious  and  especially  puruloid  expecto- 
ration ;  and,  when  these  affections  are  associated,  the  indications  for  its 
use  are  still  stronger.  But  particular  care  must  be  taken  that  the  stom- 
ach is  in  no  degree  phlogosed  when  it  is  administered.  It  has  been 
much  used  in  phthisis ;  but  I  cannot  say  that  I  have  known  it  to  be  of 
material  service  in  that  complaint;  while  it  has  often  done  harm  by  dis- 
turbing the  stomach.  It  is  seldom  given  alone.  In  anemic  states  of 
the  system  with  amenorrhoea,  it  is  often  combined  with  one  of  the  pre- 
parations of  iron,  and,  if  there  be  constipation  at  the  same  time,  or  a 
tendency  to  it,  with  aloes  or  rhubarb. 

Being  a  local  stimulant,  myrrh  has  been  much  used  externally  in  foul, 
flabby,  or  indolent  ulcers,  as  a  mouth-wash  in  spongy  or  ulcerated  gums, 
and  as  a  gargle  in  ulcerous  affections  of  the  fauces.  For  these  purposes, 
the  powder  is,  in  external  ulcers,  simply  sprinkled  on  the  diseased  sur- 
face, or  applied  in  the  form  of  an  ointment;  in  affections  of  the  mouth  and 
fauces,  it  is  employed  rubbed  up  with  water. 

Administration.  Myrrh  may  be  administered  in  powder,  pill,  or  emul- 
sion, in  the  dose  of  from  ten  to  thirty  grains.     In  the  simple  form  of 
powder,  it  is  little  used. 
VOL.  i.— 20 


306  GENERAL   STIMULANTS.  [PART  II. 

Nor  is  it  often  given,  uncombined,  in  the  form  of  pill;  but  it  enters 
into  several  officinal  combinations  in  this  form.  Such  are  the  Pilulse 
Aloes  el  Myrrhse,  formerly  called  Rufus's  pills,  Pilulae  Ferri  Comp., 
Pil.  Galbani  Comp.,  and  Pil.  Rhei  Comp.,  of  the  U.  S.  Pharmacopoeia. 
To  these  the  reader  is  referred,  under  the  heads  of  their  prominent  in- 
gredients respectively. 

Emulsion  is  the  form  of  administration  most  frequently  used.  It 
should  be  made  by  selecting  the  finest  pieces,  powdering  them,  and  rub- 
bing the  powder  up  thoroughly  with  such  a  proportion  of  water,  that  a 
tablespoonful  of  the  mixture  shall  contain  the  dose  of  the  gum-resin 
which  it  may  be  desired  to  exhibit.  If  an  alkaline  carbonate  be  indi- 
cated at  the  same  time,  its  addition  will  tend  to  facilitate  the  prepara- 
tion. The  noted  anti-hectic  mixture  of  Dr  Griffiths,  formerly  very 
popular,  and  still  considerably  used  in  chlorosis,  amenorrhcea,  hysteria, 
and  the  hectic  fever  of  pulmonary  complaints,  is  made  of  these  ingre- 
dients, with  the  addition  of  sulphate  of  iron,  which  is  converted  into 
the  carbonate  through  reaction  with  the  carbonate  of  potassa  used. 
The  Mistura  Ferri  Composita  of  the  Pharmacopoeias  is  an  imitation 
of  this  preparation. 

Decoction  is  not  an  appropriate  mode  of  preparing  myrrh,  as  the 
whole  of  its  active  properties  are  not  extracted  by  water.  The  gum- 
resin,  however,  is  an  ingredient  in  the  Compound  Decoction  of  Aloes 
of  the  British  Pharmacopoeia,  in  which  the  resin  is  dissolved  by  means 
of  the  alkaline  carbonate  used. 

Tincture  of  Myrrh  (TiNCTURA  MYRRHS,  U.  S.),  though  little  used 
internally,  is  often  employed  locally  as  a  stimulant  to  indolent  and  foul 
ulcers,  to  promote  the  exfoliation  of  bones,  and,  diluted  with  water,  as  a 
mouth-wash  or  gargle,  in  spongy  gums,  aphthous  sore  mouth,  and  ulcer- 
ation  of  the  mouth  and  fauces.  When  mixed  with  water,  it  becomes 
turbid  by  the  separation  of  the  resin.  The  dose  is  from  thirty  minims 
to  a  fluidrachm. 


There  are  several  other  stimulant  tonics,  which  owe  their  virtues  to 
bitter  principles  and  volatile  oils,  but  having  little  to  recommend  them 
in  preference  to  those  in  more  general  use,  and  not  being  at  present 
much  employed,  will  be  more  appropriately  considered  in  a  subordinate 
position.  Such  are  angustura,  cascarilla,  contrayerva,  wormwood, 
tansy,  and  horehound.  A  brief  notice  will  suffice  for  each  of  these. 

1.  ANGUSTURA  BARK  — ANGUSTURA.  U.  S.  —  CUSPARIA.  Br. 

is  the  bark  of  the  Galipea  officinalis  of  Hancock,  a  small  tree 
in  the  interior  of  South  America,  on  the  banks  of  the  Orinoco. 
It  is  taken  first  to  the  town  of  Angustura  upon  the  Orinoco,  and  thence 
to  the  West  Indies,  whence  it  enters  into  general  commerce. 


CHAP.  I.]  TONICS. — ANGUSTURA   BARK.  307 

Properties.  It  is  in  pieces  of  various  length,  usually  short,  slightly 
rolled  or  nearly  flat,  thin,  with  edges  pared  obliquely,  externally  covered 
with  a  soft,  yellowish-gray  or  whitish  epidermis,  internally  yellowish, 
and  when  pulverized  yielding  a  pale-yellow  powder.  It  has  a  peculiar 
odour  becoming  fainter  with  age,  and  a  bitter,  slightly  aromatic,  and  ad- 
hesive taste,  leaving  a  sense  of  pungency  on  the  end  of  the  tongue. 

Active  Constituents.  These  appear  to  be  a  peculiar  bitter  principle 
soluble  in  water  and  alcohol,  called  angusturin  or  cusparin,  a  hard  bit- 
ter resin,  a  soft  acrid  resin,  and  a  volatile  oil;  but  it  may  be  questioned 
whether  the  bitter  resin  referred  to  may  not  owe  its  taste  to  an  unsepa- 
rated  portion  of  the  proper  bitter  principle.  The  soft  resin  is  probably 
the  oxidized  volatile  oil. 

Medical  Properties  and  Uses.  Angustura  was  employed  by  the  abo- 
rigines, who  appear  to  have  made  it  known  to  the  early  settlers.  From 
the  continent  it  passed  to  the  West  Indies ;  and  was  not  introduced  into 
Europe  till  about  ninety  years  since.  Its  effects  on  the  system  are  those 
of  a  stimulant  tonic,  in  small  doses  acceptable  to  the  stomach,  but  in 
larger  apt  to  vomit  and  purge.  Its  tonic  property  depends  probably  on 
the  bitter  principle,  the  stimulant  on  the  volatile  oil.  It  has  no  special 
influence  on  the  brain  or  nervous  system.  In  South  America  and  the 
West  Indies,  it  has  been  used  as  a  substitute  for  cinchona  in  intermittent 
and  remittent  fevers,  and  is  said  to  have  proved  very  efficacious  in  the 
malignant  bilious  fevers  of  those  latitudes.  Experience  in  Europe  and 
this  country  has  not  proved  favourable  to  its  claims  as  an  antiperiodic. 
and  it  probably  possesses  no  peculiar  property  of  this  kind.  Though  it 
has  succeeded  in  arresting  some  slight  cases  of  ague  and  fever,  which 
almost  anything  capable  of  impressing  the  system  at  all  will  occasionally 
do,  yet  in  the  more  obstinate  kinds  it  has  failed,  and  can  be  certainly 
relied  upon  in  none.  Another  application  made  of  it  has  been  to  the 
treatment  of  bilious  diarrhcoa  and  dysentery,  as  they  occur  in  tropical 
countries ;  and  it  may  have  been  useful  as  a  tonic  and  stimulant  in  some 
of  those  cases:  but,  in  the  diseases  as  they  occur  with  us,  it  would  in 
general  probably  do  more  harm  than  good.  It  is  little  used  in  this 
country. 

Administration.  It  may  be  given  in  powder,  in  the  dose  of  from  ten 
to  thirty  grains.  The  Infusion  (!NFUSUM  ANGUSTUR^E,  U.  S.)  is,  how- 
ever, preferred.  It  is  made  by  macerating  half  an  ounce  with  a  pint  of 
boiling  water;  or,  in  essentially  the  same  proportions,  by  percolation 
with  cold  water;  and  given  in  the  dose  of  two  fluidounces,  three  or 
four  times  a  day.  The  Tincture  is  no  longer  officinal.  The  dose  of  it,  as 
formerly  prepared,  was  one  or  two  fluidrachms. 

FALSE  ANGUSTURA  BARK.  Under  this  name,  a  bark,  now  believed  to 
be  the  product  of  Strychnoa  Nux  Vomica,  has  sometimes  been  sold  for 
genuine  Angustura  bark,  with  fatal  consequences.  This  could  happen 


308  GENERAL   STIMULANTS.  [PART  II. 

only  before  attention  had  been  called  to  the  subject.  Such  a  mistake 
would  be  unpardonable  now ;  for  there  is  little  real  resemblance  between 
the  two  barks,  and  it  is  only  necessary  that  the  slightest  caution  should 
be  observed.  In  this  country,  I  do  not  think  that  the  substitution  has 
ever  taken  place.  I  have  never  seen  false  Angustura  bark  in  the  United 
States,  except  parcels  which  have  been  sent  hither  as  specimens.  It  is 
not  used  in  medicine,  but,  containing  a  large  proportion  of  brucia,  and 
probably  also  strychnia,  it  might  be  employed  for  the  extraction  of  those 
principles. 

2.  CASCARILLA.   U.S.,Sr. 

Cascarilla  is  the  bark  of  Croton  Eleuteria,  a  small  "West  India  shrub, 
inhabiting  especially  the  Bahamas,  and  abundant  in  the  little  island  of 
Eleuteria,  from  which  it  derived  its  name. 

Properties.  It  is  in  small  quills  or  pieces  of  quills,  from  three  or  four 
inches  long  and  half  an  inch  in  diameter,  down  to  the  smallest  fragment. 
Sometimes  it  is  in  pieces  curved  longitudinally,  and  appearing  as  if 
shaved  from  the  stem,  having  now  and  then  portions  of  the  wood 
attached  to  their  inner  surface.  Externally  the  bark  is  invested  with  a 
whitish  or  grayish-white  epidermis,  which,  however,  is  sometimes  want- 
ing, in  which  case  the  surface  of  the  proper  bark  presents  a  dark-brown 
colour.  The  inner  surface  is  of  a  chocolate  colour,  and  the  fracture, 
which  is  short  and  abrupt,  is  reddish-brown.  The  odour  is  agreeably 
aromatic,  and  increased  by  friction ;  the  taste,  warm,  spicy,  and  bitter. 
When  burnt,  the  bark  emits  an  odour,  resembling  that  of  musk,  though 
not  so  strong,  and  more  agreeable.  On  this  account,  it  is  used  for  fumi- 
gation ;  and  smokers  sometimes  add  it  to  their  tobacco.  It  yields  its  vir- 
tues to  water  or  alcohol,  but  more  completely,  it  is  said,  to  a  mixture  of 
the  two. 

Active  Constituents.  These  are  a  peculiar  bitter  principle,  called  cas- 
carillin,  and  a  volatile  oil,  which  is  abundant,  and  may  be  obtained  by 
distillation. 

Medical  Properties  and  Uses.  The  first  account  of  the  use  of  casca- 
rilla  dates  as  far  back  as  about  the  year  1690.  It  was  for  a  time  a  very 
popular  remedy  in  Europe,  having  been  seized  upon,  as  a  substitute  for 
bark,  by  many  who  were  prejudiced  against  that  medicine;  and  its  febri- 
virtues  were  for  some  time  in  high  esteem.  It  came,  however,  at 
to  be  estimated  at  its  true  value;  and  at  present  is  considered 
nothing  more  than  a  mild  aromatic  tonic,  usually  acceptable  to  the  stom- 
ach, and,  in  consequence  of  the  predominance  of  its  aromatic  properties, 
deserving  perhaps  better  to  rank  in  that  division  of  the  tonics,  than 
among  the  bitters.  When  smoked  in  connection  with  tobacco,  it  is  said 
to  have  induced  vertigo  and  intoxication;  but,  admitting  this  effect, 
which,  however,  is  doubtful,  it  must  be  ascribed,  not  to  the  cascarilla 
itself,  but  to  its  empyreumatic  product.  The  strong  resemblance  of  its 


CHAP.  I.]  TONICS. — CASCARILLA. — CONTRAYERVA.  309 

odour,  when  burned,  to  that  of  musk,  would  justify  an  attempt  to  collect 
the  volatile  products  resulting  from  its  combustion,  and  to  ascertain 
whether  they  might  not  also  imitate  that  powerful  antispasmodic  in  its 
effects  on  the  system. 

The  bark  is  used  chiefly  in  debilitated  states  of  the  stomach  and  bow- 
els, as  in  dyspepsia,  flatulence,  and  diarrhoea  and  dysentery  connected 
with  weakness  or  relaxation  of  the  bowels,  or  in  the  convalescence  from 
these  affections.  It  is  a  good  addition  to  more  powerful  tonics. 

M.  Follemberg,  a  European  veterinary  surgeon,  has  found  cascarilla  to 
exercise  a  powerful  influence,  in  the  lower  animals,  in  promoting  a  flow 
of  milk  after  the  birth  of  their  first  young.  He  gives  to  a  mare,  in 
twenty-four  hours,  about  two  ounces  of  the  powder  incorporated  with 
meal.  In  greatly  reduced  doses,  it  may  possibly  prove  equally  useful  in 
the  puerperal  woman  whose  milk  is  retained.  (Ann.  de  Therap.,  A.D. 
1863,  p.  84.) 

The  dose  of  the  powder  is  from  ten  to  thirty  grains.  The  Infusion 
(INFTJSUM  CASCARILL^E,  U.  S.)  is  made  by  macerating  an  ounce  of  the 
coarsely  powdered  root  in  a  pint  of  boiling  water,  or  by  percolation  in 
similar  proportions  with  cold  water;  and  is  given  in  doses  of  two  fluid- 
ounces,  repeated  as  customary  with  tonic  medicines.  A  Tincture  (TiNC- 
TURA  CASCARILLA,  Br.)  is  directed  by  the  British  Pharmacopeia,  and 
may  be  added  to  stomachic  or  purgative  infusions  in  the  quantity  of  one 
or  two  fluidrachms. 

3.  CONTRAYERVA.   U.  S.  1850. 

Contrayerva  has  been  omitted  in  the  present  Pharmacopoeia.  It  is 
the  root  or  rhizome  of  Dorstenia  Conirayerva,  a  small  perennial  plant, 
growing  in  the  West  Indies,  Mexico,  and  Peru.  As  in  the  shops, 
it  is  of  a  somewhat  oblong  shape,  an  inch  or  two  in  length,  rough, 
very  hard,  reddish -brown  externally,  pale  internally,  and  furnished 
with  numerous  long,  slender,  yellowish  radicles,  attached  to  the  lower 
part.  The  odour  is  aromatic;  the  taste  warm,  pungent,  and  bitter. 
Boiling  water  or  alcohol  extracts  its  virtues,  which  probably  depend 
on  a  volatile  oil,  and  a  bitter  principle,  though  the  latter  has  not  been 
isolated. 

In  its  effects  on  the  system,  it  is  gently  tonic,  aromatic,  stimulant,  and 
diaphoretic,  bearing  some  resemblance  to  serpentaria,  but  less  powerful 
as  a  tonic.  It  was  formerly  used  in  low  febrile  diseases  disposed  to  as- 
sume a  typhous  or  malignant  character,  in  dysentery  and  diarrhoea  with 
debility,  and  in  other  conditions  supposed  to  call  for  stimulation  ;  but  it 
has  given  place  to  more  convenient  or  efficient  remedies,  and  is  now 
scarcely  used.  The  dose  of  the  powder  is  from  twenty  to  thirty  grains. 
An  infusion,  made  in  the  proportion  of  an  ounce  of  the  bruised  root  to 
a  pint  of  boiling  water,  may  be  given  in  doses  of  one  or  two  fluid- 
ounces. 


310  GENERAL   STIMULANT?.  [PART  II. 

4.  WORMWOOD.  —  ABSINTHIUM.  U.S. 

Wormwood,  as  a  medicine,  consists  of  the  leaves  and  flowering  tops 
of  Artemisia  Absinthium,  the  common  wormwood  of  our  gardens,  but 
a  native  of  Europe.  It  has  a  strong,  peculiar  odour,  and  an  extremely 
bitter,  disagreeable,  nauseous  taste.  These  properties,  as  well  as  its 
medical  virtues,  it  imparts  to  water  and  alcohol.  They  reside  chiefly,  if 
not  exclusively,  in  a  bitter  principle  called  absinthin,  and  a  peculiar  vol- 
atile oil,  which,  when  separated  by  distillation  with  water,  has  a  deep- 
green,  brown,  or  yellowish  colour,  an  acrid,  bitter  taste,  and  a  strong 
odour  of  the  plant.  The  herb  may  contain  a  little  tannic  acid,  but  not 
enough  sensibly  to  modify  its  effects. 

Wormwood  is  a  stimulating  tonic,  resembling  chamomile  in  its  effects, 
but  stronger  and  more  disagreeable.  In  small  doses,  it  operates  like  the 
simple  bitters ;  in  larger,  excites  the  pulse,  increases  the  heat  of  the 
skin,  produces  headache,  and  is  said  sometimes  to  have  exhibited  nar- 
cotic effects.  Its  active  principles  are  no  doubt  absorbed,  as  it  renders 
the  flesh  and  milk  of  animals  fed  with  it  bitter.  In  very  large  doses  it 
is  apt  to  vomit.  It  is  among  the  medicines  used  by  the  ancients,  and, 
before  the  discovery  of  Peruvian  bark,  was  much  relied  on  in  the  treatr 
ment  of  intermittent  Though  greatly  inferior  in  antiperiodic  power  to 
cinchona,  it  has  some  efficacy  in  arresting  intermittent  fevers,  and  is 
particularly  recommended  as  a  preventive.  It  has  been  used  also  as  an 
anthelmintic  and  emmenagogue,  and  probably  has  some  efficiency  in  these 
respects.  It  is  probably  not  without  a  stimulant  influence  over  the  ner- 
vous system,  such  as  characterizes  the  antispasmodics,  or  nervous  stimu- 
lants of  the  classification  adopted  in  this  work;  and  hence  may  be  used, 
with  hope  of  benefit,  in  hysterical  cases  attended  with  feeble  digestion, 
and  defective  menstruation. 

The  dose  of  the  powder  is  one  or  two  scruples;  that  of  the  infusion, 
made  in  the  proportion  of  an  ounce  to  the  pint,  is  two  fluidounccs.  The 
herb  has  been  used  externally  with  hot  water  as  a  fomentation,  but  prob- 
ably with  little  other  benefit  than  such  as  may  be  ascribed  to  the  heat 
and  moisture. 

A  cordial  is  much  used  in  France  under  the  name  of  absinthe.  It  is 
said  to  be  prepared  by  mixing  about  five  drachms  of  the  volatile  oil  of 
wormwood  (essence  d'absinlhe)  with  100  quarts  of  alcohol.  It  might 
be  supposed  that,  in  so  small  a  proportion,  the  oil  could  produce  no  se- 
riously injurious  effects;  but  M.  E.  Descaine  has  satisfied  himself  that 
the  cordial  is  much  more  marked  in  its  effects,  and  much  more  injurious 
than  the  spirit  contained  in  it  can  be ;  intoxication  being  more  rapidly 
produced;  the  phenomena  included  under  the  name  of  alcoholism,  both 
acute  and  chronic,  more  quickly  developed ;  and  the  effects  on  the  nervous 
system  more  marked,  resembling  those  of  the  acrid  narcotic  poisons. 
(Complex  Rendus,  A  out,  1864.)  In  confirmation  of  the  statements  of 
M.  Descaine,  M.  Marce  made  various  experiments  with  the  lower  ani- 


CHAP.  I.]  TONICS. — TANSY. — HOREHOUND.  311 

mals,  from  the  result  of  which  it  appears  that  the  oil  of  wormwood  is 
in  large  doses  a  violent  narcotic  poison.  In  the  dog  two  or  three 
grammes  (30  to  45  grains)  caused  trembling,  stupor,  and  insensibility; 
three  or  four  grammes,  epileptic  convulsions,  involuntary  evacuations, 
foaming  at  the  mouth,  and  stertor.  But  these  symptoms  were  tran- 
sient, and  death  did  not  result.  (Bullet.  Gen.  de  Therap.,  Mai  15, 
1864.) 

5.  TANSY.— TANACETUM.   U.  S. 

The  tansy,  or  Tanacetum  vulgare,  is  an  herbaceous  perennial,  indige- 
nous in  Europe,  but  introduced  into  the  United  States,  where  it  grows 
wild,  and  is  cultivated  in  gardens.  The  whole  herbaceous  part  is  used. 
It  has  a  strong,  peculiar  odour,  which  is  much  diminished  by  drying, 
and  a  warm,  bitter,  sub-acrid,  aromatic  taste.  Its  activity,  which  is  im- 
parted to  water  and  alcohol,  depends  on  a  bitter  ingredient,  and  a  vola- 
tile oil.  There  is  also  a  little  tannic  acid,  but  insufficient  materially  to 
influence  the  operation  of  the  medicine.  The  oil  is  greenish-yellow,  and 
has  the  characteristic  odour  of  the  plant. 

Tansy  has  been  known  as  a  medicine  for  at  least  one  thousand  years. 
It  is  a  stimulating  tonic,  and  supposed  also  to  possess  anthelmintic  and 
emmenagogue  properties.  In  large  quantities,  it  is  probably  somewhat 
narcotic ;  at  least,  so  we  may  infer  from  the  operation  of  the  volatile  oil. 
From  its  supposed  possession  of  the  power  of  causing  abortion,  this  oil 
has  been  repeatedly  taken  in  large  doses ;  and  three  cases  of  death  from 
it,  in  this  country,  have  been  recorded;  one  resulting  from  a  single 
fluidrachm  of  the  oil,  a  second  from  half  a  fluidounce,  and  the  third  from 
an  ounce.  The  symptoms  were  violent  convulsions,  coma,  and  great 
prostration,  which  speedily  ended  in  death.  The  fatal  issue  was  too 
rapid  to  be  owing  to  any  irritant  operation  on  the  stomach,  and  in  one 
case,  which  was  examined  after  death,  no  inflammation  was  found. 

The  medicine  has  been  given  in  dyspeptic  affections-,  intermittent 
fever,  to  prevent  the  paroxysms  of  gout,  in  hysteria,  amenorrhoea,  and 
worms  in  the  bowels.  At  present,  its  use  is  confined  mainly  to  the  two 
latter  affections,  and  in  these  it  is  employed  much  more  in  popular  than 
regular  practice.  The  seeds  are  thought  to  be  more  powerful,  as  a 
vermifuge,  than  the  oil. 

The  dose  of  the  powder  is  from  thirty  grains  to  a  drachm ;  that  of  an 
infusion,  made  with  an  ounce  of  the  herb  to  a  pint  of  water,  two  or  three 
fluidounccs,  two  or  three  times  a  day.  A  drop  or  two  of  the  oil  may  be 
added  to  each  dose  of  the  infusion. 

6.  HOREHOUND.— MARRUBIUM.  U.S. 

Common  horehound,  or  Marrubium  vulgare,  is  a  perennial  herba- 
ceous plant,  a  native  of  Europe,  but  introduced  into  the  United  States, 
where  it  grows  abundantly  along  the  roadsides.  The  whole  herbaceous 


312  GENERAL   STIMULANTS.  [PART  II. 

part  is  used.  This  has,  when  fresh,  a  strong,  rather  agreeable  odour, 
which  is  diminished  by  drying,  and  lost  by  long  keeping.  The  taste  is 
bitter  and  lasting.  The  herb  yields  its  sensible  properties  and  medical 
virtues  to  water  and  alcohol.  These  depend  on  a  bitter  constituent  and 
a  volatile  oil.  It  contains  also  a  little  tannic  acid. 

Horehound  has  been  known  as  a  medicine  from  the  times  of  Charle- 
magne. In  reference  to  its  effects  on  the  system,  it  is  mildly  tonic  and 
gently  stimulant,  and  is  thought  also  to  be  somewhat  diaphoretic,  diu- 
retic, and  laxative.  If  we  may  judge  of  the  opinion  entertained  of  its 
action  by  the  use  made  of  it,  we  must  add  to  the  properties  just  men- 
tioned those  also  of  an  expectorant.  The  complaints  in  which  it  has 
been  given  are  dyspepsia,  chronic  hepatitis,  jaundice,  amenorrhcea,  vari- 
ous cachectic  affections,  chronic  bronchitis,  pulmonary  consumption,  and 
ordinary  catarrh.  What  good  can  be  effected,,  in  these  and  other  com- 
plaints, from  a  mild  tonic,  which,  when  taken  in  warm  infusion,  may 
gently  promote  the  cutaneous  and  bronchial  secretions,  and  perhaps  the 
uterine,  may  be  expected  from  horehound,  but  nothing  more.  It  is  at 
present  seldom  used  by  regular  practitioners,  and,  even  as  a  domestic 
medicine,  is  chiefly  employed  in  catarrhal  affections  of  the  air-passages. 
The  dose  of  the  powder  is  from  thirty  grains  to  a  drachm.  The  infusion 
is  made  in  the  proportion  of  an  ounce  to  a  pint  of  hot  water,  and  given 
in  wineglassful  doses.  A  syrup  is  often  prepared  from  it,  and  a  candy 
impregnated  with  its  taste  is  sold  in  the  shops;  both  being  used  for 
ordinary  colds. 

7.  CATNEP.— CATARIA.  U.S. 

This  well-known  plant,  sometimes  called  catmint  (Nepeta  Gataria),  is 
a  very  old  medicine,  at  present  more  employed  in  domestic  than  in 
regular  practice.  The  whole  herb  is  efficacious ;  but  the  leaves  only  are 
recognized  in  our  Pharmacopeia.  They  have  a  strong  peculiar  odour, 
and  a  pungent,  bitterish,  somewhat  aromatic  taste ;  but  both  the  smell 
and  taste  are  disagreeable  rather  than  otherwise.  Their  virtues,  so  far 
as  known,  depend  on  their  peculiar  volatile  oil,  tannic  acid,  and  a  bitter 
principle,  which,  however,  has  not  been  isolated.  They  impart  their 
virtues  to  water  and  alcohol.  In  its  effects  on  the  system,  catnep  is  a 
moderately  stimulant  tonic,  with  antispasmodic  and  emmenagogue  prop- 
erties. In  cats  it  is  said  to  act  as  an  aphrodisiac.  Certainly  these 
animals  exhibit  a  great  fondness  for  it ;  and  it  owes  its  name  to  this  cause. 
It  is  generally  used  in  the  form  of  infusion,  which  may  be  made  in  the 
proportion  of  an  ounce  to  the  pint,  and  given,  in  the  dose  of  one  or  two 
fluidounces,  in  flatulent  colic,  amenorrhcea,  and  the  different  forms  of 
hysteria.  The  fresh  leaves  are  said  to  relieve  toothache,  if  chewed,  and 
kept  for  a  few  minutes  in  contact  with  the  diseased  tooth. 


CHAP.  I.]  TONICS. — AROMATICS.  313 

8.  YARROW.— ACHILLEA.  U.S. 

This  was  introduced  into  the  secondary  catalogue  of  the  U.  S.  Phar- 
macopoeia at  the  recent  revision.  The  whole  herb  is  used.  It  is  the 
product  of  Achillea  Millefolium,  often  called  milfoil,  from  the  great 
number  and  minuteness  of  the  divisions  of  the  leaves.  Though  a  native 
of  Europe,  it  is  now  abundant  in  this  country,  in  which  it  has  become 
completely  naturalized.  The  herb  has  a  feeble  though  rather  agreeable 
odour,  which  is  retained  after  drying,  and  a  bitterish,  pungent,  some- 
what astringent  taste.  The  aromatic  properties  are  somewhat  stronger 
in  the  flowers  than  the  leaves.  In  the  latter  the  astringency  and  tonic 
property  predominate.  The  active  principles  are  volatile  oil,  tannic  acid, 
and  a  bitter  substance  which  has  not  been  isolated.  There  is  also  a 
peculiar  acid,  called  the  achilleic ;  but  how  far  this  possesses  any  thera- 
peutic properties  has  not  been  ascertained.  The  volatile  oil,  separated 
by  distillation,  has  a  beautiful  blue  colour,  and  the  odour  of  milfoil. 
The  virtues  are  extracted  by  water  and  alcohol. 

Yarrow  is  a  mild  aromatic  tonic  and  astringent.  It  has  been  used  in 
intermittent  fever,  flatulent  colic,  and  hysterical  disorders.  M.  Richard, 
of  Soissons,  in  France,  finds  it  efficacious  in  low  conditions  of  the  ex- 
anthematous  fevers  with  imperfect  eruption,  in  colic,  infantile  convulsions 
and  dysmenorrhcea,  using  it  at  the  same  time  as  a  drink  in  the  form  of 
infusion,  as  an  injection  in  the  same  form,  and  in  fomentation.  Dr.  B. 
H.  Coates,  of  Philadelphia,  confirms  the  old  opinion  as  to  its  efficiency 
in  hemorrhages.  (Trans,  of  College  of  Phys.  of  Philadelphia,  N.  S.,  ii. 
334.)  Dr.  Joly,  of  France,  considers  it  an  excellent  emmenagogue,  and 
has  obtained  advantageous  results  from  it  in  suppression  of  the  lochia. 
(Bullet.  Gen.  de  Therap.,  Mars,  1857.)  The  most  convenient  form  of 
administration  is  uiat  of  infusion,  which  may  be  made  in  the  proportion 
of  an  ounce  to  the  pint,  and  given  in  the  dose  of  a  wineglassful.  The 
dose  of  the  volatile  oil  is  twenty  drops. 


3.  dramatics. 

This  subdivision  of  medicines  is  characterized  by  an  agreeable  odour 
and  taste,  dependent  on  the  presence  of  volatile  oil.  They  do  not  cor- 
respond exactly  with  the  tonics,  being  more  excitant,  though  less  so 
than  the  class  of  circulatory  stimulants.  They  do  not  eq\ial  the  bitter 
tonics  in  the  property  of  promoting  the  digestive  and  nutritive  functions. 
Their  action,  moreover,  is  more  speedy,  and  less  durable.  Yet  they 
approach  more  closely  to  these  medicines  than  to  any  other  division  in 
the  classification  I  have  adopted,  and  are  often  used,  in  conjunction  with 
tonics,  to  increase  then:  stimulant  influence,  or  in  other  ways  modify 


314  GENERAL   STIMULANTS.  [PART  II. 

their  action.  I  have,  therefore,  thoughl  it  best  to  follow  the  example  of 
Dr.  J.  Murray,  of  Edinburgh,  in  his  excellent  system  of  Materia  Medica, 
in  arranging  them  in  the  position  they  here  hold;  guarding  the  student, 
however,  against  the  mistake  of  supposing  them  identical,  or  even  very 
analogous,  in  their  operation,  with  the  bitters. 

Effects  on  the  System.  When  taken  internally,  the  aromatics  occasion 
generally  an  agreeable  feeling  of  warmth  in  the  stomach,  moderately 
increase  the  frequency  of  pulse  and  heat  of  the  surface,  and  often  diffuse 
a  pleasant  glow  over  the  system,  without  exhibiting  any  special  tendency 
towards  the  brain  or  nervous  system  generally,  or  any  particular  in- 
fluence over  the  secretions.  They  resemble,  in  their  direction  to  the  cir- 
culatory function,  the  medicines  hereafter  to  be  described  under  the  name 
of  arterial  stimulants;  but  they  differ,  in  being  much  more  powerful, 
relatively,  in  their  local  than  their  general  excitant  effect.  Thus,  to 
whatever  surface  they  are  directly  applied,  whether  the  skin,  the  mouth 
and  fauces,  or  the  mucous  membrane  of  the  stomach,  they  stimulate 
actively  the  blood-vessels  of  the  part,  and,  largely  used,  cause  high 
vascular  irritation,  or  even  inflammation ;  while  upon  the  heart  and  gen- 
eral circulation  they  produce  little  greater  effect  than  might  be  ascribed 
to  sympathy  with  the  local  excitement.  This  disproportion  in  their 
local  stimulation  may  be  ascribed  to  the  difficult,  absorption  of  the  vola- 
tile oils,  to  which  they  owe  their  powers.  There  is  a  great  difference  in 
the  absorbability  of  the  different  volatile  oils.  Some,  as  those  of  tur- 
pentine, copaiba,  garlic,  etc.,  enter  the  circulation  with  great  facility, 
and  hence  display  considerable  energy  in  their  action  upon  the  system 
generally,  or  on  organs  remote  from  the  point  of  their  application.  The 
aromatic  oils,  as  those  of  cinnamon,  cloves,  ginger^  peppermint,  etc., 
have,  in  general,  much  less  of  this  facility;  and,  though  they  may  act 
locally  with  equal  power,  are  much  less  diffusible  in  their  effects. 

In  their  operation  specially  upon  the  stomach  and  other  portions  of 
the  alimentary  canal,  they  do  not  so  much  invigorate  the  particular 
function  of  digestion,  as  produce  a  general  vascular  excitement  of  the 
parts,  attended  with  a  comfortable  or  pleasurable  sensation,  comparable 
to  that  of  a  genial  glow  on  the  surface  of  the  body.  In  the  accompany- 
ing plentiful,  but  not  excessive  supply  of  blood,  which  is  the  proper 
material  for  all  the  functions,  that  of  the  stomach  is  in  a  state  to  respond 
to  its  special  stimulants ;  and  tonics,  therefore,  will  often  operate  with 
greater  energy,  in  connection  with  aromatics,  than  when  administered 
alone.  The  muscular  tissue,  too,  without  being  stimulated,  as  by  purga- 
tives, to  an  increase  of  its  regular  peristaltic  action,  is  yet  put  into  a 
condition  of  greater  power,  and  will  contract  with  increased  energy 
under  the  special  stimulus  of  distension,  or  with  a  better  regulated  move- 
ment under  that  of  cathartic  medicine.  Upon  these  principles  may  be  ex- 
plained all  the  peculiar  therapeutic  uses  of  the  aromatics. 


CIIAP.  I.]  TONICS. — AROMATICS.  315 

Ther-apeutic  Application.  They  are  much  used  as  cordial  stimulants 
to  the  stomach  and  bowels,  in  debility  of  these  organs;  and  have  the 
great  advantage  over  the  more  diffusible  stimulants,  such  as  alcohol  in 
its  different  forms,  that  their  operation  is  limited  mainly  to  the  part. 
Given  in  connection  with  food,  particularly  with  such  as  may  be  of  diffi- 
cult digestion,  they  favour  its  solution  in  the  stomach,  by  enabling  this 
organ  both  to  secrete  the  solvent  juice  more  vigorously,  and  the  muscular 
coat  of  the  stomach  to  perform  its  office  more  efficiently,  under  the  stim- 
ulus of  the  nutriment.  Hence  their  use  as  condiments  in  all  times,  and  in 
all  parts  of  the  world. 

They  are  given  also  to  relieve  nervous  uneasiness  and  spasmodic  pain 
of  the  stomach,  to  aid  in  the  expulsion  of  flatus,  and  to  correct  nausea. 
All  these  offices  they  perform  upon  the  principle  above  stated.  The 
nervous  tissue,  duly  supplied  with  blood,  is  relieved  of  those  irregular 
sensations  and  actions  to  which  it  is  so  liable  when  debilitated,  and  can 
better  resist  the  disturbing  influence  of  substances  calculated  to  produce 
nausea  or  griping  pain.  The  muscular  coat,  in  the  same  state  of  its  sup- 
ply, feels  duly  the  presence  of  the  distending  flatus,  which  it  now  expels 
by  a  vigorous  contraction,  instead  of  being  thrown  by  it  into-  those 
irregular  and  vain  contractions  called  spasms.  In  reference  to  this 
operation  of  aromatics,  they  are  called  carminatives,  a  word  handed 
down  from  the  ancients,  who  were  familiar  with  this  effect,  but  could 
not  so  satisfactorily  explain  it,  and  therefore  referred  it  to  the  mysterious 
influence  of  charms,  and  believed  it  to  be  much  promoted  by  singing 
verses  (carmina),  during  the  administration  of^e  medicine. 

To  sum  up,  in  a  few  words,  the  therapeutic  applications  of  aromatics; 
they  are  used  to  relieve  the  nervous  pains,  spasms,  disordered  sensations, 
and  languor  of  stomach,  attendant  on  dyspepsia  or  other  debilitated  states 
of  the  organ ;  to  correct  flatulence  and  pains  arising  from  it,  whether  in 
the  stomach  or  bowels;  as  anti-emetics  to  obviate  nausea  or  gastric  irri- 
tability when  purely  nervous;  and,  lastly,  to  aid  or  correct  the  operation 
of  other  medicines,  or  facilitate  their  administration  by  concealing  or 
modifying  their  disagreeable  taste. 

They  are  given  with  substances  disposed  to  nauseate,  whether  by 
their  taste,  or  their  direct  influence  on  the  stomach,  in  order  to  obviate 
this  effect. 

With  cathartics  they  are  very  often  exhibited,  not  only  in  reference  to 
the  influence  just  mentioned,  but  also  to  correct  or  obviate  their  griping 
tendency. 

With  tonics  they  are  habitually  administered,  to  cover  their  taste,  to 
render  them  more  acceptable  to  the  stomach,  to  give  them  greater  effi- 
ciency in  the  promotion  of  digestion,  and  to  increase  their  stimulant 
effect,  when  such  an  increase  is  indicated. 

They  are  contraindicated  by  existing  vascular  irritation  or  inflamma- 


316  GENERAL   STIMULANTS.  [PART  II. 

tion  of  the  stomach,  and  by  any  considerable  febrile  excitement,  in  a 
sthenic  state  of  the  system. 

In  very  large  quantities,  some  of  them,  and  all  in  the  concentrated 
form  of  their  volatile  oil,  are  capable  of  inducing  inflammation  of  the 
stomach,  and  thus  proving  dangerous  if  not  fatal. 

When  abused  as  condiments,  they  may  cause  the  following  evil  effects. 
In  the  first  place,  they  may  give  rise  to  chronic  inflammation  of  the 
stomach,  by  sustaining  a  constant  vascular  irritation  of  that  organ; 
secondly,  they  may  debilitate  the  stomach  by  wearing  out  its  excita- 
bility through  over-excitement;  and  thirdly,  by  increasing  the  amount  of 
food  digested,  they  may  lead  to  an  excess  in  the  supply  of  blood,  a  con- 
sequent plethoric  state  of  system,  and,  in  conjunction  with  other  influ- 
ences, to  the  generation  of  a  gouty  diathesis.  • 

They  are  not  unfrequently  used  externally,  either  alone,  or  in  con- 
junction with  other  medicines,  as  irritants  to  the  skin,  or  rubefacients. 
(See  Rubefacienls.) 

As  they  depend  mainly  for  their  efficiency  upon  the  volatile  oils  they 
contain,  these  are  often  separated  by  distillation  with  water,  and  very 
advantageously  used  as  substitutes  for  the  aromatics  themselves.  Their 
effects  are  the  same ;  but  they  require  to  be  administered  with  more 
caution,  as  they  are  more  liable  to  produce  serious  effects,  if  taken  in 
over-closes.  As  to  the  modes  of  preparing  the  aromatic  volatile  oils, 
their  chemical  composition  and  reactions,  the  tests  of  their  purity,  and 
the  general  rules  regulating  their  pharmaceutical  management,  the  reader 
is  referred  to  the  U.  ^Dispensatory. 

Administration.  Tl^iromatics  may  be  given  in  substance,  or  in  the 
forms  of  infusion,  tincture,  fluid  extract,  and  volatile  oil.  The  form  of 
infusion  is  much  used,  and  generally  very  suitable ;  but  it  should  be  re- 
membered that  water  will  dissolve  but  a  small  proportion  of  volatile  oil, 
and,  in  the  case  of  those  particular  aromatics  which  depend  for  their  in- 
fluence exclusively  on  the  oil,  the  proportion  of  the  medicine  to  the  men- 
struum should  be  small,  to  avoid  waste.  Decoction  and  dry  extract  are 
inappropriate  forms ;  as  the  volatile  oil  on  which  their  virtues  depend 
is  more  or  less  driven  off  during  their  preparation.  In  the  fluid  extract, 
if  properly  made,  the  oil  may  be  retained ;  and  this  is  often  a  very  con- 
venient form  for  use.  Tincture  is  a  very  appropriate  form,  whenever 
the  necessary  amount  of  alcohol,  used  in  the  preparation,  may  not  be 
objectionable. 

The  aromatic  oils  are  frequently  preferred,  in  consequence  of  their 
less  bulk,  their  greater  power,  and  their  greater  convenience  of  admin- 
istration. Some  of  them  may  be  given  undiluted,  simply  dropped  on 
sugar;  but  most  of  them  are  too  pungent  and  powerful  to  be  exhibited 
in  that  way.  They  are,  however,  often  and  very  conveniently  exhibited 
by  dropping  them  on  sugar,  and  then  mixing  this  thoroughly  with  water. 


CHAP.  I.]  TONICS.—  AROMATICS.  317 

The  sugar  enables  the  water  to  hold  the  oil  suspended  sufficiently  long 
for  use. 

A  common  method  of  exhibiting  the  oil  is  in  alcoholic  solution,  in 
the  shape  of  spirits  or  essences.  The  name  spirit,  in  relation  to  the 
aromatic  oils,  was  formerly  used  to  designate  preparations  made  by 
exposing  a  mixture  of  the  aromatic  and  alcohol  to  distillation;  the  oil 
coming  over  dissolved  in  the  alcohol.  It  is  now  also  applied  to  similar 
preparations,  made  either  by  directly  dissolving  the  oil  in  alcohol,  or  by 
distilling  the  oil  and  alcohol  together.  Such  is  the  meaning  of  the  term 
spirit  as  employed  in  the  present  U.  S.  Pharmacopoeia,  though  it  is  ex- 
tended so  as  to  embrace  spirituous  solutions  of  aeriform  or  volatile  sub- 
stances in  general.  But,  in  former  editions  of  the  Pharmacopoeia,  to 
entitle  an  alcoholic  solution  of  one  of  the  volatile  oils  to  the  officinal 
title  of  spirit,  it  was  required  to  be  of  a  strength  approaching  that 
of  the  spirits  made  in  the  original  method.  The  name  of  essences  has 
been  popularly  appropriated  to  stronger  solutions  of  the  oil  in  alcohol ; 
generally  of  such  a  strength  as  to  permit  the  preparation  to  be  taken  on 
sugar  without  further  dilution.  These  were  designated  iu  the  Pharma- 
copoeia of  1850  as  tinctures  of  the  respective  oils.  Thus,  we  had  tinc- 
tures of  the  oil  of  peppermint,  and  oil  of  spearmint;  but  this  nomen- 
clature has  been  abandoned. 

Another  very  common  and  useful  form  of  exhibition  is  that  of  the 
aromatic  waters.  These  were  originally  made  by  distilling  water  from 
the  aromatic  in  substance;  but  this  method  of  preparation  has,  in  the 
United  States,  been  almost  entirely  abandoned^ar  the  much  more  con- 
venient method  of  simply  dissolving  the  oil  in  ^tter.  When  the  oil  and 
water  are  merely  shaken  together,  they  unite  but  sparingly,  and  the 
resulting  solution  is  very  feeble.  But,  by  the  intervention  of  some  body 
which,  without  being  itself  soluble,  may,  by  trituration  with  the  oil,  so 
divide  its  particles  as  to  bring  them  into  intimate  contact  with  the  par- 
ticles of  water,  when  the  two  are  shaken  or  rubbed  together,  a  consider- 
able proportion  of  the  oil  is  taken  up;  enough  to  give  a  decided  odour 
and  taste,  and  some  medicinal  activity  to  the  solution.  The  substance 
preferred  for  this  purpose  is  usually  carbonate  of  magnesia;  and  the 
aromatic  waters  of  our  national  standard  are  prepared  in  this  way;  care 
being  always  taken  to  separate  the  insoluble  matter  by  filtration.  The 
aromatic  waters  may  sometimes  be  advantageously  given  with  a  view 
simply  to  the  medicinal  effect  of  the  oil;  but  much  more  frequently  they 
are  used  as  menstrua  or  vehicles  for  other  substances,  the  taste  of  which 
they  cover,  while  they  often  render  them  more  acceptable  to  the  stomach. 


318  GENERAL   STIMULANTS.  [PART  II. 


I.  ORANGE-PEEL. 

1.  BITTER  ORANGE-PEEL.    AURANTII  AMARI  CORTEX.  V.  S.— 
AURANTII  CORTEX.  Br. 

2.  SWEET  ORANGE-PEEL.    AURANTII  DULCIS  CORTEX.  U.S. 

Origin.  This  is  the  rind  of  the  orange,  of  which  there  are  two  kinds, 
derived  from  different  species  or  varieties  of  Citrus;  the  one,  Citrus  vul- 
garis,  the  bitter,  or  Seville  Orange;  the  other,  Citrus  Auranlium,  or 
common  sweet  orange.  Both  are  natives  of  India  and  China,  but  culti- 
vated generally  in  tropical  latitudes. 

Sensible  and  Chemical  Properties.  The  rind  consists  of  two  parts, 
the  outer,  which  is  coloured,  and  the  inner,  white  and  spongy.  In  the 
former  exclusively  reside  the  virtues  of  the  medicine;  and  sometimes  it 
is  only  the  outer  coating  that  is  kept  in  the  shops. 

The  bitter  orange-peel,  which  is  imported  into  the  United  States,  is 
generally,  as  found  in  the  shops,  in  vertical  slices,  though  sometimes  in 
thin  parings,  as  if  cut  off  from  the  orange  with  a  knife,  like  the  paring  of 
an  apple.  In  the  former,  the  white  inner  portion  is  retained,  in  the  lat- 
ter is  wanting.  The  peel  has  an  agreeable  characteristic  odour,  and  a 
bitter  aromatic  taste. 

The  sweet  orange-peel  is  also  in  vertical  slices,  usually  thinner  than 
the  other  variety,  with  the  same  characteristic  odour,  and  warm,  aro- 
matic taste,  but  withouLbitterness. 

In  both,  there  is  a  p^Riliar  volatile  oil,  which  resides  in  distinct  cells 
in  the  rind,  and  may  be  obtained  by  pressure  when  the  rind  is  fresh.  In 
addition  to  this,  there  is,  in  the  bitter  orange-peel,  a  principle  to  which  it 
owes  its  bitterness,  but  which  has  not  been  fully  investigated.  Water 
and  alcohol  extract  all  the  virtues  of  the  peel. 

Kept  in  moist  places,  orange-peel  is  apt  to  spoil,  in  consequence  of  the 
attraction  of  the  inner  spongy  portion  for  moisture.  The  parings  keep 
better. 

Medical  Effects  and  Uses.  Bitter  orange-peel  has  the  virtues  of  the 
aromatics  combined  with  those  of  the  simple  bitters;  the  sweet  variety 
is  simply  aromatic.  Both  are  mild,  and  the  tonic  powers  of  the  bitter 
are  feeble.  They  are  used  almost  exclusively  in  connection  with  other 
medicines,  to  render  them  less  disagreeable  to  the  taste,  and  more  accept- 
able to  the  stomach.  It  is  usually  with  tonics  that  they  arc  associated, 
as  with  Peruvian  bark,  gentian,  etc. ;  or  with  purgatives,  as  rhubarb. 
When  with  the  former,  the  bitter  variety  should  be  preferred;  when  with 
the  latter,  the  sweet. 

Orange-peel  is  not  altogether  without  danger  if  abused.  I  knew  of  a 
case  in  which  death  occurred,  in  an  infant,  from  swallowing  considera- 


CHAP.  I.]     TONICS. — AROMATICS. — ORANGE-PEEL. — LEMON-PEEL.     319 

ble  quantities  of  the  fresh  rind.  The  child  died  with  symptoms  of  ob- 
struction of  the  bowels;  and,  on  examination  after  death,  the  rind  was 
found  impacted  in  the  intestines.  But  I  am  by  no  means  certain  that 
the  oil  contained  in  the  rind  may  not  have  acted  injuriously.  In  Buch- 
ner's  Neues  Repertorium  (ii.  440-5)  are  given  the  results  of  numerous 
observations,  by  Dr.  A.  Imbert-Gourbeyre,  of  the  effects  of  the  oil  of 
bitter  orange,  among  which  are  mentioned  headache,  painful  vision, 
buzzing  in  the  ears,  oppression  of  chest,  loss  of  sleep,  and  phenomena 
similar  to  those  of  epileptic  spasms.  (Cent.  Blalt,  15  Feb.  1854,  s.  128.) 

Administration.  The  peel  is  rarely  given  in  substance.  The  dose  of 
the  powder  might  be  from  ten  grains  to  a  drachm. 

The  infusion  is  generally  preferred.  When  used  as  an  adjuvant  or 
corrective  of  other  medicines,  the  peel  is  most  commonly  employed  in 
this  form;  half  an  ounce  of  it,  well  bruised,  being  added  to  a  pint  of  the 
liquid.  When  the  other  ingredients  are  prepared  in  decoction,  the  peel 
should  not  be  added  till  the  end  of  the  boiling.  The  British  Pharmaco- 
poeia directs  an  Infusion  (!NFUSUM  AURANTII,  Br.),  prepared  with  half 
an  ounce  of  orange-peel,  and  an  imperial  half-pint  or  ten  fluidounces  of 
water.  This  may  be  used  for  the  general  purposes  of  the  aromatics  (see 
page  315),  in  wineglassful  doses. 

A  Tincture  (TINCTURA  AURANTII,  Br.)  is  directed  by  the  British 
Pharmacopoeia  to  be  prepared  from  bitter  orange-peel,  and  may  be  used 
to  qualify  the  taste  and  action  of  various  liquid  preparations. 

A  Syrup  (SYRUPUS  AURANTII  CORTICIS,  U.  S.;  SYRUPUS  AURANTII, 
Br.\  prepared  by  the  U.  S.  Pharmacopoeia  from  the  sweet  peel,  by  the 
British  from  a  tincture  of  the  bitter,  is  a  very  grateful  addition  to  other 
medicines.  The  U.  S.  preparation  is  much  to  be  preferred. 

A  Confection  (CONFECTIO  AURANTII  CORTICIS,  U.  S.)  is  prepared  by 
separating  the  rind  by  a  grater,  and  incorporating  the  coarse  powder 
thus  made  with  sugar.  It  is  used  chiefly  as  a  vehicle  for  tonic  and  pur- 
gative medicines  in  powder. 

An  Aromatic  Water  (AURANTII  FLORUM  AQUA,  U.  S.;  AURANTII 
AQUA,  Br.),  made  by  distilling  water  from  the  fresh  flowers,  is  occasion- 
ally used  as  a  perfume  in  the  sick  room. 


Other  products  of  the  genus  Citrus  are  occasionally  used  in  medicine 
for  their  aromatic  properties.  Among  these  are  the  following. 

1.  LEMON-PEEL.— LIMONIS  CORTEX.  U.  S.,  Br. 

This  is  the  rind  of  the  lemon,  which  is  the  fruit  of  a  variety  of  Citrus 
medica,  a  native  of  Asia,  but  now  cultivated  throughout  the  civilized 
world,  either  in  the  open  air,  or  in  conservatories.  It  has  the  same  aro- 
matic properties  no  orange-peel,  though  less  agreeable,  and  is  employed 
for  the  same  purposes. 


320  GENERAL    STIMULANTS.  [PART  II. 

The  Volatile  Oil  of  Lemons  (OLEUM  LIMONIS,  U.  S.,  Br.)  is  often  ob- 
tained from  the  fresh  rind,  either  by  distillation  or  pressure ;  that  pro- 
cured in  the  latter  method  having  more  exaetly  the  odour  of  the  rind, 
though  the  former  is  more  clear.  It  is  used  to  impart  an  agreeable 
flavour  to  other  medicines,  for  which  purpose  a  drop  or  two  may  be 
added  to  a  fluidounce  of  a  liquid  for  internal  use,  and  ten  drops  to  an 
ounce  of  unctuous  matter  for  outward  application.  It  has  been  em- 
ployed, undiluted,  as  a  local  application  to  the  conjunctiva,  in  affections 
requiring  stimulation;  being  pressed  from  the  fresh  peel  directly  into  the 
eye.  It  produces,  however,  excessive  pain,  and  should  be  used  with 
caution. 

A  Spirit-  of  Lemons  (SPIRITUS  LIMONIS,  U.  S.),  prepared  by  the  TJ.  S. 
Pharmacopoeia  from  lemon-peel,  with  the  addition  of  the  volatile  oil  of 
lemons,  by  maceration  in  alcohol,  and  a  Tincture  (TINCTURA  LTMONIS, 
J5r.),  prepared  in  the  same  manner  from  the  fresh  peel,  may  be  used  as 
grateful  additions  to  bitter  and  laxative  infusions  and  mixtures. 

2.  OIL  OF  BERGAMOT.  —  OLEUM  BERGAMII.  U.S. — BERGAMOTJE 
OLEUM.  Ed. 

This  oil  is  obtained  by  expression,  or  distillation,  from  the  fresh  rind  of 
the  fruit  of  Citrus  Limetta.  It  is  employed  chiefly,  if  not  exclusively,  for 
the  sake  of  its  very  agreeable  odour;  being  mixed  with  substances  used 
as  liniment  or  ointment,  in  the  same  manner  as  oil  of  lemons.  It  has 
been  asserted,  however,  to  be  of  itself  very  efficacious  in  the  itch.  (Med. 
andSurg.  Reporter,  Oct.  1,  1864,  p.  112.) 


II.  CINNAMON. 

CINNAMOMUM.  U.S.,Br. 

Under  the  above  name,  the  U.  S.  Pharmacopeia  recognizes  two  pro- 
ducts, the  proper  cinnamon  gathered  in  Ceylon,  and  another  kind  brought 
from  China,  and  known  in  commerce  by  the  name  of  cassia.  These  may 
be  conveniently  distinguished,  in  reference  to  their  commercial  origin,  as 
Ceylon  cinnamon  and  Chinese  cinnamon.  It  is  the  latter  which  is 
most  commonly  found  in  our  shops,  being  brought  to  this  country 
directly  from  Canton.  The  former  is  used  only  in  small  proportion,  and 
generally  comes  to  us  by  special  order  from  England.  It  is  the  only 
variety  recognized  in  the  British  Pharmacopoeia.  Cinnamon  was  known 
to  the  ancients. 

Origin.  Ceylon  cinnamon  is  the  prepared  inner  bark  of  Cinnamomum 
Zeylanicum,  a  tree  growing  wild  in  the  East  India  island  of  Ceylon, 
where  it  is  largely  cultivated.  The  tree  has  been  introduced  into  other 


CHAP.  I.]  TONICS. — AROMATICS. — CINNAMON.  321 

tropical  countries,  and  is  cultivated  to  a  considerable  extent  in  the  French 
province  of  Cayenne  in  South  America.  When  the  tree  has  attained  a 
proper  age,  the  stems  arc  cut  and  decorticated ;  and  the  bark,  deprived 
of  its  epidermis,  is  allowed  to  roll  into  quills,  which  are  inserted  one 
within  another,  so  as  to  form  a  solid  cylinder. 

Chinese  cinnamon  or  cassia  is  the  inner  bark  of  a  species  of  Cinna- 
momum  growing  in  China,  which  is  believed  to  be  the  G.  aromalicum, 
though  certain  knowledge  upon  this  point  is  wanting. 

Sensible  Properties.  Ceylon  cinnamon  is  in  cylindrical  fasciculi,  each 
consisting  of  a  congeries  of  quills,  inserted  one  into  another,  and,  when 
unbroken,  several  feet  in  length ;  distinct  fasciculi  being  neatly  joined  end 
to  end,  so  as  to  appear  as  if  of  one  piece.  This  variety  is  of  a  yellowish- 
brown  colour,  almost  as  thin  as  paper,  smooth,  somewhat  shining,  pliable, 
and  of  a  splintery  fracture.  Its  odour  is  very  fragrant,  and  its  taste 
warm,  pungent,  sweetish,  slightly  astringent,  and  exquisitely  grateful. 

The  Chinese  variety  is  in  single  tubes,  of  which  the  finest  differ  little 
in  appearance  from  the  cinnamon  of  Ceylon,  but  by  far  the  greater  pro- 
portion are  larger,  thicker,  deeper-coloured,  rougher,  denser,  and  of  a 
shorter  fracture.  The  pieces  are  often  much  rolled  upon  themselves,  but 
sometimes  not  completely  quilled.  The  odour  and  taste  are  of  the  same 
general  character ;  but  the  former  is  less  agreeably  fragrant,  and  the  lat- 
ter less  sweet  and  grateful,  though  equally  or  more  pungent,  and  more 
astringent. 

In  both  varieties,  the  powder  is  of  a  yellowish-brown  colour,  so  char- 
acteristic that,  when  met  with  in  other  bodies,  it  is  distinguished  by  the 
name  of  cinnamon  colour. 

Active  Constituents.  These  are  a  peculiar  volatile  oil,  and  tannic  acid, 
the  latter  of  which  is  not  in  large  proportion.  The  oil  is  separated  by 
distillation  with  water;  being  generally  prepared  in  the  East,  probably 
from  the  broken  fragments  and  refuse  barks.  There  are  two  kinds  of 
oil,  distinguished  as  oil  of  cinnamon  and  oil  of  cassia,  the  former  ob- 
tained from  the  Ceylon,  the  latter  from  the  Chinese  bark.  Both  oils,  as 
first  procured,  are  of  a  fine  yellow  colour;  and  both  become  red  by  age. 
The  flavour  of  the  proper  cinnamon  oil,  however,  is  sweeter  and  finer  than 
that  of  the  oil  of  cassia.  Both,  when  oxidized  by  exposure  to  the  air. 
yield  cinnamic  acid. 

Cinnamon  yields  its  virtues  in  small  proportion  to  water,  and  much 
more  freely  to  alcohol. 

Medical  Properties  and  Uses.  This  bark  has  in  a  very  high  degree 
the  general  properties  of  the  aromatics,  with  some  astringency,  dependent 
on  the  tannic  acid.  It  is  among  those  most  employed.  It  is  used  for  all 
the  purposes  of  the  aromatics  (see  page  3 15),  but  most  frequently  in  con- 
junction with  other  medicines,  to  qualify  their  taste,  and  render  them 
more  acceptable  to  the  stomach.  One  of  its  most  appropriate  applica- 
VOL.  i. — 21 


322  GENERAL   STIMULANTS.  [PART  II. 

tions  is  to  the  treatment  of  diarrhoea,  in  association  with  other  astringents 
and  with  chalk;  a  purpose  to  which  the  tannic  acid  it  contains  especially 
adapts  it.  It  has  also  been  highly  recommended  in  uterine  hemorrhage. 
In  consequence  of  its  peculiarly  agreeable  flavour,  it  is  used  as  a  con- 
stituent of  a  great  number  of  officinal  preparations. 

Administration.  Cinnamon  is  sometimes  administered  in  powder,  in 
the  dose  of  from  ten  to  twenty  grains.  It  is  often,  in  this  state,  associated 
with  other  medicines  given  in  the  same  form. 

The  Aromatic  Powder  of  the  Pharmacopoeias  (PULVIS  AROMATICUS, 
U.  £)  consists  of  cinnamon,  ginger,  cardamom,  and  nutmeg;  a  very  fine 
combination  of  spices.  From  ten  to  thirty  grains  of  this  may  be  given 
for  a  dose.  It  is  occasionally  applied  externally  in  the  form  of  cataplasm, 
which  may  be  prepared  by  adding  a  little  heated  spirit  so  as  to  bring  the 
oil  into  activity,  and  rendering  the  mixture  adhesive  by  honey  or  other 
viscid  substance.  Such  a  cataplasm  may  be  advantageously  applied  to 
the  epigastrium  in  vomiting,  and  over  the  whole  abdomen  in  the  cholera 
of  children. 

An  officinal  Confection  (CONFECTIO  AROMATICA,  U.  S.)  is  prepared  by 
incorporating  the  aromatic  powder  above  referred  to  with  clarified  honey. 
It  may  be  used  for  the  general  purpjoses  of  the  aromatics,  in  the  dose  of 
from  ten  grains  to  a  drachm. 

An  infusion  of  cinnamon  may  be  made  by  macerating  two  drachms  in 
a  pint  of  boiling  water,  and  given  in  the  dose  of  one  or  two  fluidounces ; 
and  the  bark  may  be  added  to  other  substances  in  infusion  in  the  same 
proportion.  When  added  to  decoctions,  it  should  be  introduced  at  the 
end  of  the  boiling,  but  while  the  liquid  is  still  boiling  hot. 

The  Oil  of  Cinnamon  (OLEUM  CINNAMOMI,  U.  S.)  is  never  used  alone, 
in  an  undiluted  state ;  as,  independently  of  its  extreme  pungency,  it  might 
endanger  serious  irritation,  if  not  inflammation  of  the  stomach.  In  over- 
doses it  may  prove  fatal.  Mitscherlich  killed  a  dog  in  forty  hours  wit^r 
two  drachms,  and  in  five  hours  with  six  drachms.  But,  made  into  emul- 
sion with  gum  arabic,  loaf  sugar,  and  water,  it  will  produce  all  the  effects 
of  cinnamon  except  those  dependent  on  its  astringency;  and  may  often 
be  administered  advantageously  as  a  stomachic  and  carminative.  It  is, 
however,  more  frequently  employed  in  solution,  in  one  of  the  following 
forms.  The  dose  of  it  is  one  or  two  drops. 

Cinnamon  Water  (AQUA  CINNAMOMI,  U.  £)  was  formerly  made  by  dis- 
tilling water  from  cinnamon,  and  this  is  recognized  in  the  U.  S.  Pharma- 
copoeia as  an  alternative  process ;  but  it  is  now  much  more  generally  and 
conveniently  prepared  by  dissolving  the  oil  in  water,  through  the  inter- 
vention of  carbonate  of  magnesia,  as  described  under  the  general  head 
of  aromatics  (see  page  317).  Although  only  thirty  minims  are  employed 
to  two  pints  of  water,  the.  resulting  solution  is  too  strong  for  ordinary  pur- 
poses, unless  diluted.  It  is  chiefly  employed  as  a  menstruum  or  vehicle 


CHAP.  I.]  TONICS. — AROMATICS. — CANELLA.  323 

for  other  medicines,  given  in  liquid  mixture  or  solution;  but,  when  used 
for  this  purpose,  it  should  generally  be  diluted  with  an  equal  measure  or 
double  its  measure  of  water.  The  dose  of  this  aromatic  water  is  from 
half  a  fluidounce  to  a  fluidounce. 

Spirit  of  Cinnamon  (SriRrrus  CINNAMOMI,  U.  S.)  is  prepared  by  dis- 
solving a  fluidounce  of  the  oil  in  fifteen  fluidounces  of  stronger  alcohol. 
The  dose  is  from  ten  to  twenty  drops. 

A  Tincture  of  Cinnamon  (TIXCTURA  CIXNAMOMI,  U.  S.,  Br.\  prepared, 
according  to  their  ordinary  method,  both  by  the  U.  S.  and  British  Phar- 
macopoeias, affords  an  agreeable  mode  of  obtaining  the  effects  of  the 
aromatics,  with  the  astringency  of  the  cinnamon,  when  alcohol  is  not 
contraindicated.  The  dose  is  from  one  to  four  fluidrachms. 


The  two  following  barks,  though  little  used,  are  noticed  in  most  works 
on  Materia  Medica,  and,  as  appears  to  me,  can  be  nowhere  more  appro- 
priately considered  than  as  subordinates  to  cinnamon. 

1.  CANELLA.  U.  S. 

This  is  the  bark  of  Canella  alba,  ajarge  tree  growing  in  Jamaica  and 
other  West  India  islands.  The  bark  is  stripped  from  the  branches,  de- 
prived of  its  epidermis,  and  dried. 

Sensible  Properties.  It  is  in  pieces  of  various  size,  usually  thicker 
and  larger  than  the  coarsest  cinnamon,  either  completely  or  partially 
quilled,  often  twisted,  of  a  pale-orange  or  light  reddish-yellow  colour  on 
the  outer  surface,  nearly  white  on  the  inner,  brittle  with  a  short  fracture, 
and  yielding  a  yellowish-white  powder.  Its  odour  is  aromatic,  its  taste 
warm,  bitterish,  and  very  pungent. 

Active  Constituents.  A  peculiar  volatile  oil  is  the  main  active  ingre- 
4i*  nt;  but  there  is  also  a  bitter  substance,  and  an  aromatic  resin,  which 
are  probably  not  without  influence.  The  bark  yields  its  virtues  imper- 
fectly to  water,  but  readily  and  wholly  to  alcohol. 

Medical  Properties  and  Uses.  Canella  has  the  properties  of  the  aro- 
matics generally,  with  a  greater  degree  of  pungency  than  most  of  them, 
and  some  tonic  power.  It  is  well  adapted  to  atonic  states  of  the  stom- 
ach and  bowels ;  but  is  seldom  used  except  in  conjunction  with  other 
medicines,  of  which  it  may  cover  the  taste,  and  correct  any  nauseating 
or  griping  property.  The  dose  of  the  powder  is  from  ten  to  thirty 
grains.  Associated  with  aloes,  it  forms  the  Powder  of  Aloes  and  Ca- 
nella (PULVIS  ALOES  ET  CANELLA,  U.  S.),  which  was  formerly  so  much 
esteemed  as  to  have  received  the  name  of  hiera  picra,  or  sacred  bitter, 
though  now  comparatively  little  used.  Whatever  its  virtues  may  be, 
they  must  be  ascribed  almost  exclusively  to  the  aloes,  of  which  the  ca- 
nella  is  merely  a  corrective.  Canella  is  also  an  ingredient  in  the  Wine 
of  Rhubarb  (ViNUM  RHKI,  U.  S.}. 


324  GENERAL    STIMULANTS.  [PART  II. 

2.  WINTER'S  BARK.  —  WINTERA. 

This  has  been  of  late  rejected  from  the  Pharmacopoeia,  and  owes  what 
little  attention  is  now  paid  to  it  to  old  associations.  It  is  the  bark  of 
Drimys  Winteri  {Winter a  aromatica,  Willd.),  an  evergreen  tree,  grow- 
ing in  the  southern  extremity  of  the  American  continent,  along  the 
straits  of  Magellan,  and  thence  northward  to  Chili  and  Brazil.  As  found 
in  commerce,  the  bark  is  in  quills  about  a  foot  long  by  an  inch  in  di- 
ameter, or  in  larger  flat  pieces.  On  the  outside  it  appears  as  if  it  had 
been  scraped  or  rubbed,  and  has  a  pale-yellowish  or  reddish-gray  colour, 
with  red  elliptical  spots;  the  inner  surface  is  reddish-brown  or  cinnamon 
coloured.  Its  powder  resembles  that  of  Peruvian  bark.  Its  smell  is 
fragrant,  its  taste  hot,  pungent,  and  spicy.  Its  chief  active  constituent 
is  a  peculiar  volatile  oil,  with  which  there  is  also  a  somewhat  acrid  resin. 
and  sufficient  tannic  acid  to  cause  the  infusion  to  be  darkened  by  the 
salts  of  iron. 

Winter's  bark  was  first  made  known  by  Captain  Winter,  who  com- 
manded one  of  the  vessels  in  Drake's  famous  expedition,  and,  on  his 
return  to  England,  in  1579,  brought  some  of  the  bark  with  him.  It  has 
often  been  confounded  with  canella,  which  it  resembles  in  appearance; 
but  it  may  be  distinguished  by  its  dark  inner  surface,  while  that  of 
canella  is  white,  and  by  affording  with  reagents  evidence  of  containing 
tannic  acid,  which  canella  does  not. 

Its  medical  properties  are  essentially  the  same  as  those  of  canella,  and 
it  may  be  used  for  the  general  purposes  of  the  aromatics ;  but  it  is  sel- 
dom to  be  found  in  the  markets  of  the  United  States,  and  is  little  em- 
ployed. The  dose  of  the  powder  is  about  half  a  drachm. 


III.  CLOVES. 
CARYOPHYLLUS.  U.  S.  —  CARYOPHYLLUM.  Br. 

Origin.  Cloves  are  the  dried  unexpanded  flower-buds  of  Caryophyllus 
aromaticus,  a  small  and  beautiful  tree,  inhabiting  the  Molucca  Islands, 
in  the  East  Indies,  whence  it  has  been  successfully  transplanted  to  va- 
rious parts  of  the  world,  as  the  Isle  of  France,  Singapore,  Sumatra,  and 
Cayenne  in  South  America,  in  which  places  it  is  now  cultivated  to  a 
considerable  extent 

Sensible  Properties.  Cloves  have  the  form  of  a  small  nail,  being  on 
the  average  somewhat  more  than  half  an  inch  long,  with  a  round  head, 
having  four  spreading  points  beneath  it.  When  pressed  with  the  finger- 
nail, if  of  good  quality,  they  exude  oil.  Their  colour  is  dark-browii,  their 
odour  strong  and  fragrant,  and  their  taste  hot,  pungent,  aromatic,  and 
lasting.  The  powder  is  dark  and  oily. 


CHAP.  I.]          TONICS. — AROMATICS. — CLOVES. — NUTMEG.  325 

Chief  Constituents.  The  active  principle  of  cloves  is  a  volatile  oil, 
which  may  be  separated  by  distillation.  When  first  procured,  it  is 
colourless,  but  gradually  becomes  yellowish  by  time,  and  ultimately 
reddish-brown.  It  has  the  odour  and  taste  of  the  cloves;  but  is  rela- 
tively less  pungent.  It  is  heavier  than  water.  Besides  the  oil,  there 
are  two  crystalline  principles,  called  respectively  caryophyllin  and  eu- 
genin,  and  a  little  tannic  acid ;  but  the  first  two  are  insipid,  and  the 
last  is  of  no  practical  importance.  Cloves  yield  their  active  matter  only 
in  small  proportion  to  water,  but  freely  and  entirely  to  alcohol.  The 
alcoholic  extract  is  excessively  fiery,  but  becomes  insipid  when  distilled, 
while  the  oil  which  comes  over  is  relatively  mild.  Distillation  would 
appear,  then,  to  have  produced  some  change  in  the  oil,  which  renders  it 
less  active. 

Medical  Properties  and  Uses.  Cloves  were  made  known  to  Europe 
by  the  Arabians,  but  were  not  largely  used  until  after  the  discovery  of 
the  passage  to  India  by  the  Cape  of  Good  Hope.  They  possess,  in  a 
high  degree,  the  characteristic  properties  of  the  aromatics,  and  may  be 
used  for  all  the  purposes  mentioned  in  the  general  observations  on  this 
subdivision  of  the  tonics.  They  are,  however,  much  more  employed  as 
a  condiment  in  cookery,  than  as  a  medicine.  Occasionally  they  are 
given  to  correct  nausea,  relieve  flatulent  pains,  and  stimulate  the  languid 
digestion;  but  their  chief  medicinal  employment  is  as  an  adjuvant  to 
other  medicines,  and  they  form  a  subordinate  ingredient  in  several  offici- 
nal preparations. 

The  dose  of  the  powder  is  from  five  to  twenty  grains.  The  officinal 
Infusion  (!NFUSUM  CARYOPHYLLI,  U.  S.)  is  made  with  two  drachms  of 
the  cloves  to  a  pint  of  boiling  water,  and  given  in  the  dose  of  two  fluid- 
ounces.  The  French  Codex  directs  a  tincture,  of  which  the  dose  is  a 
fluidrachm.  The  Oil  of  Cloves  (OLEUM  CARYOPHYLLI,  U.  S.),  prepared 
by  distillation  from  cloves,  is  occasionally  employed  either  alone,  in  the 
dose  of  from  two  to  six  drops,  properly  diluted,  or  as  an  ingredient  in 
purgative  pills,  to  prevent  nausea  or  griping.  It  is  also  used  to  relieve 
toothache,  by  being  introduced,  upon  cotton,  into  the  carious  hollow.  It 
relieves  the  pain  by  blunting  the  sensibility  of  the  part  through  ex- 
cessive irritation. 


IV.  NUTMEG. 
MYRISTICA.  U.S.,Br. 

Origin.  Nutmeg  is  the  kernel  of  the  fruit  of  Myristica  moschata,  a 
handsome  middle-sized  tree,  originally  confined  to  the  Moluccas,  but 
now  cultivated  in  Sumatra,  Java,  Singapore,  Cayenne,  Brazil,  and  other 


326  GENERAL    STIMULANTS.  [PART  II. 

intertropical  countries.  The  product,  however,  is  said  nowhere  to 
attain  such  perfection  as  in  its  native  islands.  The  fruit,  about  the  size 
of  a  small  peach,  has  an  outer  covering  or  hull;  and  within  this  is  a  red 
membrane  with  slits,  through  which  is  seen  a  chestnut-coloured  nut 
The  shell  of  the  nut  being  broken,  the  kernel  is  obtained,  and,  having 
been  steeped  in  a  mixture  of  lime  and  water,  and  afterwards  cleaned,  is 
prepared  for  market. 

Sensible  Properties.  The  appearance  of  the  nutmeg  is  too  well  known 
to  require  description.  When  broken,  or  cut  through,  it  presents  a  yel- 
lowish surface,  with  dark,  branching  veins,  in  which  volatile  oil  abounds. 
It  is  not  very  easily  pulverized  by  pounding,  and  is  reduced  to  powder 
by  grating  or  grinding.  It  has  a  fragrant  odour,  and  a  warm,  spicy 
taste,  and  is  among  the  most  grateful  of  the  aromatics.  It  yields  its 
virtues  much  more  readily,  and  in  larger  proportion,  to  alcohol  than  to 
water. 

Chief  Constituents.  The  most  interesting  constituents  of  nutmeg  arc 
a  volatile  and  fixed  oil,  the  former  of  which  is  obtained  by  distillation 
with  water,  the  latter  by  expression  with  heat.  The  volatile  oil  is 
lighter  than  water,  colourless  or  of  a  pale  straw  colour,  with  the  odour 
of  nutmeg,  and  a  pungent,  aromatic  taste.  It  is  the  active  principle  of 
the  medicine.  The  faced  oil,  often  though  erroneously  called  oil  of  mace, 
concretes,  after  expression,  into  a  soft  unctuous  solid,  of  a  yellowish  or 
orange-yellow  colour,  often  more  or  less  mottled,  and  of  the  smell  and 
taste  of  the  nutmeg,  owing  to  a  proportion  of  the  volatile  oil  contained 
in  it. 

Medical  Properties  and  Uses.  Nutmeg  seems  not  to  have  been  known 
to  the  ancients.  The  Arabians  were  acquainted  with  it;  but  it  was  little 
employed  in  Europe  until  after  the  discovery  of  the  maritime  passage  to 
India.  It  has  the  ordinary  properties  of  the  aromatics,  and,  in  large 
doses,  is  somewhat  narcotic.  In  the  quantity  of  two  or  three  drachms, 
it  has  produced  delirium  and  stupor;  but  no  danger  need  be  appre- 
hended from  it  in  the  ordinary  medicinal  doses.  It  is  more  used  as  a 
condiment,  or  to  give  flavour  to  ordinary  drinks,  than  as  a  medicine; 
and,  in  the  latter  capacity,  it  is  chiefly  employed  to  cover  the  taste  and 
qualify  the  action  of  other  substances.  It  is  an  excellent  addition  to 
farinaceous  drinks  used  as  a  diet  by  the  sick. 

The  dose  of  the  powder  is  from  five  to  twenty  grains.  The  Volatile 
Oil  (OLEUM  MYRISTIC^,  U.S.)  may  be  used,  for  any  of  the  purposes  of 
the  aromatics,  in  the  dose  of  two  or  three  drops.  There  is  an  officinal 
Spirit  (SpiRixus  MYRISTIC^G,  U.S.),  prepared  by  distilling  proof  spirit 
from  bruised  nutmeg.  In  the  quantity  of  from  one  to  four  fluidrachms, 
it  forms  an  elegant  addition  to  tonic  and  purgative  infusions,  when  the 
stimulus  of  alcohol  is  not  forbidden.  The  expressed  oil  is  sometimes 


CHAP.  I.]  TONICS. — AROMATICS. — BLACK   PEPPER.  327 

used  as  a  gentle  rubefacient  in  local  rheumatism  and  palsy,  and  is  an  in- 
gredient in  Emplastrum  Picis  of  the  British  Pharmacopoeia. 

Mace  (MACIS,  U.  <S.)  is  the  membrane  above  referred  to  as  surround- 
ing the  nut  in  the  fruit.  It  is  in  flat,  longitudinally  slit  pieces,  of  a 
rather  soft  consistence,  of  a  reddish  colour,  and  an  odour  and  taste 
recalling  those  of  nutmeg,  but  different  and  peculiar.  Like  nutmeg, 
mace  contains  a  volatile  and  a  fixed  oil.  It  may  be  used  for  the  same 
purposes  as  that  spice,  but  is  much  less  agreeable,  and  proportionably 
less  employed. 


V.  BLACK  PEPPER. 
PIPER.    U.  S.,  Br. 

Origin.  Black  pepper  consists  of  the  dried  unripe  berries  of  Piper 
nigrum,  a  climbing  plant,  indigenous  in  the  East  Indies,  where  it  is 
also  largely  cultivated,  especially  on  the  coast  of  Malabar,  in  the  penin- 
sula of  Malacca,  in  Siam,  and  in  the  islands  of  Java  and  Sumatra. 

White  pepper  is  the  ripe  fruit,  deprived  of  its  outer  coating  by  macer- 
ation in  water.  It  is  weaker  than  the  black,  and  is  little  used  in  this 
country. 

Sensible  Properties.  Black  pepper  is  too  well  known  to  require  de- 
scription. Its  odour  and  taste  are  familiar  to  every  one. 

Chief  Constituents.  These  are  volatile  oil,  a  soft  acrid  resin,  and 
a  peculiar  crystalline  principle  called  piperin.  The  volatile  oil  may  be 
separated  by  distillation  with  water.  It  is  at  first  limpid  and  colourless, 
but  becomes  yellow  by  age.  Its  odour  is  strong,  and  resembles  that  of 
pepper;  but  the  taste,  though  warm  and  pungent,  is  less  acrid  than  that 
of  the  berries  themselves.  The  acrimony  resides  chiefly  in  the  soft 
resin,  which  is  semi-fluid,  of  a  deep-green  or  blackish  colour,  extremely 
acrid,  insoluble  in  water  and  the  volatile  oils,  but  readily  dissolved  by 
alcohol  and  by  ether.  Piperin  is  a  crystalline  substance,  white,  inodor- 
ous, and  tasteless  when  perfectly  pure  ;  but,  as  commonly  obtained, 
yellow  and  acrid.  At  least  this  is  the  statement  made  by  Pelletier;  but 
Dr.  Christison  says  that  the  whitest  and  purest  crystals  he  had  been 
able  to  procure  were  as  acrid  as  the  coloured,  and  emitted  an  intensely 
irritating  vapour  when  thrown  on  a  heated  iron  plate.  It  is  insoluble 
in  cold  water,  slightly  soluble  in  hot  water,  and  readily  soluble  in  alco- 
hol, ether,  and  acetic  acid. 

Medical  Properties  and  Uses.  Black  pepper  has  been  known  as  a 
medicine  and  condiment  from  the  time  of  Hippocrates.  It  has  the  prop- 
erties of  the  aromatics  in  general,  but  is  much  more  stimulating  than 
most  of  them,  and  acts  with  still  greater  proportionate  energy  on  the 


328  GENERAL   STIMULANTS.  [PART  II. 

stomach  than  on  the  general  system.  It  is  thought  to  have  a  specially 
excitant  effect  on  the  urino-genital  apparatus,  and  probably  stimulates 
the  urinary  passages  through  the  direct  contact  of  some  one  of  its  ingre- 
dients, altered  or  unaltered,  with  the  mucous  membrane  of  these  pas- 
sages, as  it  escapes  with  the  urine.  In  contact  with  the  skin,  it  is  highly 
irritant,  acting  as  a  rubefacient,  and  sometimes,  it  is  said,  blistering. 
When  taken  too  largely,  it  may  produce  serious  irritation  or  inflamma- 
tion of  the  stomach,  with  general  febrile  phenomena;  and  its  long- 
continued  use  in  excess  endangers  a  loss  of  excitability  in  that  organ, 
with  or  without  chronic  gastritis.  It  is  much  more  employed  as  a  con- 
diment than  as  a  medicine.  In  the  former  capacity,  it  not  only  serves  to 
impart  an  agreeable  flavour,  but  often  facilitates  the  digestion  of  sub- 
stances ordinarily  of  difficult  solution  in  the  stomach,  especially  fresh 
vegetables  when  boiled.  Care  should  be  taken,  however,  not  to  abuse 
it,  for  fear  of  the  evil  consequences  just  referred  to.  As  a  medicine,  it  is 
given  occasionally  in  torpidity  of  the  stomach  and  bowels,  with  flatu- 
lence, especially  in  old  people,  in  whom  these  organs  are  apt  to  be  inert 
It  is  thought  to  act  directly  upon  the  mucous  coat  of  the  rectum,  and 
thus  to  prove  useful  in  chronic  ulcers  of  that  part,  in  piles,  and  fistula 
in  ano.  From  its  influence  upon  the  urinary  and  genital  passages,  it  has 
been  recommended  in  gonorrhoea,  gleet,  and  leucorrhcea ;  but  care  should 
be  taken  not  too  much  to  excite  these  parts,  when  there  is  any  tendency 
to  acute  inflammation. 

Much  attention  has  been  directed  to  black  pepper  from  its  supposed 
possession  of  antiperiodic  properties.  It  was  recommended  in  parox- 
ysmal fevers  by  Celsus  and  Dioscorides ;  but,  though  occasionally  used 
in  domestic  practice  in  intermittents,  it  seems  for  a  long  time  to  have  been 
lost  sight  of  by  the  profession.  Louis  Frank,  in  imitation  of  a  practice 
which  he  had  witnessed  in  the  Kiist.  was  induced  to  try  it  in  this  com- 
plaint, and  found  it  successful  in  a  hundred  and  seventy  cases,  which  re- 
covered as  rapidly  as  under  cinchona,  and  with  less  tendency  to  relapse. 
(Trousseau  et  Pidoux,  Trait,  de  Therap.,  etc.,  4e  ed.,  ii.  465  )  Many 
others  followed  the  example  of  Frank,  and  the  remedy  came  into  great 
repute,  which  it  has  not  yet  entirely  lost.  There  is  no  doubt  that  it  will 
often  cure  intermittents;  and,  in  cases  of  great  torpidity  of  stomach,  as 
in  drunkards,  it  may  with  advantage  be  associated  with  sulphate  of 
quinia,  in  order  to  arouse  susceptibility  to  the  action  of  the  latter  rem- 
edy. When  used  alone,  it  should  be  preceded  by  a  thorough  evacuation 
of  the  bowels;  and  it  is  recommended  to  administer  it  in  the  form  of 
whole  grains,  as  less  liable  than  the  powder  to  irritate  or  inflame  the 
stomach. 

In  reference  to  its  local  effects,  black  pepper  is  sometimes  used  as  a 
direct  application  to  the  mouth  or  fauces,  in  paralysis  of  these  parts, 
relaxed  uvula,  severe  toothache,  etc.  Externally  it  may  often  be  usefully 


CHAP.  I.]  TONICS. AROMATICS. — BLACK    PEPPER.  329 

employed  as  a  rubefacient,  for  which  purpose  it  may  be  made  into  a 
cataplasm,  with  or  without  other  irritants. 

It  may  be  given  whole,  or  in  powder.  The  dose  is  from  five  to 
twenty  grains.  In  intermittents  it  has  been  recommended  preferably, 
as  already  stated,  in  the  whole  form ;  and  eight  or  ten  grains  of  it  may 
be  given  three  or  four  times  a  day. 

There  is  an  officinal  Confection  (CONFECTIO  PIPERIS,  Br.},  consisting 
of  black  pepper  and  caraway,  incorporated  with  honey.  It  has  been 
highly  recommended  in  piles,  in  which  it  is  employed  as  an  officinal  sub- 
stitute for  an  empirical  remedy,  which  acquired  much  credit,  in  the 
treatment  of  this  affection,  under  the  name  of  Ward's  paste.  Sir  B. 
Brodie  has  found  it  successful  in  severe  cases,  and  recommends  that  it 
should  be  continued  for  two,  three,  or  four  months.  The  dose  is  from 
one  to  three  drachms,  twice  or  three  times  a  day.  It  should  be  accom- 
panied with  a  laxative,  in  order  to  prevent  inconvenient  accumulation  in 
the  bowels;  and  should  not  be  used  when  the  parts  are  inflamed. 

An  Oleoresin  (OLEORESINA  PIPERIS,  U.  S.;  EXTRACTUM  PIPERIS  FLU- 
IDUM,  U.  S.  1850)  is  directed  by  the  U.  S.  Pharmacopeia,  in  which  the 
virtues  of  the  medicine  are  extracted  by  ether,  and  this  fluid  subse- 
quently evaporated.  It  contains  the  volatile  oil  and  acrid  resin  of  the 
pepper;  and,  as  the  piperin  is  of  doubtful  efficacy,  may  be  considered  as 
representing  the  virtues  of  black  pepper.  It  is  a  thick,  opaque,  greenish 
liquid,  having  the  smell  of  pepper,  and  an  acrid,  burning  taste.  A  re- 
siduary matter,  left  in  the  process  of  preparing  piperin,  has  been  kept  in 
the  shops,  under  the  name  of  oil  of  pepper.  It  has  a  black  colour,  and 
is  essentially  of  the  same  character  as  the  fluid  extract,  though  of  less 
uniform  strength,  and  therefore  less  to  be  relied  on.  The  dose  is  one  or 
two  minims,  which  may  be  given  in  emulsion,  or  in  connection  with 
other  medicines  in  the  pilular  form. 

Piperin  has  had  considerable  reputation  in  the  treatment  of  intermit- 
tent fever,  having  been  supposed  to  be  the  active  principle  of  black 
pepper.  As  found  in  the  shops,  it  certainly  has  some  effect,  and  has 
been  used  successfully  in  that  complaint.  Dr.  Meli,  an  Italian  phy- 
sician, who  was  the  first,  I  believe,  to  employ  it,  considered  it  superior 
to  Peruvian  bark.  It  has  been  much  employed  also  in  this  country, 
particularly  in  connection  with  sulphate  of  quinia.  As  before  stated, 
however,  there  is  much  reason  to  doubt  its  efficiency  when  pure.  Ac- 
cording to  Pelletier,  the  acrid  taste,  and  consequently  the  medicinal 
activity  of  the  impure  form  in  which  it  is  commonly  found,  are  owing  to 
a  portion  of  the  acrid  resin  remaining  mixed  with  it.  The  dose  is  stated 
at  from  one  to  ten  grains.  A  drachm  has  been  given  in  twenty-four 
hours  without  inconvenience.  Meli  considers  that  two  or  three  scruples 
are  sufficient  to  cure  intermittents. 

An  ointment,  made  by  rubbing  one  part  of  powdered  pepper  with 


330  GENERAL   STIMULANTS.  [PART  II. 

three  or  four  parts  of  lard,  was  formerly  employed  in  scald-head,  but  is 
little  used  at  present. 


VI.  CUBEBS. 
CUBEBA.  U.  S.,  Br. 

Origin.  Cubebs  are  the  dried  unripe  fruit  of  Piper  Cubeba  (Cubeba 
officinal**  of  Miquel),  a  climbing  perennial  of  the  E.  Indies,  inhabiting 
especially  Java  and  the  neighbouring  islands. 

Sensible  Properties.  The  fruit  is  spherical,  about  the  size  of  a  small 
pea,  and  furnished  with  a  short  stalk,  continuous  with  a  network  of  raised 
veins  which  surround  the  berry.  Their  colour  in  mass  is  a  dark  gray ; 
some  of  the  berries  being  almost  black,  others  much  lighter-coloured. 
The  powder  is  dark  and  oily,  and  bears  no  inconsiderable  resemblance 
to  that  of  opium,  which  has  been  fatally  mistaken  for  it.  The  odour  is 
peculiar  and  aromatic,  the  taste  warm,  bitterish,  and  camphorous,  im- 
parting a  sense  of  coolness  when  the  air  is  drawn  through  the  mouth. 
Water  very  imperfectly  extracts  the  virtues  of  cubebs,  Alcohol  and  ether 
completely.  They  gradually  deteriorate  by  age,  and,  as  this  deteriora- 
tion takes  place  most  rapidly  in  powder,  they  should  be  kept  whole,  and 
pulverized  as  wanted  for  use. 

Chief  Constituents.  These  are  volatile  oil,  an  acrid  resin,  and  a 
peculiar  principle  called  cubebin.  The  volatile  oil,  which  is  obtained  by 
distillation  with  water,  is  when  pure  quite  colourless,  but,  as  commonly 
met  with,  yellowish  or  greenish.  It  is  lighter  than  water,  of  about  the 
consistence  of  olive  oil,  of  an  odour  like  that  of  cubebs,  and  a  warm, 
aromatic,  camphorous  taste.  The  resin  is,  according  to  Yauquelin, 
somewhat  acrid,  and  has  a  balsamic  odour  and  taste  resembling  those 
of  copaiba.  Cubebin  is  closely  analogous  to  piperin,  and,  when  pure, 
quite  destitute  of  odour  and  taste.  The  chief  active  constituent  is  un- 
doubtedly the  volatile  oil,  the  operation  of  which  is  somewhat  aided  by 
the  resin.  Cubebin  is  probably  inert. 

Medical  Properties  and  Uses.  It  is  probable  that  cubebs  were  known 
to  the  ancient  Greeks.  The  Arabians  certainly  were  acquainted  will: 
them,  and  by  these  they  were  introduced  into  Europe.  Employed  for 
the  same  purposes  as  black  pepper,  they  were  at  once  feebler  and  less 
agreeable,  and  fell  at  length  into  entire  neglect.  It  is  only  about  forty 
or  fifty  years  since  the  use  of  them  was  revived,  in  consequence  of  the 
favourable  reports  of  English  physicians  in  India,  as  to  their  efficacy  in 
the  treatment  of  gonorrhoea,  in  which  they  had  been  long  employed  by 
the  native  practitioners.  Cubebs  have  the  properties  of  the  stimulant 
aromatics,  with  a  peculiar  direction  to  the  urinary  organs.  When  freely 


CHAP.  I.]  TONICS. — AROMATICS. — CUBEBS.  331 

taken,  they  produce  a  feeling  of  warmth  in  the  stomach,  increase  the 
frequency  of  pulse  and  heat  of  skin,  sometimes  occasion  giddiness  or 
headache,  and,  in  consequence  of  the  absorption  of  the  volatile  oil,  and 
its  escape  through  the  kidneys,  augment  the  secretion  of  urine,  and  im- 
part to  it  a  peculiar  odour.  In  excess,  they  may  cause  burning  in  the 
stomach,  nausea  and  vomiting,  griping  pains  in  the  bowels  with  more  or 
less  of  a  laxative  effect,  irritation  or  inflammation  of  the  urinary  pas- 
sages, and  a  general  febrile  condition.  Occasionally  their  operation,  in 
ordinary  doses,  is  attended  with  a  rash  upon  the  surface,  somewhat  re- 
sembling urticaria.  Though  applicable  to  the  same  purposes  as  pepper, 
in  reference  to  their  cordial  operation  on  the  stomach,  it  is  mainly  in  the 
treatment  of  gonorrhoea,  and  other  affections  of  the  urino-gcnital  organs, 
that  they  are  employed.  They  are  recommended  in  the  earliest  stage 
of  gonorrhoea,  and,  thus  given,  occasionally  produce  speedy  cures;  but 
they  often  also  fail,  and  have  been  accused  of  increasing  inflammation, 
and  aggravating  any  existing  tendency  to  swelled  testicle.  They  should, 
I  think,  be  used  with  caution  when  inflammation  exists,  beyond  that 
which  is  an  essential  constituent  of  the  affection ;  and  it  is  probable  that 
their  greater  efficacy  in  the  earliest  stage  is  owing  to  the  circumstance, 
that  highly  inflammatory  symptoms  have  not  yet  been  developed.  They 
probably  operate  through  a  direct  alterative  influence  of  the  urine,  im- 
pregnated with  their  properties,  upon  the  portion  of  mucous  membrane 
affected.  In  the  advanced  or  chronic  stage  of  gonorrhoea,  and  in  gleet, 
though  perhaps  less  efficient,  they  would  be  less  likely  to  produce  mis- 
chievous effects.  Upon  the  same  principle  as  in  this  complaint,  they 
have  been  recommended  in  chronic  cystirrhcea,  chronic  pyelitis,  leucor- 
rhoea,  abscess  of  the  prostate,  and  other  conditions  of  the  urinary  and 
genital  passages,  in  which  a  moderate  stimulation  of  the  diseased  sur- 
face is  indicated.*  They  are  said  to  have  proved  useful  in  piles.  Some 
suppose  them  to  have  an  alterative  action  on  the  mucous  surfaces 
generally,  and  therefore  recommend  them  also  in  chronic  bronchial 
affections,  attended  with  copious  expectoration,  and  a  relaxed  condition 
of  the  tubes. 

Administration.  The  most  common  form  of  exhibition  is  that  of  pow- 
der, of  which  from  ten  grains  to  half  a  drachm  is  usually  given  in  affec- 
tions of  the  bladder,  kidneys,  and  bronchial  tubes;  but  in  gonorrhoea  the 
requisite  dose  is  larger,  varying  from  half  a  drachm  to  three  drachms, 
three  or  four  times  a  day.  The  volatile  oil  (OLEUM  CUBEB^E,  U.  S.), 

*  Dr.  Caudmont  has  obtained  peculiar  advantages  in  affections,  whether  inflam- 
matory or  neuralgic,  of  the  neck  of  the  bladder  and  the  prostatic  portion  of  the 
urethra,  from  a  combination  of  cubebs  with  copaiba.  The  medicine  may  be  given 
in  the  form  of  bolus,  each  containing  about  six  grains  of  the  mixed  medicine,  and  of 
which  from  fifteen  to  twenty-five  are  to  be  given  in  the  twenty-four  hours.  (Bulletin 
Gin.  de  Therap.,  Juillet  30,  1861.) 


332  GENERAL    STIMULANTS.  [PART  II. 

which  is  obtained  by  distilling  cubebs  with  water,  may  be  employed  in 
emulsion,  or  dropped  on  sugar,  in  the  dose  of  ten  drops  to  begin  with, 
gradually  increased  till  its  effects  on  the  urinary  passages  have  become 
evident.  The  dose  has  sometimes  been  increased  to  a  fluidraehm.  An 
Oleoresin  (OLEORESINA  CUBEBS,  U.  S.;  EXTRACTUM  CUBEBS  FLUIDUM, 
U.  S.  1850)  is  directed  by  the  U.  S.  Pharmacopeia.  It  is  made  by  ex- 
tracting the  virtues  of  the  medicine  with  ether,  and  then  allowing  the 
ether  to  evaporate.  It  is  a  greenish-brown  fluid,  of  variable  consistence, 
and  may  be  given  in  doses  of  from  five  to  thirty  minims,  either  mixed 
with  sugar,  or  suspended  in  sweetened  water.  There  is  an  officinal 
Tincture  (TINCTURA  CUBEB^B,  U.  S.),  of  which  the  dose  is  from  thirty 
minims  to  two  or  three  fluidrachms. 


I  do  not  know  where  better  to  introduce  the  following  medicine,  than 
in  a  subordinate  position  to  pepper  and  cubebs,  with  which  it  agrees  in 
botanical  affinities,  and,  to  a  considerable  degree,  in  its  effects. 

MATICO.  U.S.  —  MATICA.  Br.  This  consists  of  the  herbaceous  parts, 
more  especially  the  leaves,  of  Piper  angustifolium  (Artanthe  elongata, 
Miquel),  a  shrub  growing  in  Peru.  The  medicine,  as  imported,  usually 
consists  of  the  dried  leaves,  spikes,  and  stalks,  mixed  together,  and 
closely  flattened  by  pressure.  They  are  of  a  greenish  colour,  and,  when 
pulverized,  yield  a  greenish,  light,  absorbent  powder.  They  have  an 
agreeable  aromatic  odour,  and  a  strong  spicy  taste.  These  properties, 
as  well  as  their  medical  virtues,  they  yield  readily  to  alcohol,  and  less 
perfectly  to  water.  Their  active  constituents  are  volatile  oil,  a  bitter 
principle,  soluble  iu  alcohol  and  water,  called  maticin,  and  probably 
resin.  They  contain  neither  tannic  nor  gallic  acid. 

Matico  has  long  been  used  in  Peru,  externally  as  a  styptic  in  hemor- 
rhage, and  a  stimulant  to  ulcers,  and  internally  as  an  aphrodisiac,  and  a 
remedy  in  venereal  diseases.  But  it  was  not  introduced  into  Europe 
until  1839,  when  a  portion  of  it  was  taken  to  Liverpool,  and  prescribed 
by  Dr.  Jeffreys,  of  that  place,  in  various  diseases.  Its  effects  on  the 
system  are  those  of  an  aromatic  tonic  and  stimulant,  bearing  no  incon- 
siderable resemblance  to  those  of  pepper  and  cubebs.  It  has  been  em- 
ployed, with  asserted  advantage,  in  chronic  inflammation  of  the  mucous 
membranes,  as  gonorrhoea,  leucorrhcea,  catarrh  of  the  bladder,  ami  dys- 
entery, and  as  a  haemostatic  in  hemorrhage  from  the  nostrils,  lungs, 
stomach,  urinary  organs,  and  uterus.  If  useful  in  these  latter  affections, 
it  is  not  through  any  astringent  properties,  of  which  it  is  quite  destitute, 
but  probably  by  an  influence  analogous  to  that  of  oil  of  turpentine,  which 
is  often  an  efficient  remedy  in  hemorrhage.  Its  chief  use,  given  internally, 


CHAP.  I.]  TONICS. — AROMATICS. — PIMENTO.  333 

is  as  an  alterative  to  chronically  inflamed  mucous  membranes.  As  a  local 
styptic,  it  has  been  highly  recommended.  In  this  application,  it  probably 
acts  mechanically,  by  absorbing  the  blood,  and  favouring  its  coagulation. 
The  dose  of  the  powder  is  from  half  a  drachm  to  two  drachms,  three 
times  a  day.  The  Infusion  (INFUSUM  MATIC^,  Br.),  directed  in  the 
British  Pharmacopoeia,  is  made  in  the  proportion  of  half  an  ounce  to  ten 
fluidounces  of  boiling  water,  and  given  in  the  dose  of  one  or  two  fluid- 
ounces.  The  Dublin  College  formerly  directed  a  Tincture  (TiNCTURA 
MATICO),  of  which  the  dose  was  from  one  to  three  fluidrachms. 


VII.  PIMENTO. 
PIMENTA.  U.  S.,  Br. 

Origin.  Pimento  consists  of  the  dried  unripe  berries  of  Myrlus 
Pimento,  (Eugenia  Pimento.,  De  Cand.),  a  handsome  tree,  growing  in 
the  West  Indies,  Mexico,  and  South  America,  where  it  is  indigenous, 
and  cultivated  in  Jamaica,  whence  the  fruit  derives  the  name  of  Jamaica 
pepper. 

Sensible  Properties.  The  berries  are  similar  to  those  of  black  pepper, 
but  rather  larger,  and  smoother.  They  are  of  a  brown  colour,  a  fragrant 
odour,  and  a  warm,  pungent,  aromatic,  slightly  astringent  taste.  The 
odour  has  been  thought  to  resemble  that  of  a  mixture  of  other  spices; 
and  hence  the  name  of  allspice,,  by  which  the  fruit  is  generally  known. 

Active  Principles.  According  to  the  analysis  of  Bonastre,  the  active 
constituents  are  volatile  oil,  a  green  acrid  fixed  oil,  and  a  little  tannic 
acid.  Berzelius,  however,  thought  that  the  green  acrid  fixed  oil  of 
Bonastre  was  a  mixture  of  volatile  oil,  resin,  fixed  oil,  and  perhaps  a 
little  chlorophyll.  This  is  probably  true;  so  that,  as  the  tannic  acid  is 
of  little  or  no  account,  the  berries  may  be  considered  as  owing  their  vir- 
tues exclusively  to  their  volatile  oil.  This,  when  first  obtained  by  dis- 
tillation, is  colourless ;  but  it  changes  with  time,  and  ultimately  becomes 
reddish-brown.  It  has  the  flavour  of  the  fruit. 

Medical  Properties  and  Uses.  Pimento  became  known  as  a  spice  very 
soon  after  the  discovery  of  America.  Its  effects  are  those  of  the  arorna- 
tics  generally,  without  any  special  distinguishing  property.  It  may, 
therefore,  be  used  for  the  same  purposes  as  other  pure  aromatics  (see 
page  315),  being  preferably  prescribed,  when  its  odour  and  taste  are 
peculiarly  agreeable  to  the  patient.  It  is  much  more  used  in  cooking 
than  as  a  medicine. 

The  dose  of  the  powder  is  from  ten  to  forty  grains;  that  of  the  Vola- 
tile Oil  (OLEUM  PIMENTO,  U.  S.)  from  three  to  six  drops.  A  Water  of 


334  GENERAL   STIMULANTS.  [PART  II. 

Pimento  (AQUA  PIMENTO,  Br.)  is  made  cither  by  distilling  water  from 
the  bruised  fruit,  or  by  simply  dissolving  the  oil  in  distilled  water,  and 
given  in  the  dose  of  one  or  two  fluidounces.  A  Spirit  of  Pimento,  pre- 
pared by  dissolving  the  oil  in  diluted  alcohol,  was  formerly  officinal;  but 
it  has  been  omitted  in  the  late  revision  of  our  Pharmacopoeia.  The  dose 
was  one  or  two  fluidrachms,  or  more. 


VIII.  CARDAMOM. 
CARDAMOMUM.  U.  S.,  Br. 

Origin.  This  is  the  fruit  of  Eleilaria  Cardamomum,  a  perennial 
plant,  with  clustered  stems,  from  six  to  twelve  feet  high,  and  bearing 
its  fruit  upon  a  flower-stalk,  which  springs  from  the  base  of  the  stem, 
and  lies  along  the  ground.  It  is  a  native  of  the  mountains  of  the  Mala- 
bar coast  of  Hindostan,  where  also  it  has  been  cultivated  from  time 
immemorial. 

Sensible  Properties.  The  fruit  is  a  coriaceous  capsule,  about  half  an 
inch  in  average  length,  and  seldom  more  than  three  lines  thick,  three- 
sided,  with  rounded  angles,  somewhat  wrinkled  longitudinally,  of  a 
dirty-whitish  or  yellowish-white  colour,  and  containing  small,  angular, 
irregular  seeds,  of  a  deep-brown  colour,  and  appearing  as  if  embossed  on 
the  surface.  The  odour  of  cardamom  is  highly  fragrant,  the  taste  warm, 
grateful,  pungent,  and  purely  aromatic.  The  capsular  covering  has  little 
of  the  aromatic  property,  which  resides  mainl}r  in  the  seeds.  In  making, 
therefore,  the  preparations  of  cardamom,  the  former  should  be  rejected; 
although,  as  the  seeds  keep  better  in  the  capsule  than  when  exposed, 
they  should  not  be  separated  until  wanted  for  use. 

Active  Principle.  The  virtues  of  cardamom  reside  exclusively  in  a 
volatile  oil,  which  is  lighter  than  water,  colourless,  and  highly  pungent 
and  aromatic ;  but  it  is  so  liable  to  deterioration  by  time,  that  it  is  seldom 
kept  separate  for  use.  Water  dissolves  the  oil  from  the  seeds  in  small 
proportion;  but  alcohol  is  a  much  better  solvent. 

Medical  Properties  and  Uses.  Cardamom  was  probably  known  to  the 
ancient  Greeks  and  Romans,  and  has  been  employed  in  India,  as  a  con- 
diment, from  the  earliest  times.  It  is  among  the  most  agreeable  and 
purest  of  the  aromatics,  less  stimulating  than  many  others,  whether 
locally  or  generally,  and  therefore  highly  useful,  as  an  adjuvant,  under 
circumstances  which  might  forbid  the  use  of  a  less  mild  article  of  the 
class.  Though  seldom  given  alone,  it  is  very  much  employed  to  aid  or 
correct  the  action  of  other  remedies,  and  enters  into  a  large  number  of 
officinal  preparations,  particularly  tinctures.  Perhaps  no  aromatic,  on 
the  whole,  answers  better  than  this  as  an  addition  to  tonic  and  purgative 


CHAP.  I.]  TONICS. — AROMATICS. — FENNEL-SEED.  335 

mixtures  and  infusions,  where  the  object  is  merely  to  cover  the  taste, 
obviate  nausea,  and  produce  a  slight  cordial  impression  on  the  stomach ; 
and  it  is  considerably  used  for  this  purpose  in  various  officinal  prepara- 
tions, as  the  aromatic  powder,  the  compound  extract  of  colocynth,  com- 
pound tincture  of  gentian,  tincture  of  rhubarb,  and  wine  of  aloes. 

When  used  alone,  it  is  most  conveniently  given  in  infusion,  which 
may  be  made  with  one  or  two  drachms  of  the  bruised  capsules  to  a  pint 
of  boiling  water ;  and  in  the  same  proportion  they  may  be  added  to  com- 
pound infusions.  The  dose  is  two  fluidounces,  or  more.  There  are  two 
officinal  Tinctures  of  this  aromatic  specially,  one  simple  (TiNCTURA 
CARDAMOMI,  U.  /S.),  and  the  other  compound  (TINCTURA  CARDAMOMI 
COMPOSITA,  U.  S.,  Br.)  ;  the  latter  containing,  in  addition,  cinnamon, 
caraway,  and  honey,  and  coloured  red  with  cochineal.  The  honey  was 
substituted,  in  the  U.  S.  preparation,  for  raisins,  which  are  directed  in  the 
British  Pharmacopoeia;  and  it  is  very  doubtful,  in  my  estimation,  in 
reference  to  the  sensible  properties  of  the  tincture,  whether  the  change 
was  an  improvement.  These  are  agreeable  preparations,  especially  the 
compound  tincture,  which  is  much  used  as  an  extemporaneous  addition 
to  stimulant,  tonic,  and  purgative  mixtures  and  infusions,  in  the  quantity 
of  one  or  two  fluidrachms  for  each  dose  of  the  preparation. 


IX.  FENNEL-SEED. 
FCENICULUM.  U.S.,Br. 

Origin.  Fennel-seed  is  the  fruit  of  Foeniculum  vulgare  (De  Cand.), 
F.  officinale  (Merat  and  De  Lens),  and  possibly  F.  dulce  (De  Cand.). 
These  are  perennial  umbelliferous  herbs,  growing<wild  in  the  South  of 
Europe  and  in  Asia  Minor,  and  cultivated  both  in  Europe  and  the  United 
States.  The  whole  plant,  in  the  different  species,  has  a  grateful  aro- 
matic odour  and  taste,  on  account  of  which  F.  dulce  is  cultivated  in 
Southern  Europe  ;  the  shoots  being  eaten  raw,  or  in  the  form  of  salad. 

Sensible  Properties.  Fennel-seed  consists  usually  of  the  separated 
half-fruits  (mericarps)  of  the  plant,  usually  called  seeds.  These  are  ob- 
long-oval, flat  on  one  side  and  convex  on  the  other,  occasionally  con- 
nected by  their  flat  surfaces,  and  of  a  grayish-green  colour,  with  yellow- 
ish longitudinal  ridges  on  the  convex  surface.  There  are  two  varieties, 
one  smaller,  a  line  or  two  in  length,  always  in  separate  half-fruits;  the 
other  larger,  three  or  four  lines  long,  of  a  lighter  colour,  more  prominent 
ridges,  often  connected  together  forming  whole  fruits,  and  with  a  short 
footstalk.  The  former  comes  probably  from  F.  vulgare,  the  latter  from 
F.  officinale.  Both  have  a  pure  aromatic  odour  and  taste,  peculiar  and 


336  GENERAL    STIMULANTS.  [PART  II. 

very  agreeable.     They  impart  their  sensible  properties  and  virtues  to 
water  and  alcohol,  but  more  largely  to  the  latter. 

Active  Principle.  Fennel-seed  depends  for  its  activity  exclusively  on 
a  volatile  oil,  which  is  obtained  by  distillation  with  water,  is  lighter  than 
water,  colourless  or  yellow,  and  of  a  very  grateful  flavour. 

Medical  Properties  and  Uses.  The  ancients  were  acquainted  with 
this  medicine.  It  is  purely  aromatic,  mild  in  its  action  on  the  stomach, 
and  scarcely  stimulant,  in  ordinary  doses,  to  the  system  at  large.  Being 
less  heating  than  cloves,  cinnamon,  ginger,  or  even  cardamom,  and  yet 
of  a  very  grateful  flavour,  it  is  preferable  to  these  aromatics,  when  there 
is  an  indication  at  the  same  time  for  their  peculiar  influence,  and  for  the 
avoidance  of  over-excitement,  whether  local  or  general.  In  the  form  of 
infusion,  or  of  fennel  water,  it  is  often  employed  in  infantile  cases  to 
relieve  flatulent  colic,  and  to  obviate  nausea.  It  may  sometimes  be  use- 
ful for  the  former  purpose,  given  as  an  enema.  It  is  one  of  the  best 
additions  to  purgative  medicines,  and  is  often  associated  with  senna, 
rhubarb,  and  magnesia,  in  infusion  or  mixture. 

An  Infusion  may  be  made  in  the  proportion  of  two  drachms  to  a  pint 
of  water,  and  given  in  the  dose  of  two  or  more  fluidounces  to  an  adult, 
and  two  or  three  fluidrachms  to  an  infant. 

The  Volatile  Oil  (OLEUM  FCENICULI,  U.S.)  may  be  used  in  doses  of 
from  five  to  fifteen  drops  as  a  carminative  or  antiemetic ;  and  may  be 
associated  with  other  substances  in  pill,  lozenge,  or  confection,  to  give 
them  flavour,  or  enable  them  to  sit  better  on  the  stomach. 

Fennel  Water  (AQUA  FOSNICULI,  U.  S.)  is  made  by  dissolving  the  oil 
in  distilled  water,  by  the  instrumentality  of  carbonate  of  magnesia.  In 
the  British  Pharmacopeia,  it  is  directed  to  be  made  by  distilling  water 
from  the  seed ;  and  the  same  directions  are  given  in  our  national  code 
as  an  alternative  process.  The  dose  for  an  adult  is  one  or  two  fluid- 
ounces,  for  an  infant*  as  many  fluidrachms.  It  is  a  very  good  vehicle 
for  medicines  given  in  the  form  of  mixture. 


There  are  several  other  aromatic  fruits,  the  medical  properties  and 
uses  of  which  so  closely  resemble  those  of  fennel,  that  what  is  said  of 
one  may  be  nearly  as  well  said  of  all ;  one  being  preferable  to  another, 
mainly  from  its  according  better  with  the  taste  or  stomach  of  the 
patient.  It  is  unnecessary,  therefore,  to  do  more  than  name  them,  and 
very  briefly  describe  their  origin  and  distinctive  physical  properties. 

1.  CARAWAY.  — C ARUM.  U.S.  —  CARUI.  Br. 

Caraway  consists  of  the  half-fruits  or  mericarps,  commonly  called  seeds, 
of  Carum  Carui,  a  small  biennial  umbelliferous  plant,  growing  wild  in 
many  parts  of  Europe,  and  cultivated  both  there  and  in  this  country. 


CHAP.  I.]  TONICS. — AROMATICS. — CORIANDER. — ANISE.  337 

They  are  usually  separate,  about  two  lines  long,  rather  flat,  slightly 
curved  inwards,  with  five  yellowish  longitudinal  ridges,  and  intervening 
spaces  of  a  dark-brown  colour.  They  liave  an  aromatic  odour  and 
taste,  which  depend  on  a  volatile  oil.  This,  when  separated  by  distilla- 
tion, is  at  first  colourless,  but  becomes  yellow  with  age,  and  ultimately 
brownish.  It  is  lighter  than  water.  The  medical  properties  and  uses 
are  the  same  as  those  of  fennel-seed.  An  Infusion  is  prepared  in  the 
same  way,  and  used  in  the  same  dose.  The  Volatile  Oil  (OLEUM  CARI, 
U.S.;  OLEUM  CARUI,  Br.)  is  likewise  used  for  the  same  purposes,  and  in 
the  same  manner  as  that  of  fennel-seed,  in  a  dose  varying  from  one  to 
ten  drops.  It  is  occasionally  applied  to  the  relief  of  toothache,  by  being 
introduced  upon  cotton  into  the  carious  cavity.  It  probably  acts  by 
deadening  sensibility  through  its  powerful  stimulation.  There  is  an  offici- 
nal Water  (AQUA  CARUI,  Br.),  which  is  prepared  from  the  seeds  by  dis- 
tillation, and  used  like  fennel-water.  The  old  London  Spirit  of  Caraway 
was  abandoned  in  the  preparation  of  the  British  Pharmacopoeia.  Cara- 
way was  known  to  the  ancients. 

2.  CORIANDER.  — CORIANDRUM.  U.S.,  Br. 

This  is  the  fruit  of  Coriandrum  sativum,  a  small  plant  inhabiting 
Egypt  and  the  South  of  Europe,  and  cultivated  for  use.  It  is  com- 
monly called  coriander  seed.  It  is  spherical,  about  the  eighth  of  an 
inch  in  diameter,  grayish-brown,  obscurely  ribbed,  and  separable  into 
two  portions  or  half- fruits.  The  odour  and  taste  are  agreeably  aromatic, 
and  must  be  familiar  to  all  who  have  eaten  the  confectionery  product 
called  sugar-plums,  each  of  which  generally  contains  one  of  the  fruits. 
These  properties  depend  on  a  volatile  oil,  which,  however,  is  not  sepa- 
rated for  medicinal  use.  The  fruit  may  be  employed  in  infusion,  and  is 
occasionally  added  to  other  substances  administered  in  this  form.  It 
enters  into  a  number  of  officinal  preparations,  among  which  is  that  excel- 
lent laxative,  the  confection  of  senna.  The  dose  of  powdered  coriander 
is  from  thirty  grains  to  a  drachm.  It  was  known  to  the  ancients,  and 
is  mentioned  in  the  Hebrew  Scriptures. 

3.  ANISE.  —  ANISUM.  U.S. 

Anise  is  the  fruit  of  Pimpinella  Anisum,  a  small  plant,  native  of 
Egypt  and  Syria,  but  introduced  into  the  South  of  Europe,  where,  as 
well  as  in  Germany,  it  is  cultivated  for  use.  Each  fruit,  commonly 
called  seed,  is  about  a  line  long,  oval,  striated,  slightly  downy,  and  of  a 
gray  yellowish-green  colour.  It  usually  has  a  small  footstalk  attached. 
The  smell  and  taste  are  agreeably  aromatic.  Its  virtues  depend  on  a 
volatile  oil,  which,  when  separated  by  distillation,  is  lighter  than  water. 
colourless,  or  yellowish,  and  of  the  odour  and  taste  of  the  seeds.  Anise 
imparts  its  virtues  to  water,  but  more  readily  and  largely  to  alcohol.  It- 
is  much  used  for  imparting  flavour  to  liqueurs.  Its  medical  virtues  are 
VOL.  i. — 22 


338  GENERAL   STIMULANTS.  [PART  II. 

simply  those  of  the  aromatic*  ;  but  it  has  been  supposed  to  increase 
the  flow  of  milk,  of  urine,  and  the  menses.  The  milk  is  said  to  acquire 
the  odour  of  anise  when  it  is  taken  by  nursing  women ;  and  it  has  been 
asserted  to  give  an  unpleasant  smell  to  the  urine.  The  Volatile  Oil 
(OLEUM  ANISI,  U.  S  ,  Br.)  is  more  employed  than  the  fruit  itself.  Dr. 
Ruschenberger,  U.  S.  N.,  discovered  in  it  the  remarkable  property  of  com- 
pletely deodorizing  a  solution  of  tersulphide  of  potassium  (sulphuret  of 
potassa).  A  single  drop  of  the  oil  was  sufficient  to  overcome,  instantly 
and  entirely,  the  offensive  smell  of  twenty  grains  of  the  tersulphide,  dis- 
solved in  two  fluidounces  of  water.  (Am.  J.  of  Med.  Set.,  Oct.  1864,  p. 
419.)  It  is  easy  to  conceive  of  numerous  modes  in  which  this  property  of 
the  oil  may  be  very  usefully  employed.  The  dose  of  the  oil  is  from  five  to 
fifteen  drops.  It  is  an  ingredient  in  several  officinal  preparations,  among 
which  may  be  especially  mentioned  the  Camphorated  Tincture  of  Opium, 
or  common  paregoric  elixir.  A  Water  and  Spirit  were  formerly  officinal 
in  the  London  Pharmacopoeia,  but  they  have  been  omitted  in  the  British. 
Anise  was  used  by  the  ancients.  Poisonous  effects  have  happened  in 
consequence  of  mistaking  the  seeds  of  Conium  maculatum  for  aniseed. 

4.  STAR  ANISEED.  —  ANISUM  STELLATUM. 

This  is  the  fruit  of  Illicium  anisatum,  an  evergreen  tree,  growing  in 
China,  Japan,  and  Tartary.  It  consists  of  from  five  to  ten  brownish 
ligneous  capsules,  four  or  five  lines  long,  each  containing  a  brown  shining 
seed,  and  connected  together  at  one  end,  in  a  star-like  form.  It  has  al- 
most precisely  the  odour  of  anise,  and  yields  by  distillation  a  volatile  oil, 
which  closely  resembles  the  oil  of  anise,  and  is  often  substituted  for  it 
without  inconvenience.  This  is  the  more  singular,  as  there  is  no  botan- 
ical affinity  between  the  two  plants.  Either  the  star  aniseed,  or  its  oil 
may  be  used  for  the  same  purposes  as  fennel-seed. 

5.  DILL.  —  ANETHUM.  /.'/-. 

The  fruit  of  Anethum  graveolens,  or  common  dill-plant,  though  little 
employed  in  this  country,  is  still  considerably  used  in  Great  Britain, 
and  retains  a  place  in  the  Hril  ish  Pharmacopoeia.  The  plant  is  annual  and 
umbelliferous,  belonging  to  the  same  family  as  the  fennel  and  caraway, 
and  producing  a  similar  fruit.  It  is  a  native  of  the  south  of  Europe,  and 
is  cultivated  almost  everywhere  in  gardens.  The  fruits,  commonly,  though 
erroneously,  called  seeds,  are  about. a  line  in  diameter,  and  distinguished 
from  the  other  officinal  fruits  of  this  kind  by  a  yellowish  membranous 
expansion  that  surrounds  them.  They  have  an  aromatic  odour  and  ta-te. 
but  le-s  agreeable  than  those  of  anise,  ejiraway,  or  fennel,  and  have 
consequently  not  been  introduced  into  our  Pharmacopoeia.  These  prop- 
erties they  owe  to  a  volatile  oil,  which  is  separated  by  distillation.  Water 
and  alcohol  extract  their  virtues.  The  Oil  (OLEUM  ANETIII,  ///-.)  and 
a  Distilled  Water  (AQUA  ANETHI,  Br.),  prepared  from  the  fruits,  are  the 


CHAP.  I.]  TONICS. — AROMATICS. — LAVENDER.  339 

forms  in  which  dill  is  most  commonly  used.  It  is  given  for  the  general 
purposes  of  the  aromatics ;  the  fruits  in  the  dose  of  from  a  scruple  to  a 
drachm,  and  the  oil  in  that  of  three  or  four  drops.  Dill  water  is  used 
mainly  as  a  vehicle. 


X.  LAVENDER. 
LAVANDULA.   U.S. 

Origin.  Lavender  consists  of  the  flowers  of  Lavandula  vera,  a  small 
shrub,  growing  wild  in  the  South  of  Europe,  and  cultivated  everywhere 
in  gardens  The  flowers  are  arranged  around  a  terminal  flower-stem, 
forming  long,  slender  spikes.  These  are  cut  at  the  commencement  of 
their  flowering  in  August,  and  tied  in  bundles,  which  are  sold  both  fresh 
and  dried. 

Sensible  Properties.  The  separated  flowers  are  small,  blue,  and  of  a 
remarkably  fragrant  odour,  which  they  retain  long  after  being  dried, 
sometimes  even  for  years.  Their  taste  is  warm,  aromatic  and  bitterish. 
Though  they  yield  their  virtues  in  a  moderate  degree  to  water,  alcohol 
is  a  much  more  efficient  solvent. 

Chief  Constituents.  The  flowers  contain  a  volatile  oil,  a  bitter  prin- 
ciple, and  tannic  acid.  Though  all  of  these  have  some  activity,  the 
virtues  of  the  medicine  depend  mainly  upon  the  volatile  oil.  This  is 
obtained  by  distillation  with  water.  It  is  very  light,  and  of  a  pale  lemon- 
yellow  colour,  with  the  fragrance  of  the  flowers,  and  a  burning  aromatic- 
taste. 

Medical  Properties  and  Uses.  Lavender  has  the  properties  of  the 
arOmatics,  with  a  feeble  tonic  power,  and  probably  a  slight  stimulant  in- 
fluence upon  the  nervous  system.  Its  odour  alone  is  often  refreshing  in 
languor  and  general  uneasiness;  and  it  is  probably  more  employed  in 
reference  to  its  fragrant  properties,  than  internally  as  a  medicine.  Some 
of  its  preparations,  however,  are  in  considerable  vogue. 

The  Volatile  Oil  (OLEUM  LAVANDULA,  U.  S.),  which  is  also  officinal 
in  the  British  Pharmacopoeia,  though  the  flowers  are  not,  may  be  given 
internally  in  nervous  headache  and  languor,  as  well  as  for  its  cordial 
aromatic  properties,  in  the  dose  of  from  one  to  five  drops.  It  is,  how- 
ever, much  more  used  in  the  form  of  alcoholic  solution. 

The  Spirit  of  Lavender  (SrmiTUS  LAVANDUL^E,  U.S.)  is  made,  ac- 
cording to  the  officinal  directions,  by  distilling  alcohol  from  the  flowers; 
but  much  more  commonly  by  simply  dissolving  the  oil  in  alcohol,  in  the 
proportion  of  a  fluidounce  to  a  gallon ;  and  the  latter  mode  of  prepara- 
tion is  recognized  in  the  British  Pharmacopeia.  Made  in  the  former 
method,  it  is  more  agreeably  fragrant.  The  lavender  water  of  the  shops 


340  GENERAL    STIMULANTS.  [PART  II. 

is  usually  a  solution  of  the  oil  of  lavender,  with  some  other  aromatic  oils, 
in  alcohol.  Spirit  of  lavender  is  useful  in  the  sick  room  for  its  grateful 
and  refreshing  odour.  It  may  be  given  internally  for  the  relief  of  nervous 
headache,  languor,  and  depression  of  spirits,  in  the  dose  of  one  or  two 
fluidrachms  ;  but  its  frequent  use  might  lead  to  intemperate  habits,  by 
originating  a  fondness  for  the  alcoholic  ingredient ;  and  it  should  not, 
therefore,  be  incautiously  prescribed.  The  following  is  a  far  more  pop- 
ular preparation. 

The  Compound  Spirit  of  Lavender  (SpiRiius  LAVANDUL^E  COM- 
POSITUS,  U.  S.;  TINCTURA  LAVANDULyE  CoMPOSiTA,  Br.)  is  made,  ac- 
cording to  the  U.  S.  Pharmacopoeia  of  18GO,  by  dissolving  the  oils  of 
lavender  and  rosemary  in  alcohol,  percolating  with  the  solution  a  mix- 
ture of  powdered  cinnamon,  cloves,  nutmegs,  and  red  saunders,  and 
adding,  towards  the  close  of  the  operation,  enough  diluted  alcohol  to 
give  a  certain  measure  to  the  percolated  fluid.  When  duly  prepared, 
it  is  a  delightful  compound  of  the  spices,  of  which  the  laviMidrr  is  not 
the  most  important.  It  is  much  used  in  gastric  uneasiness,  llatulemv, 
colicky  pains,  nausea,  general  languor,  faintness,  depression  of  spirits, 
and  slight  hysterical  disorder.  But  the  same  caution  is  necessary,  in 
prescribing  it,  as  mentioned  in  reference  to  the  preceding  preparation. 
It  is  much  employed  popularly,  under  the  name  of  lavender  com- 
pound, and,  it  is  to  be  feared,  not  unfrequently  when  there  is  no  real  oc- 
casion. It  is  one  of  the  best  additions  to  mixtures,  in  order  to  recom- 
mend them  to  the  taste  and  the  stomach.  Its  red  colour  is  sometimes  of 
advantage,  in  otherwise  colourless  preparations,  as  in  the  solution  of 
arsenite  of  potassa  or  Fowler's  solution,  by  preventing  their  being  mis- 
taken  for  water.  The  dose  is  from  thirty  minims  to  a  fluidradun. 


XI.  ROSEMARY. 
ROSMARINUS.  U.S. 

Origin.  This  consists  of  the  tops  of  Roxm&tznus  officinalis,  an  ever- 
green shrub,  inhabiting  the  shores  of  the  Mediterranean,  and  cultivated 
in  the  gardens  of  Europe  and  this  country.  As  found  in  our  shops,  it 
consists  chiefly  of  the  leaves. 

Sensible  Properties.  The  leaves  are  distinguished  by  their  linear 
shape,  their  length  of  an  inch  and  more,  their  breadth  about  one-six! h 
of  an  inch,  the  faded  greenness  of  their  upper  and  the  whiteness  of  their 
under  surface,  and  by  a  singular  folding  backward  of  both  edges,  which 
causes  the  colour  of  their  under  surface  to  be  concealed  on  each  side  by 
a  green  border,  leaving  only  a  slender  streak  of  whiteness  in  the  middle. 
They  have  a  balsamic  odour,  and  a  bitterish  a  nd  camphorous  taste,  and  yield 
these  properties  to  water  and  alcohol,  but  much  more  freely  to  the  latter. 


CHAP.  I.]  TONICS. — AROMATICS. — PEPPERMINT.  341 

Active  Principles.  Rosemary  owes  its  virtues  to  a  volatile  oil,  which 
is  obtained  by  distillation  with  water.  It  is  lighter  than  water,  colourless, 
of  an  odour  similar  to  that  of  the  plant,  but  less  agreeable,  and  a  hot  some- 
what aromatic  taste. 

Medical  Properties  and  Uses.  Rosemary,  though  in  some  degree 
aromatic,  is  more  characterized  by  its  stimulant  and  rubefacieut  prop- 
erties. It  agrees,  however,  with  the  aromatics,  in  being  proportionably 
more  stimulating  locally,  than  upon  the  system  at  large.  Some  have  be- 
lieved it  to  possess  ernmenagogue  properties;  but  when  it  has  appeared 
to  promote  the  menstrual  discharge,  it  has  probably  been  simply  as  a 
general  stimulant.  In  this  country  it  is  seldom  used  internally,  except  as 
an  ingredient  in  some  officinal  preparation,  as  the  compound  spirit  of 
lavender.  The  Volatile  Oil  (OLEUM  ROSMARINI,  U.  S.,  Br.}  is  recognized 
in  both  the  U.  S.  and  Br.  Pharmacopoeias,  though  the  leaves,  from  which 
it  is  procured,  are  rejected  by  the  latter.  It  may  be  given  as  a  carmina- 
tive, or  gastric  stimulant,  in  the  dose  of  from  three  to  six  drops.  The 
Spirit  (SPIRITUS  ROSMARINI,  Br.)  is  made  by  dissolving  the  oil  in  alco- 
hol, and  is  used  almost  exclusively  either  as  a  perfume,  an  ingredient  in 
rubefacient  liniments,  or  as  one  of  the  constituents  of  the  compound 
spirit  of  lavender. 


XII.  PEPPERMINT. 
MENTHA  PIPERITA.  U.  S. 

Origin.  Peppermint  is  the  herb  of  Meniha  piperita,  a  small,  herba- 
ceous perennial,  indigenous  in  Europe,  but  naturalized  in  this  country, 
and  cultivated  largely  in  England  and  the  United  States.  The  herb 
should  be  gathered  at  the  flowering  period  in  August. 

Sensible  Properties.  Peppermint  has  a  quadrangular  stem,  branching 
near  the  top,  from  one  to  two  feet  long,  with  leaves  opposite,  petiolate, 
ovate,  serrate,  pointed,  dark-green  on  the  upper  surface,  and  paler  on 
the  under.  The  flowers  are  small,  purple,  and  arranged  in  terminal 
spikes,  which  are  rounded  at  top,  and  interrupted  beneath.  All  parts 
of  the  plants  are  aromatic,  either  fresh  or  dried;  but  the  herb  rapidly 
deteriorates  by  keeping,  and  at  length  becomes  inert.  It  has  a  pene- 
trating, grateful,  somewhat  camphorous  odour,  and  a  pungent,  glowing, 
camphor ou a,  bitterish  taste,  which  is  followed  by  a  sense  of  coolness 
when  the  air  is  drawn  through  the  mouth. 

Active  Principles.  The  virtues  of  the  herb  may  be  said  to  depend 
exclusively  on  its  volatile  oil ;  for,  though  there  is  a  trace  of  tannic  acid, 
and  probably  a  small  proportion  of  some  bitter  principle,  these  are  in- 
sufficient materially  to  modify  its  effects.  The  volatile  oil  is  obtained  by 


342  GENERAL    STIMULANTS.  [PART  II. 

distillation  with  water.  It  is  at  first  nearly  colourless,  but  gradually  be- 
comes greenish-yellow,  and  ultimately  reddish-brown.  Its  odour  and 
taste  are  like  those  of  the  herb.  It  is  lighter  than  water.  It  is  often 
adulterated^especially  with  alcohol,  which,  if  in  considerable  quantity, 
may  be  readily  detected  by  agitation  with  water,  which  abstracts  the 
alcohol  from  the  oil,  and  thus  diminishes  its  bulk. 

Medical  Properties  and  Uses.  Peppermint  has  all  the  characteristic 
properties  of  the  aromatics,  and  may  be  used  for  all  their  general  pur- 
poses (see  page  315).  The  fresh  herb  is  sometimes  applied  externally,' 
well  bruised,  over  the  stomach  and  bowels,  in  infantile  vomiting  and 
colic.  It  is  a  good  remedy,  thus  employed,  in  the  earlier  stages  of 
cholera  infantum.  Internally  the  medicine  may  be  given,  in  the  form  of 
infusion,  in  colicky  pains  and  flatulence;  but  the  preparation  almost 
universally  employed  in  this  way  is  the  volatile  oil. 

The  Infusion,  made  in  the  proportion  of  half  an  ounce  to  a  pint,  may 
be  given  in  doses  of  a  wineglassful. 

The  Oil  (OLEUM  MENTH^E  PIPERI-T^E,  U.  S.,  Br.)  is  very  much  used 
in  this  country,  being  almost  universally  preferred  to  the  herb  for  ob- 
taining the  effects  of  the  medicine  by  internal  exhibition.  It  is  recog- 
nized in  the  British  Pharmacopoeia,  and  directed  to  be  prepared  by  dis- 
tillation of  the  herb;  though  the  herb  itself  is  not  among  its  officinals. 
The  dose  of  it  is  from  one  to  three  drops,  which  may  be  prepared  for 
administration  by  first  rubbing  it  with  a  little  loaf  sugar,  and  then  mix- 
ing with  water.  In  consequence,  however,  of  its  extreme  pungency,  the 
oil  is  usually  given  dissolved  in  water  or  alcohol,  in  one  of  the  following 
preparations. 

Spirit  of  Peppermint  (SPIRITUS  MENTII^  PIPERIT.E,  U.  S.,  Br.; 
TINCTURA  OLEI  M  ENTILE  PIPERIT/E,  U.  S.  1850)  or  essence  of  pepper- 
mint, as  the  preparation  is  generally  called,  is  made  by  dissolving  a 
fluidounce  of  the  oil  in  fifteen  fluidounces  of  stronger  alcohol,  and  after- 
wards macerating  with  the  solution,  for  twenty-four  hours,  two  drachms 
of  the  powdered  leaves,  which  are  separated  by  filtration.  In  the  British 
process  the  oil  is  simply  dissolved  in  the  alcohol.  The  spirit  is  of  such 
a  strength  as  to  admit  of  being  taken  into  the  mouth,  simply  dropped 
on  a  piece  of  sugar.  It  is  a  very  popular  preparation,  and  often  used 
for  the  relief  of  nausea,  gastric  pains,  colic,  and  flatulence.  The  dose  is 
from  ten  to  twenty  drops.  It  may  be  given  as  above  stated,  simply 
dropped  on  a  piece  of  sugar,  or  diffused  by  means  of  sugar  in  water. 

Peppermint  Water  (AQUA  MENTH.E  PIPERIT^E,  U.  S.),  formerly  pre- 
pared exclusively  by  distilling  water  from  the  fresh  herb,  is  now  made 
by  simply  dissolving  the  oil  in  water,  through  the  intervention  of  Car- 
bonate of  magnesia.  The  present  U.  S.  Pharmacopoeia,  however,  admits 
distillation  from  the  herb  as  an  alternative  process.  Peppermint  water 
is  probably  more  used  in  this  country  as  a  vehicle  for  substances  given 


CHAP.  I.]  TONICS. — AROMATICS. — SPEARMINT.  343 

in  the  form  of  mixture,  than  any  other  aromatic  preparation.  It  serves 
to  render  the  mixture  more  acceptable  both  to  the  palate  and  stomach, 
and  to  obviate  griping.  Each  fluidounce  of  it  contains  about  a  minim 
of  the  oil.  It  may  be  given  internally,  for  the  ordinary  purposes  of  the 
medicine,  in  the  dose  of  from  one  to  three  fluidounces. 

Peppermint  Lozenges  (TROcinsci  MENTIIJE  PIPERIT^E,  U.  £),  con- 
sisting of  the  oil,  sugar,  and  mucilage  of  tragacanth,  afford  a  convenient 
form  of  the  medicine  for  slight  cases ;  as  they  may  be  carried  in  the 
pocket,  and  one  of  them  taken  as  required.  They  are  to  be  allowed 
slowly  to  dissolve  in  the  mouth.  They  are,  however,  very  feeble;  ten 
of  them  being  scarcely  equivalent  to  a  minim  of  the  oil. 


XIII.  SPEARMINT. 
MENTHA  VIRIDIS.  U.  S. 

This  is  the  herb  of  Me.ntha  viridis,  an  herbaceous  perennial  plant,  like 
the  above  species  a  native  of  Europe,  and  naturalized  in  this  country, 
where  it  is  also  cultivated  for  use. 

The  herb  differs  from  peppermint  in  having  lanceolate,  nearly  sessile, 
and  lighter-coloured  leaves,  and  elongated,  pointed  spikes  of  flowers, 
whence  the  name  of  spearmint  was  derived.  The  brighter  greenness  of 
the  leaves  probably  gave  origin  to  the  specific  name  of  viridis  or  green. 
The  plant  is  often  called  simply  mint ;  and,  when  that  term  is  used  with- 
out a  qualifying  epithet,  it  may  be  understood  as  applied  to  the  present 
species.  Its  smell  and  taste  are  analogous  to  those  of  peppermint,  but 
peculiar,  and  by  some  preferred.  Others,  however,  and  probably  the 
greater  number,  give  precedence  to  the  mentha  piperita. 

The  active  principle  is  the  volatile  oil ;  though,  as  in  peppermint,  there 
is  a  small  proportion  of  tannic  acid  and  of  a  bitter  principle.  The  oil 
closely  resembles  that  of  the  other  species. 

The  same  resemblance  extends  to  the  medical  properties  and  uses  of 
the  two  mints;  but  the  spearmint  is  thought  to  be  somewhat  the  weaker. 
The  same  preparations  are  used,  and  in  about  the  same  doses.  Those  of 
spearmint  recognized  by  the  U.  S.  Pharmacopoeia,  are  the  Volatile  Oil 
(OLEUM  MENTELE  VIRIDIS,  U.  S.),  of  which  the  dose  is  from  two  to  six 
drops;  the  Spirit  or  Essence  of  Spearmint  (SPIRITUS  MENTHA  VI- 
RIDIS, U.  S.;  TINCTURA  OLEI  MENTIS  VIRIDIS,  U.  S.  1850),  of  which 
from  twenty  to  forty  drops  may  be  given;  and  Spearmint  Water  (A QUA 
MENTHA  VIRIDIS,  U.S.,  Br.),  made  and  used  in  the  same  manner  as  the 
corresponding  preparation  of  peppermint.  An  infusion  of  spearmint 
was  formerly  directed  by  the  Dublin  College,  made  in  the  proportion  of 
about  half  an  ounce  of  the  herb  to  a  pint  of  water.  Though  abandoned 


344                                            GENERAL    STIMULANTS.  [PART  II. 

in  the  British  Pharmacopoeia,  it  may  nevertheless  be  useful,  when  the 

oil  is  not  at  hand.     It  may  be  given  without  special  limitation  of  the 
dose. 


There  are  several  aroniatics  of  minor  importance,  consisting  of  the 
herb  or  leaves  of  plants,  which,  though  not  extensively  used,  are  yet 
sufficiently  so  to  require  a  brief  notice,  and  may,  perhaps,  be  best  intro- 
duced in  a  subordinate  position  here. 

1.  EUROPEAN  PENNYROYAL.  —  PULEGIUM. 

This  formerly  held  a  place  in  all  the  three  Pharmacopoeias  of  Great 
Britain  and  Ireland,  but  has  been  discarded  in  the  British.  It  is,  there- 
fore, no  longer  officinal;  but  merits  a  brief  notice  in  consequence  of 
its  former  position.  It  is  the  herb  of  Mentha  Pulegium,  a  European 
plant,  having  properties  analogous  to  the  mints  above  described,  though 
less  agreeable  as  an  aromatic,  and  much  less  employed.  It  is  used  con- 
siderably in  England  as  a  domestic  remedy  in  amenorrhcea,  hysteria,  and 
hooping-cough.  In  this  country  it  is  unknown.  All  the  British  Colleges 
formerly  directed  the  Volatile  Oil  (OLEUM  MENTH^;  PULEGII),  and  Pen- 
nyroyal Water  (AQUA  MENTH^E  PULEGII);  the  Dublin  College,  an 
Essence  (ESSENTIA  MENTHJE  PULEGII);  and  the  London  a  Spirit  (SriR- 
ITUS  MENTH^E  PULEGII)  ;  all  of  which  were  given  for  similar  purposes, 
and  in  the  same  doses  as  the  analogous  preparations  of  peppermint. 

2.  AMERICAN  PENNYROYAL.  — HEDEOMA.  U.S. 

This  is  the  herb  of  Hedeoma  pulegioides,  a  small  indigenous  annual, 
growing  in  all  parts  of  the  United  States,  usually  preferring  dry,  sterile, 
or  impoverished  fields,  and  sometimes,  from  its  abundance,  scenting  the 
air  for  a  considerable  distance.  Both  fresh  and  dried,  it  has  an  agreea- 
ble aromatic  odour,  resembling  somewhat  the  European  pennyroyal  from 
which  it  derived  its  name,  and  a  warm,  pungent,  camphorous  taste. 
These  properties  reside  in  a  volatile  oil,  which  may  be  separated  by 
distillation.  The  oil  is  lighter  than  water,  of  a  light  pale-yellow  colour, 
and  a  smell  and  taste  similar  to  those  of  the  plant.  The  herb  imparts 
its  virtues  to  hot  water,  but  more  freely  to  alcohol. 

The  effects  of  hedeoma  upon  the  system  are  very  analogous  to  those  of 
the  mints;  and,  like  these.it  may  be  used  to  correct  nausea,  relieve 
flatulent  pains,  and  cover  the  taste  or  correct  the  action  of  other  medi- 
cines. When  given  in  the  form  of  hot  infusion,  in  large  draughts,  it 
often,  like  most  other  aromatic  herbs,  produces  perspiration,  and  pro- 
motes the  flow  of  the  menses.  Hence,  it  is  considerably  employed,  in 
domestic  practice,  in  commencing  catarrh  and  rheumatism,  and  to  pro- 
mote menstruation;  the  feet  being  at  the  same  time  well  soaked  in  hot 
water,  and  the  patient  covered  warmly  in  bed.  There  is  no  doubt  that 


CIIAP.  I.]  TONICS. — AROMATICS. — ORIGANUM.  345 

the  remedy,  thus  aided,  is  not  unfrequently  successful.  As  an  emmena- 
gogue  it  is  most  efficient  in  recent  cases,  and  given  at  the  regular 
monthly  period,  when  it  conies  in  aid  of  the  tendencies  of  the  system. 
It  has  little  effect  in  obstinate  cases.  It  has  been  used  also,  like  the 
European  herb  of  the  same  name,  in  hysteria  and  hooping-cough.  The 
Infusion  may  be  made  in  the  proportion  of  half  an  ounce  to  the  pint, 
and  given  in  doses  of  from  two  to  four  fluidounces  or  more.  The  Vola- 
tile Oil  (OLEUM  HEDEOM^;,  U.  S.)  is  officinal,  and  may  be  employed 
with  the  same  objects  as  the  infusion,  in  the  dose  of  from  two  to  ten 
drops.  It  is  sometimes  used  externally  as  a  rubefacient.  A  water  and 
spirit  or  essence  of  pennyroyal  may  be  prepared  from  the  oil,  in  the 
same  manner  as  the  similar  preparations  of  the  mints,  and  used  in  the 
same  way. 

3.  HORSEMINT.  — MONARDA.  U.S. 

Horsemint  is  the  herb  of  Monarda  punctata,  an  indigenous  herbaceous 
plant,  a  foot  or  two  high,  growing  preferably  in  light  and  gravelly  soils, 
from  New  Jersey  to  the  Gulf  of  Mexico.  Its  odour  is  aromatic,  its  taste 
warm,  pungent,  and  bitterish.  These  properties  depend  on  a  volatile 
oil,  which  is  obtained  by  distillation,  is  of  a  reddish-amber  colour,  an 
odour  similar  to  that  of  the  plant,  and  a  hot,  very  pungent  taste.  Hot 
water  will  extract  the  virtues  of  the  herb,  but  alcohol  is  a  better  solvent, 

Horsemint  has  the  aromatic  properties  of  the  proper  mints,  but  is 
more  stimulating  and  less  agreeable.  It  may  be  used  as  an  antiemetic 
and  carminative,  and  as  a  stimulant  to  the  stomach  in  languid  states  of 
that  organ;  but  is  little  employed  in  regular  practice.  An  infusion 
may  be  made  in  the  proportion  of  half  an  ounce  to  the  pint,  and  given 
in  wineglassful  doses.  Drank  warm  and  freely,  it  will  often  induce  per- 
spiration, and  has  been  thought  to  act  as  an  emmcnagogue ;  and,  taken 
cold,  it  has  been  supposed  t6  stimulate  the  kidneys.  Hence  it  has  been 
used  in  suppression  of  the  menses,  and  of  the  urine. 

The  Volatile  Oil  (OLEUM  MONAKDJE,  U.S.)  is  more  used.  It  may  be 
given  as  a  stimulant  and  carminative  in  the  dose  of  two  or  three  drops, 
mixed  with  suirar  and  water;  but  it  has  attracted  more  attention  as  an 
active  rubefacient.  Applied  to  the  skin,  it  causes  redness,  heat,  and  pain, 
and  sometimes  blisters.  In  cases  not  demanding  a  powerful  and  speedy 
impression,  it  should  be  diluted  with  olive  oil  before  application. 

4.  COMMON  MARJORAM.  — ORIGAMM.  U.S.  1850. 

This  has  been  discarded  both  in  the  U.  S.  and  British  Pharmacopeias, 
and  is  no  longer  officinal.  It  is  the  herb  of  Origanum  vulgare  or  com- 
mon marjoram,  a  perennial,  herbaceous  plant,  growing  wild  both  in 
Europe  and  the  United  States,  and  in  this  country  found  especially  by 
the  roadsides,  from  Pennsylvania  to  Virginia.  It  bears  a  rather  con- 
spicuous summit  of  pinkish -purple,  or  rose-coloured  flowers,  which  ap- 


346  GENERAL   STIMULANTS.  [PART  II. 

pear  during  summer  and  early  part  of  autumn.  The  herb  has  an  agrec- 
able  aromatic  odour,  and  a  warm  pungent  taste.  For  these  properties 
it  depends  on  a  volatile  oil,  which  is  separated  by  distillation,  and  for 
which  alone  the  plant  was  recognized  as  officinal.  The  oil  as  first 
prepared  is  yellow,  but  becomes  reddish  by  age,  and  is  said  to  acquire 
the  same  colour  when  over-heated  in  distillation  ;  but  it  may  be  obtained 
colourless  by  rectification.  It  is  lighter  than  water,  has  the  odour  of  the 
plant,  and  a  hot  acrid  taste. 

Origanum  is  a  stimulating  aromatic,  and  will  answer  the  same  pur- 
poses as  the  mints ;  but,  being  less  agreeable  to  the  taste,  and  probably 
less  cordial  in  its  influence  on  the  stomach,  is  little  used.  Like  penny- 
royal and  horsemint,  it  has  been  supposed  to  be  diaphoretic  and  emmena- 
gogue;  but,  like  them,  probably  acts  in  this  way  simply  as  a  general 
stimulant,  and  when  aided  with  suitable  accompaniments,  such  as  hot 
water  in  the  form  of  infusion,  and  hot  pediluvia.  The  oil  is  a  powerful 
local  irritant,  and  is  sometimes  employed  as  such  externally,  either  alone 
or  in  connection  with  other  medicines.  Diluted  with  olive  oil,  it  is  used 
as  a  liniment  in  baldness,  rheumatism,  sprains,  bruises,  and  paralytic 
affections.  Occasionally  it  is  employed  to  relieve  toothache,  being  in- 
troduced on  lint  or  cotton  into  the  carious  hollow,  lit  was  an  ingredient 
in  the  discarded  Camphorated  Soap  Liniment  of  former  editions  of  our 
Pharmacopoeia,  so  much  employed,  under  the  common  name  of  opodel- 
doc, as  an  anodyne  and  gently  rubefacient  application. 

Sweet  Marjoram  (Origanum  Mojorana)  has  been  used,  in  powder,  as 
an  errhine,  but  has  lost  its  place  in  the  officinal  lists,  and  is  now  seldom 
employed  except  as  a  spice  in  cooking. 

5.  THYME.  —  THYMUS. 

Thyme  is  the  herbaceous  part  of  Thymus  vulgaris,  a  small  under- 
shrub,  growing  wild  in  the  South  of  Europe,  and  cultivated  in  our  gar- 
dens. It  has  a  characteristic,  strong,  agreeable  odour,  which  it  retains 
when  dried,  and  a  pungent,  aromatic  camphorous  taste.  These  properties 
reside  in  a  volatile  oil  (OLEUM  THYMI,  U.  &.),  which  is  obtained,  in  the 
native  districts  of  the  plant,  by  distillation,  and  is  said  to  bo  srnt  into 
commerce  largely,  under  the  name  of  oil  of  origanum,  by  which  it  is 
often  sold  in  the  shops.  Indeed,  so  commonly  was  it  substituted  for  the 
oil  of  origanum,  that  the  U.  S.  Pharmacopoeia,  discarVng  entirely  both 
the  origanum  and  its  oil,  have  adopted  the  oil  of  commerce  with  the 
name  of  oil  of  thyme,  without,  however,  recognizing  the  plant  itself  in  its 
officinal  lists.  It  is  lighter  than  water,  and  has  at  first  a  pale- yellow  or 
greenish-yellow  colour,  which  it  gradually  exchanges  for  a  reddish-brown. 
As  found  in  our  shops,  it  is  usually  of  a  red  colour,  which  is  asserted 
to  be  that  of  the  oil  at  the  first  distillation ;  the  colourless  oil  being  ob- 
tained by  redistilling  the  red.  I  suspect,  however,  that,  as  just  stated, 
the  redness  is  the  result  of  exposure,  as  in  the  case  of  so  many  other 


CHAP.  I.]  TONICS. — AROMATICS. — SAGE. — BALM.  347 

volatile  oils.     Thyme  has  the  medicinal  properties  of  the  aromatics,  but 
is  much  more  used  in  cooking  than  in  medicine. 

6.  SAGE — SALVIA.  U.S. 

Sage  consists  of  the  leaves  of  Salvia  officinalis,  or  common  garden 
sage,  an  undershrub  of  two  feet  or  more  in  height,  originally  from  the 
South  of  Europe,  but  cultivated  everywhere  in  gardens.  They  have  a 
strong  fragrant  odour,  and  a  warm,  bitterish,  aromatic,  and  somewhat 
astringent  taste.  They  contain  tannic  acid,  and  probably  a  bitter  prin- 
ciple; but  their  virtues  depend  mainly  on  a  volatile  oil,  which  exists  in 
them  in  large  proportion. 

The  virtues  of  sage  are  those  of  a  gentle  tonic  and  astringent,  and  an 
efficient  aromatic.  In  addition  to  its  excitant  influence  upon  the  digestive 
organs  and  the  circulation,  it  has  been  supposed  also  to  stimulate  the 
nervous  and  genital  systems,  and,  when  suitably  aided,  no  doubt  pro- 
motes perspiration.  By  the  ancients  it  was  very  highly  esteemed,  and 
retained  its  credit  as  a  remedy  among  the  earlier  modern  Europeans,  as 
evinced  by  the  dictum  of  the  school  of  Salerno,  "  Cur  moriatur  homo 
cui  Salvia  crescit  in  horfo."  It  was  used  as  a  stimulant  tonic  in  weak- 
ness of  digestion  and  general  debility,  as  an  astringent  in  checking  pro- 
fuse sweats  and  excessive  lacteal  secretion,  as  a  febrifuge  in  paroxysmal 
fevers,  as  a  diaphoretic  in  catarrh,  and  as  an  antispasmodic  in  various 
nervous  affections.  From  these  over-estimates  of  its  virtues,  it  has  fallen 
into  probably  unmerited  disrepute,  and  has  been  abandoned  by  the 
British  authorities,  thgugh  retained  in  our  own  Pharmacopoeia.  It  may 
be  used  with  advantage  as  an  antiemetic,  carminative,  and  gentle  stimu- 
lant to  the  stomach  and  bowels,  especially  when  there  is  enfeebled 
digestion,  with  a  tendency  to  diarrhoeaN  But  the  chief  use  now  made  of 
it  medicinally  is  as  a  gargle  in  common  sore-throat,  and  relaxation  of  the 
uvula,  for  which  purpose  it  is  employed  in  the  form  of  infusion,  and  often 
associated  with  honey,  and  alum  or  vinegar.  It  is  much  used  as  a  con- 
diment in  cookery,  especially  in  the  filling  of  roasted  poultry,  and  in 
sausages.  As  a  gargle,  and  when  all  its  effects  on  the  system  are  de- 
manded, the  infusion  should  be  prepared  by  macerating  an  ounce  of  the 
leaves  in  a  pint  of  boiling  water,  and  the  maceration  continued  till  it 
cools.  Two  fluidounces  may  be  given  for  a  dose.  When  wanted  to 
relieve  nausea,  or  as  an  agreeable  drink  in  febrile  affections,  the  propor- 
tion of  sage  should  be  lessened,  and  the  maceration  shortened,  so  that 
the  whole  of  the  bitterness  may  not  be  extracted.  The  officinal  Infusion 
(INFUSUM  SALVING,  U.  S.)  is  made  with  half  an  ounce  to  the  pint. 

7.  BALM.  — MELISSA.  U.  S. 

Balm  is  the  herb  of  Melissa  officinalis,  a  perennial  herbaceous  plant, 
a  foot  or  two  in  height,  originally  from  the  South  of  Europe,  but  natural- 
ized in  this  country,  and  cultivated  in  our  gardens.  The  leaves  have, 


348  GENERAL   STIMULANTS.  [PART  II. 

when  fresh,  a  very  agreeable  lemon-like-  odour,  which  is  nearly  lost  when 
they  are  dried,  and  entirely  when  they  are  long  kept.  In  the  recent 
state,  they  have  a  feebly  aromatic  and  somewhat  austere  taste ;  in  the 
dried,  impart  a  slight  degree  of  roughness  to  water.  The  fresh  herb 
contains  a  little  volatile  oil,  tannic  acid,  and  bitter  matter.  Water  ex- 
tracts all  its  virtues.  Upon  the  system  it  exerts  but  a  very  feeble  influ- 
ence ;  and  it  is  chiefly  employed,  in  the  form  of  infusion,  as  an  agreeable 
drink  in  fevers,  and,  taken  warm,  to  promote  the  operation  of  diapho- 
retics. The  infusion  may  be  made  with  half  an  ounce  or  an  ounce  of 
the  herb,  to  the  pint  of  water.  The  fresh  or  recently  dried  herb  should 
be  preferred. 


XIV.  PARTRIDGE-BERRY. 
GAULTHERIA.  U.  S. 

Origin.  Gaultheria  consists  of  the  leaves  of  Gaultheria  procum- 
bens,  an  indigenous,  small,  shrubby  evergreen,  inhabiting  the  woods  or 
hill-sides,  and  dry  sandy  plains,  from  Canada  to  Georgia.  It  has  a 
creeping,  horizontal  root,  from  which,  at  short  intervals,  erect  stems 
arise,  a  few  inches  high,  bearing  the  leaves  near  the  summit,  and  a  small 
spherical,  scarlet,  berry-like  fruit.  The  plant  is  known  by  other  names, 
as  tea-berry,  mountain-tea,  winter-green,  etc. 

Sensible  Properties.  The  leaves,  which  are  the  officinal  part,  are 
ovate  or  obovate,  an  inch  or  more  in  length,  acute,  revolute  at  the  edges, 
with  a  few  mucronate  gerratares,  coriaceous,  shining,  of  a  bright-green 
colour  on  the  upper  surface,  and  paler  beneath.  These,  as  well  as  the 
whole  plant,  including  the  fruit,  have  a  peculiar  fragrant  odour  and  aro- 
matic taste,  very  similar  to  that  of  the  Betula  lenta  or  sweet-birch,  and 
ascribable  to  a  volatile  oil,  which  is  the  same  in  both  plants,  and  exists 
also  in  some  others  having  similar  sensible  properties.  Besides  their 
aromatic  properties,  the  leaves  have  a  decided  astringency,  and  the  fruit 
is  sweet. 

Active  Principle.  The  volatile  oil  is  obtained  by  distillation  with 
water.  It  is  the  heaviest  of  all  known  volatile  oils,  having  the  specilic 
gravity  1.173.  When  first  procured,  it  is  nearly  colourless;  but  as 
found  in  the  shops,  is  generally  brownish-yellow  or  reddish.  Tin- 
odour  is  that  of  the  plant,  the  taste  sweetish,  somewhat  pungent,  and 
very  peculiar. 

Mi  ilical  Properties  and  Uses.  Gaultheria  is  a  gently  stimulant  aro- 
matic, and  feeble  astringent.  For  these  properties,  it  has  been  used  in 
some  cases  of  chronic  diarrhoea,  and  with  supposed  benefit.  Like  many 
other  aromatics,  it  has  been  given  as  an  emmenagoguc  ;  but  has  no  other 


CHAP.  I.]  TONICS. — AROMATICS. — GINGER. 

claim  to  this  title  than  such  as  its  gently  stimulating  property  may  give 
it.  As  a  stomachic  cordial  and  carminative,  and  for  the  relief  of  the 
flatulent  colic  of  infants,  it  may  be  used  like  other  aroma'tics,  over  which, 
however,  it  has  no  superiority.  It  has  been  sometimes  used  by  people 
in  the  country,  in  the  form  of  infusion,  as  a  substitute  for  common  tea. 
Its  chief  claim  to  notice,  however,  rests  on  its  remarkable,  and  very  pecu- 
liar flavour,  which  serves  to  characterize  preparations,  into  the  composi- 
tion of  which  either  the  leaves  or  the  volatile  oil  enter. 

The  Oil  (OLEUM  GAULTHERI^E,  U.  S.)  is  more  or  less  employed 
throughout  the  country,  dissolved  in  alcohol  in  the  form  of  an  essence, 
for  the  same  purposes  as  the  oils  of  the  mints.  It  may  be  prepared  in 
the  same  way,  and  given  in  the  same  dose,  as  the  essence  of  spearmint. 
In  large  quantities,  the  oil  is  capable  of  producing  inflammation  of  the 
gastric  mucous  membrane.  A  case  is  on  record  in  which  half  an  ounce 
was  swallowed,  and  occasioned  the  most  alarming  gastric  symptoms, 
though  the  patient  recovered.  In  the  quantity  of  about  a  fluidounce.  it 
is  stated  to  have  caused  death  in  several  instances,  leaving  strong  marks 
of  inflammation  of  the  stomach.  The  oil  is  an  ingredient  of  the  Com- 
pound Syrup  of  Sarsaparilla  of  the  U.  S.  Pharmacopeia. 


XV.  GINGER, 
Z1NGIBER.    U.S.,  fir. 

Origin.  Ginger  is  the  root  or  rhizome  of  Zingiber  officinale,  a  bien- 
nial or  perennial  plant,  two  or  three  feet  in  height,  a  native  of  Hindos- 
tan,  and  cultivated  in  various  parts  of  the  East  Indies,  in  the  West 
Indies,  and  at  Sierra  Leone  in  Africa. 

Varieties  and  Sensible  Properties.  Ginger  comes  in  several  different 
states.  Sometimes  it  is  imported  fresh,  and  is  then  called  recent  ginger. 
As  ordinarily  used  in  medicine,  it  is  in  two  states;  in  one  with  the  epi- 
dermis remaining  more  or  less  completely,  and  prepared  simply  by  expo- 
sure to  the  action  of  boiling  water,  so  as  to  destroy  the  life  of  the  root, 
and  prevent  germination  ;  in  the  other,  wholly  deprived  of  the  epidermis, 
and  often  whitened  by  a  bleaching  process.  The  former  is  called  black 
ginger,  or  is  designated  by  the  places  from  which  it  is  derived  ;  the  latter 
is  named  ichite  ginger,  and  often  Jamaica  ginger,  from  the  island  of 
that  name,  whence  this  variety  was  first  brought  into  commerce.  Gin- 
ger is  also  imported  in  the  form  of  a  preserve  ;  the  tender  young  oil'.-ets 
from  the  old  roots  being  selected  for  its  preparation 

Recent  ginger  is  tlattish,  about  three  inches  long,  with  short  obtuse 
branches  or  lobes,  on  the  surface  of  a  light  ash  colour,  internally  fleshy 


350  GENERAL    STIMULANTS.  [PART  IT. 

and  yellowish-white.     It  will  keep  for  a  considerable  time,  but  is  apt  to 
germinate  in  warm  weather. 

Black  or  coaled  ginger  is  somewhat  shrunk  in  drying,  with  a  darkish, 
ash-coloured,  wrinkled  epidermis,  which  in  some  specimens  is  absent  in 
spots,  where  the  surface  is  blackish  from  exposure,  and  has  thus  given 
name  to  the  variety.  Beneath  the  epidermis  is  a  brownish  and  some- 
what horny  layer ;  but  the  central  portion  is  whitish  and  farinaceous. 
The  powder  is  of  a  light  yellowish-brown  colour. 

White  or  Jamaica  ginger  is  wholly  destitute  of  epidermis,  more  slender 
and  rounder  than  the  preceding,  white  externally,  internally  also  whitish, 
and  yielding  a  white  or  yellowish-white  powder.  Much  of  this  variety 
is  now  imported  from  the  East  Indies;  but,  as  obtained  from  this  source, 
it  is  not  so  white  as  that  from  Jamaica. 

The  odour  of  ginger  is  aromatic  and  penetrating;  its  taste  hot,  pun- 
gent, biting,  and  aromatic.  It  yields  its  virtues  to  water  and  alcohol ; 
but  more  completely  and  largely  to  the  latter. 

It  is  apt  to  be  injured  by  worms,  when  long  kept. 

Chief  Constituents.  The  active  principles  of  ginger  appear  to  be  a 
volatile  oil,  and  a  resino- extractive  mailer ;  the  flavour  probably  resid- 
ing in  the  former,  and  the  active  properties  mainly  in  the  latter.  There 
is  also  a  considerable  proportion  of  starch  and  gum,  which  render  cer- 
tain precautions  essential  in  preparing  the  syrup. 

Medical  Properties  and  Uses.  Ginger  was  employed  by  the  ancients. 
It  is  a  very  grateful  stomachic  stimulant,  having  some  incitant  efl'ect 
also  on  the  circulation,  and  is  one  of  the  most  useful  of  the  an>matic8. 
In  pure  dyspepsia  it  is  often  used  with  much  benefit,  either  alone  or  in 
combination;  and,  when  added  to  tonics,  in  this  affection,  it  rcndeiv 
them  111  once  more  acceptable  and  efficient.  In  the  feeble  condition  of 
the  digestive  organs  attendant  on  atonic  gout,  it  is  also  an  excellent  ad- 
juvant to  other  measures.  It  is  one  of  the  best  carminatives;  and.  in 
the  form  of  hot  infusion,  is  much  employed  in  simple  spasmodic  or 
flatulent  colic,  especially  in  children.  As  a  preventive  of  cholera,  its 
cordial  influence  upon  the  digestive  organs  renders  it  piTiiliarly  appro- 
priate; and,  in  the  epidemics  of  this  complaint,  it  has  been  among  the 
prophylactic  medicines  most  relied  on.  It  is  very  frequently  used  in 
connection  with  tonics  and  purgatives;  with  the  former,  to  inch 
their  stimulant  effect;  with  the  latter,  to  obviate  griping;  and  with  both, 
to  cover  their  taste,  and  mitigate  or  prevent  their  nauseating  effects.  It 
is  also  much  employed  as  a  condiment  in  cookery. 

Locally,  ginger  is  actively  irritant.  When  chewed,  it  produces  a 
burning  and  painful  sensation  in  the  month,  and  increases  the  flow  of 
saliva.  Jlence  it  is  -nnetimes  employed  as  a  masticatory  in  toothache, 
rheumatic  affections  of  the  jaws  or  neighbouring  parts,  relaxation  of  the 
uvula,  and  palsy  of  the  tongue,  or  other  part  of  the  mouth  or  fauces. 


CHAP.  I.]  TONICS. — AROMATICS. — GINGER.  351 

Snuffed  up  the  nostrils,  it  produces  sneezing,  and  increases  the  secretion 
of  mucus,  and  is,  therefore,  occasionally  used  as  an  errhine.  Upon  the 
skin  it  acts  as  a  rubefacient ;  and  the  powder,  formed  into  a  cataplasm 
with  warm  water,  may  often  be  advantageously  applied  to  the  cheeks  in 
toothache,  the  forehead  in  headache,  and  over  the  stomach  in  irritable 
states  of  that  organ. 

Administration.  Ginger  is  given  internally,  in  the  forms  of  powder, 
infusion,  tincture,  and  syrup. 

The  dose  of  the  powder  is  from  ten  to  thirty  grains.  In  this  state  it 
is  often  combined  with  powdered  columbo,  and  subcarbonate  of  iron, 
and  is  an  ingredient  in  the  Pulvis  Aromalicus  of  the  Pharmacopoeias. 

The  Infusion  (!NFUSUM  ZINGIBERIS,  U.  S.~)  is  made  in  the  proportion 
of  half  an  ounce  of  the  bruised  or  powdered  root  to  a  pint  of  boiling 
water.  The  dose  is  one  or  two  fluidounces;  but  it  may  be  given  more 
freely  in  urgent  cases,  especially  of  flatulent  colic.  In  that  affection,  a 
small  bowlful,  sweetened,  may  sometimes  be  drank  with  advantage.  In 
this  form,  ginger  is  much  used  in  connection  with  the  simple  bitters,  as 
gentian,  quassia,  and  columbo,  and  with  cathartics,  especially  senna  and 
rhubarb. 

The  Tincture  (TINCTURA  ZINGIBERIS,  U.  S.),  according  to  the  direc- 
tions of  our  national  code,  is  made  very  strong,  to  fit  it  for  the  prepara- 
tion of  the  syrup;  and  this  concentration  has  also  the  advantage  of  in- 
creasing the  proportion  of  the  aromatic,  and  diminishing  that  of  alcohol. 
This  is  the  more  necessary,  as  it  is  officinal  alcohol  and  not  diluted 
alcohol  or  proof  spirit,  that  is  used  as  the  menstruum ;  the  latter  causing 
1  lie  tincture  to  become  turbid,  in  consequence  of  the  quantity  of  mucilage 
dissolved. 

Under  the  name  of  essence  of  ginger,  a  still  more  concentrated  pre- 
paration is  made,  either  by  employing  a  larger  proportion  of  ginger,  or 
preferably  by  evaporating  a  portion  of  the  alcohol  of  the  tincture,  and 
filtering. 

Either  of  these  preparations  may  be  given  as  a  carminative  and 
stomachic  stimulant,  or  added  to  tonic  and  purgative  infusions,  tinc- 
tures, and  mixtures,  in  debilitated  states  of  the  alimentary  canal.  The 
dose  of  the  tincture  is  from  forty  minims  to  a  fluidrachm,  that  of  the 
essence,  according  to  the  degree  of  its  concentration,  from  twenty  to  forty 
minims. 

The  Syrup  (SYRUPUS  ZINUIBERIS,  U.  S.)  is  prepared  from  the  tincture, 
because,  by  this  method,  the  starch  and  gummy  matter  of  the  root  are 
avoided,  which,  if  present  in  the  syrup,  would  dispose  it  to  spoil.  The 
alcohol  is  driven  off  during  the  process.  Syrup  of  ginger  is  an  excellent 
addition  to  tonic  and  purgative  infusions,  and  to  other  liquids  used  for 
drink,  especially  to  carbonic  acid  water,  when  one  of  the  alkaline  car- 
bonates or  bicar1  .nates  is  exhibited  with  it  in  solution,  as  these  are  in- 


352  GENERAL    STIMULANTS.  [PART  II. 

compatible  with  most  of  tho  ordinary  syrups,  in  consequence  of  the  acid 
they  contain.  It  is  also  a  good  vehicle  for  substances  in  powder,  the 
taste  of  which  it  covers,  while  it  gives  them  a  suitable  consistence  for 
exhibition.  Rubbed  up  with  magnesia  or  its  carbonate,  it  enables  that 
medicine  to  be  readily  and  uniformly  suspended  in  water;  at  the  same 
time  covering  its  taste,  and  obviating  its  nauseating  effect.  A  fluidrachni 
of  it  may  be  added  to  every  fluidounce  dr  two  of  the  liquid  with  which 
it  is  administered. 

Ginger  Troches  or  Lozenges  (TROCHISCI  ZINGIBERIS,  U.  S. )  are  pre- 
pared in  our  Pharmacopeia  by  incorporating  tincture  of  ginger  with 
powdered  tragacanth  and  syrup  of  ginger.  They  often  answer  a  good 
purpose  in  relieving  gastric  uneasiness  and  flatulence,  on  being  taken 
into  the  mouth  and  allowed  slowly  to  dissolve.  Those  prepared  by  the 
confectioners  may  often  be  substituted  without  disadvantage.  Ginger 
beer  is  one  of  the  most  wholesome  of  its  class  of  bevn;; 

In  its  various  forms,  ginger  is  employed,  as  an  adjuvant  or  corrigent, 
in  a  considerable  number  of  officinal  preparations. 


The  four  following  roots  appear  to  me  worthy  of  a  brief  notice,  either 
for  their  former  reputation,  or  present  use,  however  limited  the  latter 
may  be. 

1.  ZEDOARY.  —  ZEDOARIA. 

Two  kinds  of  zedoary  are  noticed  by  authors,  the  round  and  the  long; 
but  the  former  only  is  now  to  be  found  in  the  shops.  The  round  zedoary 
is  the  root  of  Curcuma  Zedoaria,  growing  in  the  East  Indies,  win-re  it 
is  cultivated.  It  is  usually  in  slices,  which  are  the  halves  or  quarters  of 
a  roundish  root,  ending  in  a  point.  These  are  marked,  on  their  convex 
surface,  with  the  sections  of  circular  rings,  which  in  the  whole  root  sur- 
round it  horizontally,  and  with  small  projecting  points,  which  are  the 
remains  of  the  radical  fibres.  The  root  is  grayish-white  on  the  outside, 
yellowish-brown  and  somewhat  marbled  on  the  freshly  cut  surface,  hard, 
and  compact.  Its  odour  is  :i'_-n 'i-altly  aromatic,  and  its  taste  bitterish, 
pungent,  and  camphorous.  Its  activity  resides  mainly  in  a  volatile  oil; 
but  the  bitterness  is  probably  dependent  on  a  distinct  principle,  whieh 
may  add  a  slight  tonic  influence  to  the  aromatic  qualities  of  the  root. 
Its  medical  properties  and  effects  are  essentially  the  same  as  those  of 
ginger,  though  weaker.  It  is  at  present  seldom  if  ever  u-nl  in  this 
country.  The  dose  is  from  ten  to  thirty  grains. 

2.  TURMERIC.  — CURCUMA.  U.S. 

This  is  the  root  of  Curcuma  longa,  a  small  perennial  plant,  indigenous 
in  tin-  East   Indies  and  Cochin  China,  and  abundantly  cultivated  in  va- 


CHAP.  I.]  TONICS. — TURMERIC. — CALAMUS.  353 

rious  parts  of  Southern  Asia.  There  are  two  varieties,  both  produced 
by  the  same  species  of  Curcuma,  but  distinguished  by  their  shape,  one 
being-  long,  and  the  other  round,  and  therefore  named  curcuma  longa 
and  curcuma  rotunda.  The  former,  or  long  turmeric,  is  much  more 
abundant  in  the  market  than  the  latter.  It  is  cylindrical,  about  as  thick, 
but  generally  not  quite  so  long,  as  the  little  finger,  tuberculated,  and 
somewhat  contorted.  The  latter,  or  round  turmeric,  is  round  or  oval, 
about  the  size  of  a  pigeon's  egg,  or  somewhat  larger,  and  marked  ex- 
ternally with  numerous  annular  wrinkles.  Both  are  yellowish  on  the  out- 
side, and  of  a  deep  orange-yellow  within,  compact,  hard,  exhibiting  when 
broken  a  wax-like  fracture,  and  yielding  a  yellow  or  orange-yellow  pow- 
der. Turmeric  has  a  peculiar  aromatic  odour,  and  a  warm,  bitterish, 
somewhat  aromatic  taste,  and  tinges  the  saliva  yellow  when  chewed. 
Its  medical  properties  probably  reside  exclusively  in  a  volatile  oil,  which 
is  yellow  and  acrid.  It  contains,  however,  another  interesting  principle, 
denominated  curcumin,  on  which  its  colouring  properties,  and  its  use  as 
a  chemical  test,  depend.  (See  U.  S.  Dispensatory.)  It  formerly  had  some 
reputation  as  an  aromatic,  resembling  ginger  in  its  action  on  the  system, 
though  less  efficient,  and  also  less  agreeable.  It  was  also  supposed  to 
have  a  special  influence  upon  the  biliary  organs,  probably  from  its  yel- 
low colour,  and  was  used  in  jaundice  and  visceral  disease.  At  present, 
it  is  scarcehr  used  as  a  medicine,  and  probably  never  in  this  country.  As 
a  condiment,  however,  it  is  largely  consumed  in  the  East,  entering  into 
the  composition  of  most  of  the  curries  so  much  in  favour  there.  Its  chief 
use  here  is  as  a  test  for  alkalies,  which  change  its  yellow  colour  to 
brown.  For  this  purpose  it  is  employed  in  the  form  of  tincture,  or  of 
turmeric  paper.  The  powder  might  be  exhibited  in  the  dose  of  from  ten 
to  thirty  grains. 

3.  CALAMUS.  U.  S. 

This  is  the  root  (rhizome)  of  Acorus  Calamus  or  sweet  flag,  an  in- 
digenous plant  growing  also  in  Europe  and  Western  Asia,  and,  in  this 
country,  abounding  in  low,  meadowy  grounds,  too  wet  for  the  culture  of 
the  useful  grasses.  The  plant  may  be  distinguished,  by  those  not  ac- 
quainted with  its  botanical  character,  from  the  young  cat-tails,  and  coarse 
grasses  with  which  it  is  frequently  associated,  by  the  aromatic  odour  of 
the  leaves  when  bruised,  and  their  aromatic  taste.  The  root  is  horizon- 
tal, jointed,  somewhat  flattened  above  and  below,  often  several  feet  long, 
from  half  an  inch  to  an  inch  thick,  with  numerous  fibres  or  radicles  pro- 
ceeding from  its  under  surface,  which  are  cut  off  when  it  is  dried,  leav- 
ing little,  round,  permanent  spots.  When  dried,  it  shrinks  much.  As 
kept  in  the  shops,  it  is  in  pieces  of  various  lengths,  wrinkled,  yellowish- 
brown  externally,  and  whitish  or  yellowish-white  internally.  In  some 
pieces  the  exterior  cortical  part  has  been  removed,  leaving  the  inner  por- 
VOL.  i.— 23 


354  GENERAL   STIMULANTS.  [PART  II. 

tion,  the  surface  of  which  acquires  a  grayish-white  colour.  The  odour 
is  strong  and  fragrant ;  the  taste  warm,  bitterish,  pungent,  and  aromatic. 
It  yields  its  virtues  to  boiling  water.  These  may  be  considered  as  re- 
siding exclusively  in  a  volatile  oil,  which  is  occasionally  separated  by 
distillation,  is  yellow,  and  has  an  odour  and  taste  analogous  to  those  of 
the  root.  There  is  said  also  to  be  an  acrid  extractive  matter;  but  too 
little  is  known  of  it  to  justify  the  ascribing  to  it  of  any  of  the  virtues  of 
the  medicine.  Starch  is  another  ingredient. 

Calamus  has  been  known  from  ancient  times.  It  has  medical  virtues 
closely  analogous  to  those  of  ginger,  for  which  it  might  be  substituted 
in  most  cases,  though  it  is  generally  much  less  acceptable  to  the  palate. 
There  is  one  use  of  it  which  I  would  recommend  from  experience.  Hav- 
ing some  tenacity,  though  sufficiently  brittle  to  be  easily  broken  by  the 
teeth,  it  may  be  carried  in  the  pocket,  and  a  little  of  it  chewed  as  wanted. 
In  this  way  it  will  often  afford  great  relief  to  the  gastric  uneusim-». 
spasmodic  pains,  and  flatulence  so  frequently  attendant  on  dyspesia,  ner- 
vous gout,  and  hysterical  affections.  The  dose  of  it  is  from  twenty  grains 
to  a  drachm.  An  infusion,  made  with  half  an  ounce  or  an  ounce  to  a  pint 
of  boiling  water,  may  be  taken  in  the  dose  of  two  fluidounces  or  more. 
In  the  form  of  powder,  calamus  is  said  to  have  a  strong  preservative 
influence  against  the  attacks  of  insects,  if  sprinkled  over  the  object  to 
be  preserved.  (Med.  and  S.  Reporter,  Sept.  24,  1864,  p.  107.) 

4.  WILD  GINGER. — ASARUM.    U.S.  —  Canada  Snakeroot. 

Wild  ginger  is  the  root  (rhizome)  of  Asarutn  Canadense,  a  very  small, 
perennial  indigenous  plant,  growing  in  wooded  grounds,  from  Canada  to 
Georgia.  All  parts  of  the  plant  have  an  agreeable  aromatic  odour, 
which  is  strongest  in  the  root.  This  is  in  long,  somewhat  contorted 
pieces,  of  the  medium  thickness  of  a  crowquill,  hard  and  brittle,  exter- 
nally wrinkled  and  brownish,  internally  whitish,  and  often  furnished  with 
short  radicles.  Its  taste  is  aromatic,  bitterish,  and  grateful,  bearing  some 
resemblance  to  that  of  cardamom.  The  active  principles  are  a  volatile 
oil,  and  a  bitter  acrid  resin.  Water  extracts  them  partially,  alcohol 
completely. 

Wild  ginger  is  a  stimulant  aromatic,  with  tonic  and  diaphoretic  prop- 
erties, somewhat  analogous  to  serpentaria  in  its  operation,  but  with  less 
of  the  characteristic  effects  of  the  simple  bitters,  and  approaching  more 
nearly  the  subdivision  of  tonics  in  which  it  is  here  placed.  It  may  be 
used  as  a  gentle  stimulant  and  diaphoretic  in  low  fevers ;  but  I  should 
be  more  disposed  to  employ  it  for  the  same  purposes  as  ginger,  for  which 
the  country  people  are  said  occasionally  to  substitute  it,  and  its  affinity 
for  which  is  indicated  by  one  of  its  common  names.  It  might  be  ap- 
propriately used  as  an  adjuvant  of  tonic  and  purgative  infusions,  in  debil- 
itated states  of  the  alimentary  canal.  The  dose  of  the  powder  is  twenty 


CHAP.  I.]  VANILLA. — MINERAL   TONICS.  355 

or  thirty  grains.  It  may  be  given  also  in  infusion,  made  with  half  an 
ounce  of  the  root  and  a  pint  of  boiling  water,  in  the  dose  of  two  fluid- 
ounces.  It  would  form  an  elegant  tincture,  which  might  be  made  by 
macerating  four  ounces  in  two  pints  of  diluted  alcohol,  and  used,  as  an 
addition  to  tonic  infusions,  in  the  quantity  of  one  or  two  fluidrachms  for 
each  dose. 

5.  VANILLA.   U.  S. 

Vanilla  is  one  of  the  most  agreeable  of  the  aromatics ;  and  it  is  sin- 
gular that  it  should  not  have  been  sooner  adopted  by  the  Pharmaco- 
poeias. It  is  now  recognized  only  in  our  own.  It  is  the  fruit  of  the 
Vanilla  aromatica  and  probably  other  species  of  the  same  genus,  climb- 
ing plants,  indigenous  in  Mexico,  the  West  Indies,  and  South  America. 
The  fruit  is  a  long  slender  pod,  which  is  collected  before  maturity,  dried 
in  the  shade,  then  covered  with  a  coating  of  oil,  wrapped,  several  pods 
together,  in  sheet  lead,  and  enclosed  in  metallic  boxes.  The  prepared 
fruit  has  an  exquisite  odour  and  taste,  dependent  on  a  volatile  oil,  which 
is  said  to  be  generated  in  the  drying  process,  and  cannot  be  obtained 
separate  by  distillation  with  water. 

Vanilla,  besides  being  aromatic,  is  probably  somewhat  stimulant  to 
the  nervous  system.  It  is  very  much  employed  by  confectioners  for  its 
agreeable  flavour ;  but  has  not  been  much  used  in  medicine.  It  has 
been  recommended  in  low  fevers,  and  in  hysterical  affections,  usually  in 
the  form  of  infusion,  made  in  the  proportion  of  half  an  ounce  to  a  pint  of 
boiling  water,  and  given  in  the  dose  of  half  a  fluidounce.  It  should  be 
employed,  more  frequently  than  it  is,  to  flavour  medicine  and  food  for 
convalescents.  Nothing  so  agreeably  flavours  chocolate,  ice-cream,  and 
liquid  custard.  The  only  preparation  in  which  it  is  officinally  employed 
are  the  Troches  of  Subcarbonate  of  Iron  (TaocHisci  FERRI  SUBCARBO- 
NATIS,  U.  S.). 


III.  TONICS  OF  MINERAL  ORIGIN. 

There  is  sufficient  ground,  in  the  different  properties  exercised  by  the 
different  mineral  tonics,  for  arranging  them  in  three  subdivisions ;  one, 
including  those  which,  so  far  as  their  pure  and  direct  tonic  action  is  con- 
cerned, operate  exclusively  on  the  mucous  membrane  of  the  alimentary 
canal ;  a  second,  those  which  act  on  the  system  at  large,  and  produce 
their  effects  by  a  direct  influence  upon  the  vital  properties  of  the  tissues, 
without  entering  necessarily  into  their  composition  ;  and  a  third,  those 
which,  though  they  may  possibly  operate  in  the  mode  just  mentioned, 
are  nevertheless  peculiarly  characterized  by  forming  an  essential  element 
of  some  constituent  of  the  body,  and  produce  their  remedial  effects. 


356  GENERAL   STIMULANTS.  [PART  II. 

either  by  increasing  the  amount  of  this  constituent,  or  restoring  it  when 
diseased  to  its  normal  state  by  supplying  a  wanting  ingredient.  In  the 
first  subdivision  may  be  ranked  the  mineral  acids,  as  the  sulphuric,  nitric, 
muriatic,  and  phosphoric ;  in  the  second,  the  preparations  of  silver,  cop- 
per, zinc,  and  bismuth ;  and  in  the  third,  the  preparations  of  iron. 

1.  Mineral  Tonics  Acting  on  the  Stomach  and  Bowels. 

Mineral  Acids. 

The  peculiarity  of  this  subdivision  is  owing  simply  to  the  circumstance 
that,  in  consequence  of  their  strong  chemical  affinities,  they  seem  to  be 
incapable  of  absorption  into  the  circulation  unchanged.  Either  their  dis- 
position to  combine  with  saliiiable  bases  causes  them  to  be  neutralized 
in  the  alimentary  canal,  and  thus  to  lose  their  acid  character;  or  a  similar 
change  in  their  nature  takes  place  by  union  with  one  or  more  of  the  or- 
ganic principles  they  meet  with,  as  albumen  for  example,  with  which 
they  readily  unite;  or  they  undergo  decomposition;  or  lastly,  they  re- 
main unchanged  in  the  primae  via;  till  expelled  with  the  feces.  Indeed, 
this  incapability  of  absorption  unchanged,  is  probably  essential  to  the 
prevention  of  poisonous  effects  from  them;  as  they  might  very  danger- 
ously react  on  the  blood  itself  through  their  chemical  affinities.  Their 
direct  effects,  therefore,  as  mineral  acids,  arc  confined  to  the  alimentary 
canal.  Various  secondary  effects  result,  to  which  it  will  bo  necessary  to 
call  attention  in  considering  them  severally.  These  may  even  be  of  a 
tonic  character;  but  the  acids  are,  nevertheless,  not  less  distinctly  char- 
acterized, as  a  subdivision,  by  the  peculiarity  referred  to. 


I.  SULPHURIC  ACID. 
ACIDUM  SULPHURICUM.  U.  S.,  Br. 

Sulphuric  acid  was  known  as  early  as  the  seventh  century.  As  found 
in  commerce,  it  is  often  called  oil  of  vitriol,  and  is  more  or  less  impure, 
containing,  among  other  foreign  bodies,  a  small  proportion  of  sulphate 
of  lead,  which,  however,  is  thrown  down  when  the  acid  is  diluted  with 
water;  so  that  practically  its  presence  is  of  less  importance  than  might 
have  been  supposed.  For  an  account  of  the  chemical  properties  and 
characteristics  of  this  acid,  the  reader  is  referred  to  the  U.  S.  Dispensa- 
tory. I  shall  here  treat  of  its  relations  to  the  human  system,  and  after- 
wards of  its  preparations;  premising  that  the  strong  acid,  though  much 
employed  as  a  pharmaceutical  agent,  and  sometimes  as  a  caustic,  is  never 
directly  prescribed  for  internal  use. 


CHAP.  I.]  MINERAL   TONICS. — SULPHURIC   ACID.  357 

Effects  on  the  System.  When  taken  in  very  small  doses,  sufficiently 
diluted  with  water,  sulphuric  acid  produces  at  first  no  other  observable 
effect  than  to  increase  the  appetite.  13ut,  after  a  short  time,  digestion 
and  secondarily  nutrition  are  found  to  have  been  promoted;  and  a  tend- 
ency to  constipation  is  sometimes  evinced.  It  is  said  also  somewhat  to 
reduce  the  frequency  and  fulness  of  the  pulse,  and  to  diminish  the  temper- 
ature of  the  body,  especially  if  previously  elevated;  though  I  cannot 
say  that  I  have  myself  ever  noticed  these  effects.  Dr.  Christison,  in  his 
Dispensatory,  states  that  it  is  also  diuretic,  and  that  it  sometimes  suc- 
ceeds in  producing  an  increased  secretion  of  urine  in  dropsical  effusions, 
when  other  powerful  diuretics  have  failed.  With  these  properties,  sul- 
phuric acid  must  be  considered  as  tonic,  astringent,  refrigerant,  and 
diuretic. 

If  given  too  freely,  it  produces  uneasiness  in  the  stomach,  disturbance 
of  digestion,  griping  pains  in  the  bowels,  and  often  purging;  and  the 
same  effects  may  result  from  its  too  long  continuance  in  proper  medicinal 
doses.  They  are  the  direct  consequence  of  its  irritant  action  on  the  ali- 
mentary mucous  membrane. 

In  large  quantities,  and  even  in  smaller  if  taken  in  the  concentrated 
state,  as  not  very  unfrequently  happens  by  mistake,  in  consequence  of 
the  extensive  use  of  the  acid  in  the  arts,  it  very  quickly  produces  burn- 
ing pain  in  the  mouth,  fauces,  and  stomach,  with  nausea  and  generally 
vomiting  of  bloody  or  dark  coloured  liquids,  followed  by  excruciating 
pains  in  the  bowels,  sometimes  attended  with  constipation,  sometimes 
with  purging  and  bloody  stools.  Occasionally  there  are  spasms  of  the 
muscles  of  the  face,  back,  and  upper  extremities,  arising  no  doubt  sym- 
pathetically, through  irritation  of  the  nervous  centres.  The  voice  often 
becomes  hoarse  from  inflammation  of  the  glottis ;  the  breath  sometimes 
fetid  from  the  decomposition  of  the  destroyed  tissues;  and  generally, 
when  a  corrosive  effect  lias  been  produced,  great  prostration  comes  on, 
with  a  cold  surface,  feeble  and  irregular  pulse,  intense  anxiety,  and  in- 
cessant jactitation,  which  soon  end  in  death;  the  mind  remaining 
unclouded  not  unfrequently  even  to  the  very  last.  The  fatal  result 
sometimes  takes  place  in  a  few  hours,  but  more  frequently  at  a  period 
varying  from  twelve  hours  to  two  or  three  days,  and  occasionally  is 
much  longer  protracted.  When  the  quantity  has  not  been  sufficient  to 
cause  immediate  death,  the  case  may  run  on  for  weeks  or  months,  with 
frequent  vomiting  of  membranous  flakes,  fetid  breath,  great  disturbance 
of  the  general  system,  and  gradual  emaciation,  under  which  the  patient 
at  length  sinks.  Sometimes  the  effects  are  confined  to  the  mouth  and 
fauces;  complete  deglutition  having  been  prevented  by  the  excessive 
irritation,  or  other  cause  ;  and  great  destruction  or  inflammation  of  these 
parts  may  ensue,  from  which  the  patient  may  or  may  not  recover.  The 
appearances  after  death  are  those  indicative  of  inflammation  and  disor- 


358  GENERAL   STIMULANTS.  [PART  II. 

ganization  of  the  mucous  membrane.  In  some  places,  the  surface  is 
reddened  by  congestion ;  in  others,  whitened  from  a  combination  of  the 
acid  with  the  albumen  of  the  tissue;  and  in  others  again,  blackened 
by  its  decomposing  effect,  the  blood  being  coagulated  in  the  surrounding 
vessels  Death  results  from  the  direct  action  of  the  acid  on  the  alimen- 
tary mucous  membrane,  and  probably  in  no  degree  through  its  absorp- 
tion into  the  blood-vessels.  Dr.  Christison  states  that  the  smallest  fatal 
dose  of  sulphuric  acid  which  he  had  found  recorded  was  a  drachm,  or 
somewhat  more  than  half  a  teaspoonful.  Patients,  however,  not  unfre- 
quently  survive  the  effects  of  much  larger  quantities.  A  case  of  recovery 
IB  recorded  after  six  drachms  had  been  swallowed;  but  such  a  result 
must  be  very  rare,  and  could  probably  occur  only  in  consequence  of  a 
prompt  evacuation  or  neutralization  of  the  poison.  From  a  few  drachms 
of  the  dilute  officinal  preparation  of  the  acid,  recovery  may  be  reasonably 
hoped  for,  if  prompt  measures  of  relief  are  applied,  or  the  immediate 
occurrence  of  vomiting  has  caused  nearly  all  the  poison  to  be  thrown 
off.  A  patient  got  well  after  taking  ten  drachms  of  the  aromatic  sul- 
phuric acid,  or  elixir  of  vitriol,  which  had  brought  on  vomiting  and 
purging  of  blood.  (Lond.  Med.  Gaz.,  xxv.  944.) 

The  treatment  of  poisoning  by  sulphuric  acid  consists  in  the  prompt 
exhibition  of  substances  fitted  to  neutralize  the  acid,  with  diluent  drinks 
to  favour  the  complete  washing  out  of  the  stomach,  and  afterwards  in 
the  use  of  measures  calculated  to  allay  the  inflammation,  and  support 
the  patient,  if  necessary,  until  the  recuperative  processes  shall  have  been 
.  c6mpleted.  The  best  antidotes  are  magnesia,  chalk,  and  the  hiearbonates 
of  potassa  and  soda;  but,  in  the  absence  of  these,  any  salifiable  base 
which  may  happen  to  be  nearest  should  be  at  once  resorted  to,  as  soap, 
whiting,  or  even  wood  ashes  mixed  with  water.  The  inflammation  may 
be  treated  with  demulcent  drinks,  and  the  ordinary  antiphlogistic  meas- 
ures, carefully  graduated  to  the  amount  of  reaction,  and  the  probable 
future  strength  of  the  patient.  Where  the  stomach  rejects  everything, 
attempts  should  be  made  to  support  the  system  by  animal  broths  in- 
jected into  the  rectum. 

Mode  of  Operating.  The  first  effect  of  the  acid,  given  medicinally,  is 
to  stimulate  the  function  of  digestion.  It  probably  enables  the  stomach 
to  secrete  the  gastric  juice  more  freely,  upon  the  application  of  its  proper 
stimulus,  the  food;  and  there  is  reason  to  think  that  it  directly  aids  tin- 
solvent  power  of  the  juice  itself,  especially  when,  from  a  debilitated  con- 
dition of  the  organ,  that  fluid  may  have  been  produced  without  the  pro- 
portion of  acid  requisite  for  the  due  performance  of  this  function.  The 
phenomena  which  follow  its  more  free  exhibition  are  those  purely  of  irri- 
tation of  the  mucous  membrane,  or  of  chemical  corrosion.  The  astrin- 
gency  which  it  often  exhibits,  in  its  action  on  the  alimentary  canal, 
probably  results  chiefly  from  its  direct  influence  on  the  vital  property  of 


CHAP.  I.]  MINERAL   TONICS. — SULPHURIC   ACID.  359 

contractility  in  the  tissues,  or  from  a  similar  influence  of  the  salts  which 
it  forms  with  salifiable  bases,  present  in  the  contents  of  the  stomach  and 
bowels.  It  has  long  been  noticed  that  this  acid  is  peculiarly  apt  to  give 
astringency  to  its  salts,  more  so,  indeed,  than  any  other  mineral  acid,  as 
evinced  in  the  effects  of  alum  and  sulphate  of  iron.  Perhaps  another 
mode  in  which  it  proves  astringent  is  by  a  chemical  combination  between 
the  acid  and  the  albuminous  constituent  of  the  superficial  epithelial  layers, 
causing  a  contraction  of  the  tissue  beneath.  Something  of  this  kind  may 
occur  when  it  is  taken  very  largely ;  but,  as  ordinarily  given  for  medical 
purposes,  in  small  doses  and  very  much  diluted,  it  is  extremely  improbable 
that  it  produces  any  such  effect.  In  the  prefatory  remarks  on  the  mineral 
acids,  I  have  expressed  my  opinion  very  decidedly  that  they  never  enter 
the  circulation  as  such.  In  fact,  should  they  be  absorbed,  they  could  ex- 
ist there  only  an  instant  uncombined ;  for  they  would  immediately  be 
neutralized  by  the  alkalies  or  albumen  of  the  circulating  fluid.  Orfila  in- 
jected a  little  diluted  sulphuric  acid  into  the  veins  of  a  dog,  and  caused 
its  almost  immediate  death,  with  coagulation  of  the  blood.  But  though, 
in  the  uncombined  state,  it  cannot  enter  the  circulation,  it  is  undoubtedly, 
I  think,  often  absorbed  in  the  state  of  saline  combination ;  and,  as  its 
salts  prove  astringent  in  the  stomach  and  bowels,  they  may  exercise  a 
similar  influence  on  the  tissues  generally,  through  the  blood.  Hence  we 
may  account  for  the  supposed  efficacy  of  the  acid  in  the  relief  of  hemor- 
rhages, to  the  seat  of  which  it  can  have  no  direct  access.  Being,  how- 
ever, offensive  to  the  system,  when  thus  in  excess  in  the  blood,  the  salts 

are  thrown  off  with  the  urine ;  and,  in  order  that  this  elimination  may 

-  • 

be  effected,  it  is  probable  that  they  have  the  property  of  stimulating  the 
kidneys,  and  thus  produce  the  diuresis,  which  has  been  noticed  as  an 
occasional  result  of  the  exhibition  of  sulphuric  acid.  It  is  not  probable 
that  the  acid  exerts  any  tonic  influence  on  the  tissues  generally,  other 
than  the  indirect  promotion  of  sanguification  and  nutrition,  by  the  in- 
vigoration  of  the  digestive  process.  None  of  the  salts  of  the  acid,  ex- 
cepting those  with  a  tonic  base,  as  the  sulphates  of  iron  and  zinc,  act  as 
tonics ;  and  these  metals  produce  their  effects  as  well  without  as  with 
the  sulphuric  acid.  The  absorption,  therefore,  of  the  salts  it  may  form 
in  the  bowels,  will  not  be  followed  by  a  tonic  operation  on  the  system. 
This  is  a  point  of  more  than  merely  speculative  interest.  If  the  opinion 
thus  given  be  well  founded,  it  would  be  useless  to  prescribe  sulphuric 
acid  with  the  view  to  a  tonic  effect,  except  in  so  far  as  it  may  be  desira- 
ble to  invigorate  digestion. 

Tlierapeulic  Application.  Sulphuric  acid  is  admirably  adapted  by  its 
local  tonic  powers  to  cases  in  which,  without  organic  disease  or  vascular 
irritation  of  stomach,  there  is  loss  of  appetite,  with  languid  or  inefficient 
digestion,  general  debility,  and  especially  night-sweats.  These  conditions 
are  often  presented  in  the  convalescence  from  acute  diseases,  particu- 


360  GENERAL   STIMULANTS.  [PART  II. 

larly  fevers,  in  which  this  acid,  given  alone,  or  in  connection  with  the 
simple  bitters,  or  some  preparation  of  Peruvian  bark,  produces  the  hap- 
piest effects.  The  hectic  fever  of  scrofula  and  consumption,  and  the 
advanced  stage  of  suppurative  inflammation,  often  afford  similar  indi- 
cations. 

In  pure  dyspepsia  the  medicine  is  little  used;  as,  though  it  would 
seem  to  be  indicated  by  the  state  of  the  digestive  process,  experience 
has  not  pronounced  in  its  favour.  To  be  curative  in  this  affection,  a 
remedy  must  be  continued  for  a  considerable  time;  and  sulphuric  acid, 
when  its  use  is  long  persisted  in,  is  apt  to  become  irritant  to  the  stomach, 
though  well  borne  at  first 

The  acid  has  also  been  recommended  as  a  tonic  in  low  typhoid  and 
malignant  fevers;  but  I  believe,  that  it  is  of  little  advantage,  and  may 
often  prove  hurtful  in  these  affections,  by  a  too  irritant  action  on  the 
stomach,  and  through  it  indirectly  on  the  system.  It  is  only  upon  the 
alimentary  canal,  as  before  explained,  that  it  acts  directly  as  a  tonic; 
and  a  mere  gastric  stimulant  is  not  what  is  wanted  in  these  ca- 

With  a  view  to  its  conjoint  tonic  and  astringent  effect,  sulphuric  acid 
has  been  employed  in  diaiThoea,  cholera,  hemorrhage,  and  colliquative 
sweats.  In  diarrhoea,  connected  with  a  relaxed  state  of  the  bowels,  or 
in  that  complaint  in  its  chronic  form,  and  with  a  suspicion  of  ulccration 
of  the  mucous  membrane,  it  has  long  been  occasionally  employed  as  an 
astringent  or  alterative;  but  it  is  only  of  late  that  it  has  been  intro- 
duced, as  the  main  remedial  agent,  into  the  treatment  of  acute  diarrhoeas 
in  their  earlier  stages,  and  of  epidemic  cholera.  In  the  London  Medical 
Times  and  Gazette  for  January,  1852  (page  31),  is  a  communication  from 
Dr.  H.  W.  Fuller,  of  London,  strongly  recommending  the  use  of  the  acid 
in  this  affection,  and  ascribing  the  first  public  notice  of  the  remedy  to  a 
letter  of  Mr.  Griffiths,  which  appeared  in  the  Lancet  three  months  pre- 
viously. In  a  subsequent  communication  to  the  same  journal  (Oct. 
1853,  p.  344),  Dr.  Fuller  reiterates  his  recommendation,  based  now  upon 
a  very  large  experience  of  the  remedy.  lie  had  found  it  especially  adapted 
to  "acute  autumnal"  or  epidemic  diarrhoea,  and  to  that  form  of  the  dis- 
ease which  precedes  cholera;  and  in  all  such  cases,  amounting  to  up- 
wards of  ninety,  it  had  proved  invariably  successful.  In  many  of  the 
cases  there  were  cold  extremities,  severe  cramps,  vomiting  and  purging, 
and  sometimes  even  rice-water  discharges.  He  found  it  of  little  use  in 
bilious  diarrhoeas,  and  certain  chronic  cases  of  the  disease.  In  choleraic 
diarrhoea,  and  in  cholera  itself,  in  its  earlier  stages,  no  remedy  is.  lie 
thinks,  equally  efficient.  These  statements  have  been  confirmed  by  re- 
ports from  other  practitioners,  which  have  appeared  in  the  London 
journals;  though,  in  the  hands  of  some,  the  remedy  has  proved  of  no 
avail,  and  has  occasionally  seemed  to  be  injurious.  The  mode  of  exhib- 
iting the  acid  is  to  give  from  twenty  to  thirty  minims  of  the  diluted  sul- 


CHAP.  I.]  MINERAL  TONICS. — SULPHURIC   ACID.  361 

phuric  acid  of  the  Pharmacopoeias,  with  sufficient  cold  water  to  render 
it  palatable,  every  hour  until  its  beneficial  effects  are  experienced.  In 
some  cases,  Dr.  Fuller  recommends  that  the  dose  should  be  repeated 
every  twenty  minutes,  or  even  more  frequently,  during  the  first  hour. 
"Sometimes  after  the  second  dose,"  says  Dr.  Fuller,  "more  commonly 
after  the  third,  and  almost  always  after  the  fourth,  the  patient  expe- 
riences a  grateful  sense  of  warmth  at  the  epigastrium,  heat  returns  to 
the  extremities,  the  nausea  and  vomiting  cease,  the  purging  is  stayed, 
the  cramps  subside,  and  the  countenance  reassumes  its  natural  appear- 
ance." The  patient  goes  on  amending,  and,  after  a  few  hours,  the  remedy 
may  be  suspended.  If  the  acid  be  exhibited  at  intervals  of  six  or  eight, 
or  even  three  or  four  hours,  the  same  happy  effects  are  not  obtained. 
Should  the  liver  not  act  properly  after  the  cessation  of  the  characteristic 
symptoms,  a  little  blue  mass  may  be  exhibited.  Some  administer 
aromatic  tinctures,  opiates,  or  other  adjuvants  in  conjunction  with  the 
acid;  but  Dr.  Fuller  prefers  it  simply  diluted  with  water.  In  relation 
to  the  treatment  of  cholera  itself,  in  its  different  stages,  it  wrould  appear, 
from  the  statements  in  the  return  of  the  English  Board  of  Health,  that 
sulphuric  acid  can,  at  the  best,  boast  of  no  superiority  over  other  reme- 
dies. (B.  and  F.  Medico-cliirurg.  Rev.,  July,  1855,  Am.  ed.,  p.  103.) 

In  the  hemorrhages,  sulphuric  acid  is  occasionally  useful ;  but  it  does 
not  stand  among  the  most  efficient  remedies.  In  hemorrhage  from  the 
stomach  and  bowels  it  may  do  good  by  a  direct  action  on  the  bleeding 
surface;  but  even  here  it  has  found  no  great  favour  with  the  profession 
generally.  In  that  from  surfaces  which  it  cannot  directly  reach,  as  in 
haemoptysis,  hsematuria,  mcnorrhagia,  etc.,  its  efficacy  has  been  doubted, 
upon  the  ground  that  it  does  not  come  in  contact  with  the  bleeding  ves- 
sels ;  but  it  is  probable,  as  before  explained,  that  the  saline  compounds 
which  it  forms  in  the  alimentary  canal  may  enter  the  circulation,  and 
those  salts  may  be  as  styptic  as  the  acid  itself.  Nevertheless,  sulphuric 
acid  has  no  sufficient  haemostatic  power  to  be  relied  on  exclusively  in  the 
treatment  of  the  hemorrhages,  and,  for  the  most  part,  is  employed  merely 
as  an  adjuvant.  The  incompatibility  between  it  and  acetate  of  lead 
would  forbid  its  use,  in  any  case,  in  conjunction  with  the  latter  remedy. 

In  colliqualive  sweaty,  there  are  few  remedies  more  efficacious  than 
sulphuric  acid.  Its  use  in  cases  of  this  kind  attending  convalescence, 
the  hectic  of  phthisis  and  scrofula,  and  the  suppurative  stage  of  inflam- 
mation, has  been  already  referred  to.  But  whenever  excessive  sweating 
occurs,  especially  if  during  sleep,  and  with  general  debility,  as  happens 
sometimes  idiopathically,  and  often  in  connection  with  other  diseases, 
the  remedy  may  be  resorted  to  with  a  reasonable  hope  of  benefit.  Gen- 
erally, in  such  cases,  it  may  be  advantageously  associated  with  sulphate 
of  quinia.  It  probably  acts  either  througlL  the  astringency  of  such  of  its 


salts  as  enter  the  circulation,  or,  what  seems  to  me  more  probable,  by  a 


rns 


362  GENERAL    STIMULANTS.  [PART  II. 

sympathetic  propagation  of  its  action  on  the  bowels,  through  the  nerve 
centres,  to  the  surface  of  the  body. 

From  its  supposed  possession  of  refrigerant  properties,  it  has  been 
recommended  in  fevers  generally ;  but  I  have  never  seen  it  useful  in 
cases  where  the  prominent  indication  was  to  reduce  the  pulse  and  heat 
of  the  body;  and  I  have,  therefore,  much  doubt  as  to  the  existence  of 
any  property  of  this  kind,  at  least  in  a  sufficient  degree  to  justify  its  use 
upon  that  ground  alone.  The  saline  compounds  which  it  forms  in  the 
prima?  via?  may,  when  absorbed,  prove  somewhat  refrigerant,  as  the  neu- 
tral alkaline  salts  generally  are  known  to  do ;  but  if  such  an  effect  is 
produced  in  fevers,  it  is  more  than  counterbalanced  by  the  tendency  of 
the  acid  to  disturb  the  stomach,  already  but  too  prone  to  irritation. 

The  phoaphatic  lithiasis,  or  that  condition  of  the  system,  and  of  the 
urinary  organs,  in  which  there  is  a  disposition  to  an  excessive  formation 
and  deposition  in  the  urine  of  the  earthy  phosphates,  is  often  treated 
with  the  mineral  acids ;  and,  among  them,  with  the  sulphuric.  One  ob- 
ject in  the  treatment  of  this  affection  is  to  maintain  a  due  acidity  of  the 
urine,  by  which  the  phosphates  are  held  in  solution ;  and  another,  to  give 
tone  to  the  digestive  organs,  which  are  often  in  fault.  Now,  it  was  sup- 
posed that  these  objects  would  be  accomplished  by  acid  medicines,  pos- 
sessing, like  the  one  in  question,  tonic  powers;  the  supposition  being 
entertained  that  the  acid  would  pass  out  through  the  kidneys,  and  thus 
impregnate  the  urine.  But  the  mineral  acids  are  not  absorbed  as  such ; 
neither  are  they  thrown  off  as  such  by  the  emunctories.  As  before 
stated,  it  is  in  the  form  of  salts  that  they  enter  the  circulation,  and  are 
eliminated.  Nevertheless,  experience  has  proved  them  to  be  among  our 
best  remedies,  if  not  the  best,  in  this  affection  ;  and,  though  they  do  not 
directly  acidify  the  urine,  it  is  very  possible  that  they  may  do  so  indi- 
rectly. In  the  contents  of  the  bowels,  and  in  the  blood,  are  salts,  from 
which  the  acid  matter  normally  contained  in  the  urine  is  probably  sepa- 
rated. The  sulphuric  acid  introduced  into  the  stomach  must,  in  order  to 
form  salts,  decompose  some  saline  substance  which  it  meets  with  in  the 
primse  via? :  and  the  liberated  acid  may  either  be  absorbed,  and  escape 
with  the  urine,  or,  in  its  turn,  disengage  from  some  one  of  the  salts  of 
the  blood  an  acid  to  be  thrown  off  by  the  kidneys. 

Sulphuric  acid  had  at  one  time  some  reputation  as  a  remedy  in  colica 
pictonum,  and  is  still  considered  a  good  prophylactic  against  that  com- 
plaint, under  certain  circumstances.  It  was  supposed  to  act  by  forming 
an  insoluble  and  inert  salt  with  the  lead,  and  thus  to  remove  the  cause  of 
the  disease.  But  the  preparations  of  lead  do  not  produce  colica  picto- 
num, while  lying  loose  in  the  alimentary  canal,  or  even  precipitated  upon 
its  surface.  They  must  enter  the  circulation,  and  come  into  direct  con- 
tact with  the  nervous  tissue  which  they  affect.  Now,  sulphuric  acid 
cannot  follow  them  into  the  circulation  and  the  tissues;  and,  even  if,  in 


CHAP.  I.]  MINERAL   TONICS. — SULPHURIC   ACID.  363 

the  form  of  soluble  sulphates,  it  should  do  so,  the  formation  of  an  insol- 
uble compound  of  lead  in  these  situations,  from  which  it  could  not  be 
readily  removed,  would  not,  it  appears  to  me,  be  the  best  method  of  ex- 
pelling the  poison.  So  far  as  the  acid  can  do  good  by  combining  with  any 
lead  in  the  stomach  and  bowels,  thus  far  it  may  be  useful  in  colica  picto- 
num,  by  preventing  the  further  absorption  of  the  poison.  It  may,  there- 
fore, prove  prophylactic,  if  habitually  used  as  a  drink  by  those  who  are 
exposed  to  the  necessity  of  swallowing  small  quantities  of  lead  with 
their  saliva,  or  antidotal  in  those  who  may  accidentally  take  the  poison 
into  the  stomach  in  larger  quantities  ;  but  all  that  it  could  do  chemically 
in  such  cases,  could  be  as  well  done,  and  with  less  liability  to  injury, 
by  the  use  of  one  of  the  soluble  sulphates.  It  must,  therefore,  act  by 
some  other  than  its  mere  chemical  properties,  if  it  has  any  special  use- 
fulness in  the  poison  of  lead ;  but  that  it  has  such  usefulness,  remains 
yet  to  be  satisfactorily  proved. 

Dr.  D.  Darrach,  of  Quincy,  Illinois,  has  found  this  acid,  in  several 
cases,  very  efficient  in  the  expulsion  of  tape-worm.  He  used  it  in  the 
form  of  the  aromatic  sulphuric  acid  or  elixir  of  vitriol,  of  which  he  gave 
a  drachm,  diluted  with  several  ounces  of  water,  in  the  course  of  three 
or  four  hours.  (Am.  J.  of  Med.  Sci.,  Oct.  1860,  p.  378.) 

The  acid  has  been  used  externally  in  eruptive  affections,  as  lichen, 
prurigo,  obstinate  urticaria,  and  psora,  and  in  indolent  or  ill-condi- 
tioned ulcers.  It  is  also  employed  as  a  gargle  in  ulcerated  sore-throat, 
and  the  anginose  affection  of  scarlatina,  and  as  a  caustic  application  to 
diphtheric  exudation  in  the  mouth  and  fauces.  But  for  all  these  pur- 
poses, its  place  has  been  supplied  by  more  efficient  or  more  convenient 
remedies;  and  it  is  now  little  employed.  When  used,  it  should  be  much 
diluted.  The  precise  strength  will  be  mentioned  under  the  preparations. 

Incompatible s.  If  the  special  action  of  sulphuric  acid  is  wanted,  it 
should  not  be  given  with  metallic  iron ;  with  salifiable  bases,  with  which 
it  forms  salts;  with  the  carbonates,  or  salts  of  vegetable  acids;  with  sol- 
uble nitrates,  chlorides,  iodides,  or  sulphurets;  or  with  the  soluble  salts 
of  lime,  baryta,  and  lead,  which  it  decomposes,  forming  insoluble  or 
nearly  insoluble  sulphates  of  these  bases  respectively.  Sometimes,  pos- 
sibly, it  may  be  appropriately  administered  in  connection  with  one  or 
more  of  these  substances;  but  this  should  never  be  done,  unless  with  a 
view  to  the  reactions  which  must  follow. 


Preparations  of  Sulphuric  Acid. 

As  kept  for  internal  use,  sulphuric  acid  is  always  in  one  of  the  follow- 
ing forms.  In  relation  to  its  external  use  as  a  caustic,  it  will  be  treated 
of  under  the  escharotics. 


364  GENERAL   STIMULANTS.  [PART  II. 

1.  DILUTED  SULPHURIC  ACID.  —  ACIDUM   SULPHURICUM  Di- 
LUTUM.  U.  S.,  Br. 

This  is  prepared  by  the  U.  S.  Pharmacopoeia,  by  mixing  two  troy- 
ounces  of  concentrated  sulphuric  acid,  with  fourteen  fluidounces  of  dis- 
tilled water,  then  filtering,  and  passing  through  the  filter  as  much  more  of 
the  water,  as  may  be  necessary  to  make  the  diluted  acid  measure  a  pint. 
After  the  mixture,  a  white  insoluble  substance  gradually  separates,  if 
the  commercial  acid  is  used  in  the  preparation.  It  is  the  sulphate  of 
lead  previously  contained  in  the  strong  acid,  which  would  subside  if 
the  mixture  were  allowed  to  stand,  and  might  be  got  rid  of  by  decanting 
the  clear  liquid.  In  the  U.  S.  process,  it  is  separated  by  filtering.  The 
British  preparation  is  somewhat  stronger,  but  not  materially  so.  Even 
in  this  state  of  dilution,  the  "acid  is  still  corrosive,  and  requires  to  be 
much  more  diluted  before  it  can  be  borne  by  the  palate.  The  officinal 
preparation  is  intensely  sour,  and  will  set  the  teeth  on  edge,  if  it  come 
in  contact  with  them.  When  taken,  therefore,  it  should  either  be  sucked 
through  a  quill,  or  other  tube  introduced  far  into  the  mouth  ;  or,  what  I 
think  is  ordinarily  a  better  plan,  it  should  be  swallowed  rapidly,  and  the 
mouth,  immediately  afterwards,  well  and  repeatedly  washed  out  with 
water,  or  a  weak  solution  of  one  of  the  alkaline  carbonates.  Without 
some  precaution  of  this  kind,  the  teeth  may  be  seriously  injured. 

The  done  of  the  diluted  acid  is  from  ten  to  thirty  drops,  to  be  repeated, 
for  ordinary  purposes,  three  times  a  day,  or  more  frequently.  To  be 
efficient  in  hemorrhages,  it  must  be  given  every  two  hours.  The  dose 
should  be  taken  in  one  or  two  wineglassfuls  of  water,  sweetened  or  not, 
as  the  patient  may  prefer.  When  used  as  a  drink  in  hemorrhages  or 
fevers,  the  same  quantity  may  be  added  to  half  a  pint  or  a  pint  of  water. 

For  a  gargle,  in  ulcerative  affections  of  the  throat,  a  fluidrachm  may 
be  added  1o  a  pint  of  water;  for  application  to  the  skin,  double  the  quan- 
tity. When  intended  for  pseudomembranous  patches  in  the  mouth  or 
fauces,  this  preparation  may  be  used  undiluted,  and  should  be  applied 
by  a  brush  directly  to  the  affected  part,  and  no  other. 

Compound  Infusion  of  Roses  (!NFUSUM  ROS^E  COMPOSITUM,  U.  S.)  is 
an  infusion  of  red  roses,  containing  about  three  fluidrachms  of  the  diluted 
sulphuric  acid  in  two  and  a  half  pints.  The  preparation  acquires  a  slight 
astringency  and  a  red  colour  from  the  roses;  but  its  efficacy  depends 
altogether  on  the  acid.  It  is  considerably  used  in  Great  Britain,  as  a 
drink  in  hemorrhages  and  colliquativc  sweats,  and  as  a  vehicle  fur  saline 
medicines,  especially  sulphate  of  magnesia,  the  taste  of  which  it  in  some 
measure  conceals.  The  dose  is  from  two  to  four  fluidounces.  It  is  also 
used  as  u  gargle. 

2.  AROMATIC    SULPHURIC    ACID.  —  ACIDUM     SULPHURICUM 
AROMATICUM.  U.  S.,  Br.  —  Elixir  of  Vitriol. 

This  preparation,  which  is  very  generally  known  under  the  name  of 


CHAP.  I.]  MINERAL   TONICS. — NITRIC   ACID.  365 

elixir  of  vitriol,  is  a  simplification  of  Mynsichfs  acid  elixir.  It  is  pre- 
pared, according  to  the  present  U.  S.  process,  by  obtaining  a  tincture  of 
ginger  and  cinnamon  by  percolation  with  alcohol,  and  then  adding  the 
tincture  to  a  mixture  of  sulphuric  acid  and  alcohol  previously  prepared. 
It  may  be  considered  as  a  tincture  of  the  aromatics  mentioned  mixed 
with  the  acid;  though  some  chemical  reaction  has  no  doubt  taken  place 
between  the  several  ingredients.  It  contains  one  part  of  the  acid  to 
about  nine  parts  by  measure  of  alcohol,  and  is  therefore  considerably 
stronger  than  the  preceding  preparation.  As  the  drop,  however,  is 
smaller,  the  dose  is  about  the  same  as  given  in  drops.  The  U.  S.  prepa- 
ration is  about  one-third  stronger  than  the  British.  It  is  a  reddish-brown 
liquid,  of  a  peculiar  agreeable  odour,  and,  when  diluted,  of  an  acid  not 
unpleasant  taste.  In  this  country,  it  is  the  form  generally  preferred  for 
the  internal  administration  of  sulphuric  acid.  The  dose  of  it  is  from  ten 
to  thirty  drops,  given  in  one  or  two  wineglassfuls  of  water.  It  is  very 
often  used  as  an  addition  to  sulphate  of  quinia  to  render  it  soluble  in 
water;  and  is  an  ingredient  in  the  two  Infusions  of  Peruvian  Bark  of 
the  U.  S.  Pharmacopoeia,  in  the  preparation  of  which  it  enables  the 
water  to  extract  all  the  virtues  of  the  bark,  while  it  agreeably  qualifies 
the  taste  of  the  infusion. 

3.  OINTMENT  OP  SULPHURIC  ACID. 

This  ointment  was  until  recently  an  officinal  of  the  Dublin  College. 
It  was  made  by  rubbing  together  a  drachm  of  the  acid  and  an  ounce  of 
lard.  Reaction  took  place,  which  altered  the  colour  of  the  ointment; 
but  it  was  still  merely  a  dilute  preparation  of  sulphuric  acid  for  external 
use.  Mixed  with  an  equal  quantity  of  lard,  it  was  employed  as  a  remedy 
for  scabies,  lichenous  ringworms,  prurigo,  and  other  obstinate  cutaneous 
eruptions,  and,  still  further  diluted,  as  a  rubcfacient  in  paralysis,  chronic 
inflammation  of  the  joints,  rheumatism,  etc. 


II.  NITRIC  ACID. 
ACIDUM  NITRICUM.  U.  S.,  Br. 

Origin.  This  acid,  according  to  Dr.  Percira,  was  known  to  Geber  in 
the  seventh  century.  In  commerce  it  is  usually  denominated  aquafortis, 
and  in  technical  language  sometimes  azotic  acid.  It  is  prepared  by 
heating  together  a  mixture  of  nitrate  of  potassa  and  sulphuric  acid,  and 
condensing  in  a  receiver  the  vapours  which  are  given  off.  For  an  ac- 
count of  its  composition,  chemical  relations,  the  tests  of  its  purity,  etc., 
the  reader  is  referred  to  the  U.  S.  Dispensatory.  It  is  here  to  be  con- 
sidered mainly  in  its  direct  medical  relations. 


366  ..  GENERAL   STIMULANTS.  [PART  II. 

Properties.  Two  forms  of  the  acid  are  kept  in  the  shops,  distinguished 
as  the  nitrous  and  nitric  acids. 

Nitrous  acid  of  the  shops  is  characterized  by  its  orange  colour,  which 
is  sometimes  very  deep,  and  by  the  orange-coloured  fumes  which  it  gives 
off.  This  peculiarity  is  owing  to  its  impregnation  with  nitric  oxide  or 
deutoxide  of  nitrogen,  by  reaction  between  which  and  a  portion  of  the 
nitric  acid,  the  proper  chemical  nitrous  acid  is  generated,  which  imparts 
its  colour  to  the  mixture.  But,  when  the  liquid  acid  is  diluted  with 
water,  the  orange-coloured  nitrous  acid  is  decomposed  again  into  nitric 
acid  and  nitric  oxide,  the  latter  of  which  escapes,  assuming  an  orange 
colour  when  in  contact  with  the  air,  and  leaving  a  colourless  diluted 
nitric  acid;  and,  as  the  medicine  must  be  diluted  before  being  adminis- 
tered, it  follows  that  the  nitrous  acid  of  the  shops  has  nothing  to  dis- 
tinguish it,  in  relation  to  medical  effect,  from  the  purer  form.  This  ob- 
servation is  necessary,  as  peculiar  virtues  have  been  ascribed  to  it. 

Nitric  acid,  when  quite  pure,  is  a  colourless  liquid,  but,  as  often  kept, 
is  slightly  yellowish.  If  duly  concentrated,  it  gives  out  white  fumes. 
As  directed  by  the  U.  S.  Pharmacopoeia,  it  has  the  sp.  gr.  1.42;  but  it 
is  of  variable  strength  as  found  in  the  shops.  It  has  a  peculiar  odour, 
and,  when  so  far  diluted  as  to  be  borne  in  the  mouth,  an  intensely  sour 
taste.  When  in  contact  with  the  skin,  it  stains  the  cuticle  yellow  ;  and 
the  colour  remains  until  the  cuticle  itself  is  gradually  removed,  a  prop- 
erty which  serves  to  distinguish  the  stain  from  that  produced  by  iodine 
and  bromine.  The  colour,  moreover,  may  be  distinguished  by  becoming 
brighter  under  the  application  of  ammonia  or  soap. 

Effects  on  the  System.  Nitric  acid,  in  the  smallest  medicinal  doses, 
excites  the  appetite,  promotes  digestion,  and  secondarily  invigorates  the 
general  nutritive  process.  It  is,  therefore,  a  tonic,  acting  specially  on 
the  stomach  and  bowels,  and  in  this  respect  resembles  sulphuric  acid, 
from  which,  however,  it  differs  in  being  without  astringency.  It  is  said 
also  to  be  refrigerant,  and  to  have  alterative  properties  which  render  it 
useful  in  peculiar  morbid  states  of  the  system.  On  these  points  more 
will  be  said  directly.  It  is  thought  to  have  sometimes  induced  ptyalism ; 
but,  at  best,  this  result  is  very  rare. 

Too  largely  taken,  and  in  the  ordinary  medicinal  doses  if  continued 
too  long,  it  is  apt  to  cause  disturbance  of  the  stomach,  gastric  pain  or 
spasm,  and  sometimes  severe  attacks  of  intestinal  colic.  S  wallowed 
very  copiously,  and  even  in  smaller  quantities  if  concentrated,  it  pro- 
duces poisonous  effects  so  much  like  those  resulting  from  sulphuric  acid 
that  it  is  unnecessary  to  repeat  an  account  of  them.  (See  page  357.) 
With  the  nitric  acid,  however,  the  inside  of  the  mouth  is  stained  yellow- 
ish instead  of  whitish;  and  yellow  stains  on  the  skin  of  the  face  will 
often  serve  to  distinguish  the  poison.  Two  instances  have  recently  oc- 
curred of  fatal  poisoning  from  inhalation  of  the  fumes  of  nitric  acid, 


CHAP.  I.]  MINERAL   TONICS. — NITRIC   ACID.  367 

arising  from  the  fall  and  breaking  of  a  jar  containing  the  acid,  as  it  was 
carried  across  a  room.  Timely  efforts  to  save  the  patients  were  made 
but  unavailingly.  (Pharm.  Journ.  and  Trans.,  A.D.  1863,  iv.  475.)  The 
antidotes  and  remedial  treatment  are  absolutely  the  same  as  in  the  case 
of  poisoning  from  sulphuric  acid.  When  poisoning  results  from  inha- 
lation, as  in  the  cases  just  referred  to,  the  use  of  the  recently  invented 
atomizer  obviously  suggests  itself.  By  means  of  it,  a  perfectly  safe  solu- 
tion of  one  of  the  bicarbonated  alkalies  might  be  thrown,  in  the  form  of 
spray,  into  the  upper  passages,  and  thus  made  to  neutralize  any  acid  there 
present,  leaving  only  inflammation  to  be  combated,  which  would  require 
the  copious  use  of  leeches  preceded  by  the  lancet.  Gaseous  ammonia  is 
itself  so  irritating,  that  there  might  be  fear  of  aggravated  inflammation 
from  its  use. 

Mode  of  Operating.  Nitric  acid  is  a  direct  stimulant  to  the  alimentary 
mucous  membrane,  becoming  irritant  in  over-doses.  It  is  probably  never 
absorbed  in  the  acid  state;  but  combines  in  the  stomach  and  bowels 
with  the  albumen,  and  the  salifiable  bases  which  it  always  encounters 
there,  and  in  this  state  of  combination  may  enter  the  circulation,  in  order 
to  be  thrown  off  immediately  by  the  kidneys.  Now  the  alkaline  salts  of 
nitric  acid  are  remarkably  refrigerant  and  sedative  to  the  circulation 
when  absorbed,  especially  the  nitrates  of  potassa  and  soda;  so  that,  as 
one  of  these  salts  will  be  likely  to  be  formed  by  the  nitric  acid  in  the 
bowels,  we  may  readily  account  for  the  refrigerant  effect  asserted  to  be 
produced  by  the  acid.  As  to  its  supposed  alterative  action,  so  far  as 
such  an  effect  has  been  experienced,  it  may  be  explained  in  a  somewhat 
similar  manner.  Muriatic  acid  frequently  exists  in  the  stomach.  It  is 
possible  that,  by  reaction  with  this,  the  nitric  acid  may  sometimes  gen- 
erate that  peculiar  combination  called  nitromuriatic  acid,  which  undoubt- 
edly has  an  important  alterative  action  on  the  system.  This  view  is 
rendered  the  more  probable,  as  it  is  only  occasionally  that  nitric  acid  is 
found  to  exercise  the  alterative  influence  ascribed  to  it ;  and  it  is  only 
occasionally  that  the  reactions  can  occur  which  produce  nitromuriatic 
acid.  We  may  explain  in  the  same  way  the  reported  occurrence  of  pty- 
alism  in  some  instances;  as  one  of  the  admitted  characteristic  properties 
of  nitromuriatic  acid  is  frequently  to  act  on  the  gums. 

In  the  concentrated  state,  nitric  acid  decomposes  the  tissues  through 
its  chemical  affinities,  and  thus  causes  the  death  of  the  part,  acting  as  an 
escharotic. 

Therapeutic  Application.  The  use  of  nitric  acid  as  a  tonic  is  very 
nearly  the  same  as  that  of  sulphuric  acid.  Like  that,  it  is  peculiarly 
applicable  to  the  debility  of  convalescence,  with  want  of  appetite,  and 
a  disposition  to  sweat  at  nights;  though  not  perhaps  equally  efficient  in 
correcting  excessive  perspiration.  I  have  occasionally  met  with  cases 
of  fever,  from,  which  the  recovery  seemed  very  slow ;  the  pulse  remaining 


368  GENERAL   STIMULANTS.  [PART  II. 

rather  frequent,  especially  in  the  latter  part  of  the  day,  the  tongue  some- 
what furred,  and  the  appetite  feeble  or  wanting;  and  this  state  of  things 
continuing  for  days  with  little  or  no  change.  Under  such  circumstances, 
nitric  acid,  given  in  small  doses  every  two  or  three  hours,  has  seemed  to 
answer  an  excellent  purpose  in  hastening  and  confirming  the  conva- 
lescence. 

It  has  also  been  used  with  asserted  advantage  in  fevers  generally, 
being  prescribed  partly  as  a  tonic,  and  partly  as  a  refrigerant  in  those 
of  feeble  action,  and  as  a  refrigerant  alone,  in  such  as  require  no  sup- 
porting treatment;  but,  in  cases  of  this  kind,  having  had  little  faith  in 
its  peculiar  efficacy,  I  have  not  been  in  the  habit  of  using  it;  and  can, 
therefore,  say  nothing  from  experience  of  its, virtues.  I  have  already 
explained  how  it  is  possible  that  it  may  produce  a  refrigerant  effect.  Dr. 
Bedford  Brown,  of  Yanceyville,  N.  C.,  has  found  it  highly  advantageous 
in  the  adynamic  state  of  remittent  fever,  in  connection  with  sulphate  of 
quinia,  to  which,  he  thinks,  it  "certainly  added  efficacy."  He  began  with 
three  drops  every  six  hours,  and  gradually  increased  even  to  ten  drops  in 
cases  of  peculiar  intensity.  (Am.  J.  of  Med.  Sci.,  Jan.  1860,  p.  49.)  Dr. 
Win.  A.  Hammond  states,  as  the  result  of  his  treatment  of  41  cases  of 
intermittent,  32  by  nitric  acid,  and  9  by  sulphate  of  quinia,  that  the 
former  was  equally  successful  writh  the  latter.  He  gave  ten  drops  of 
the  acid  three  times  a  day.  (Ibid.,  April,  1861,  p.  606.)  It  had  pre- 
viously been  used  as  an  antiperiodic  by  Drs.  E.  T.  Bailey  and  Geo.  Men- 
denhall,  of  Indiana.  (U.  S.  Dispensatory,  12th  ed.) 

Some  have  supposed  it  to  have  an  alterative  influence  on  the  liver, 
and  to  be  useful  in  chronic  inflammation  of  that  organ.  Generally  it 
has  altogether  failed  of  making  any  useful  impression  in  such  cases,  and 
certainly  cannot  be  relied  on.  Nevertheless,  it  may  occasionally  do 
good,  through  the  generation  of  nitromuriatic  acid  in  the  prima3  viaj. 

Of  its  asserted  specific  virtues  in  secondary  syphilis,  scrofula,  and 
various  eruptive  affections  characterized  by  a  depraved  blood,  as  im- 
petigo, eclhyma,  rupia,  etc.,  I  have  seen  nothing  which  might  not  be 
ascribed  to  its  simple  tonic  action  upon  the  digestive  organs,  and  to  the 
consequent  improvement  in  sanguification  and  nutrition.  Nevertheless, 
there  may  possibly  result  from  its  chemical  reactions  within  the  system, 
substances  having  in  some  degree  the  peculiar  virtues  referred  to;  and 
the  statements  as  to  its  efficiency  made  by  respectable  practitioners 
would  tend  to  confirm  this  view.  It  is,  however,  acknowledged  to  be 
inferior  to  other  medicines  in  the  cure  of  the  affections  mentioned,  and, 
if  used  at  all,  should  be  so  as  an  adjuvant  merely. 

In  diarrhoea,  and  dysentery,  and  the  ordinary  forms  of  cholera,  it  ha? 
been  highly  recommended ;  and,  in  the  form  of  what  is  called  Hope's 
mixture,  was  at  one  time  in  great  repute.  This  consisted  of  nitrous 
acid,  camphor  water,  and  laudanum.  Much  stress  was  laid  upon  the 


CHAP.  I.]  MINERAL   TONICS. — NITRIC   ACID. 

choice  of  nitrous  preferably  to  nitric  acid.  I  have  already  shown  that 
this  preference  was  unfounded.  I  have  employed  this  mixture  in  the 
affections  above  referred  to,  but  generally  with  little  greater  effect  than 
could  be  ascribed  to  the  laudanum  and  camphor  water.  The  acid  often 
provoked  irritation  and  pain  in  the  stomach  or  bowels.  Nevertheless, 
there  are  cases  of  bowel  affections  in  which  the  acid  appears  to  do  good. 
I  consider  it  wholly  inapplicable  to  acute  cases,  with  severe  pain  in  the 
bowels,  and  febrile  symptoms.  The  circumstances  under  which  it  has 
appeared  to  me  useful,  are  a  certain  degree  of  general  debility,  without 
heat  of  skin,  with  no  considerable  pain,  and  evidences  of  a  feeble  or  re- 
laxed condition  of  the  mucous  membrane,  which  disables  it  from  re- 
suming its  healthful  functions.  In  such  a  condition,  whether  the  affec- 
tion be  in  the  early  or  advanced  stage,  and  whether  it  have  the  form 
of  diarrhoea  or  of  dysentery,  the  combination  above  referred  to  may 
prove  useful ;  but  it  is,  I  think,  in  cases  of  diarrhoea  following  cholera 
infantum  that  it  has  proved  most  beneficial  in  my  hands.  In  ordinary 
cholera  morbus,  other  methods  are  so  uniformly  successful,  that  I  have 
never  considered  myself  justified  in  omitting  them  in  order  to  try  nitric 
acid. 

Epidemic  cholera  has  also  been  treated  by  nitric  acid,  but  I  believe 
with  no  peculiar  success. 

In  hooping-cough  it  was  recommended  by  Dr.  Arnoldi ;  and  Dr.  Geo. 
D.  Gibbs  considers  it  as  a  most  efficient  remedy.  In  a  treatise  by  the 
latter,  published  in  London,  A.D.  1854,  he  states  that  "it  not  only  arrests 
the  paroxysms,  and  removes  the  hoop,  but  shortens  the  disease  almost 
as  effectually  as  quinine  does  intermittent  fever."  (Lond.  Med.  Times 
and  Gaz.,  July,  1854,  p.  118.)  Dr.  Arnoldi  adds  as  much  of  the  acid  to 
water,  sweetened  with  sugar  almost  to  the  consistence  of  syrup,  as  will 
give  it  the  sourness  of  pure  lemon-juice.  Of  this  preparation  he  gives 
to  a  child  one  year  old  a  dessertspoonful  every  hour,  to  an  adult  a  tum- 
blerful during  the  day.  It  is  useless  to  speculate  upon  the  mode  of 
action  of  the  remedy,  till  further  experience  shall  have  established  its 
efficacy.  Hooping-cough  is  sometimes  protracted  in  consequence  of  a 
state  of  debility  into  which  the  patient  is  apt  to  fall,  and  which  is  re- 
lieved by  tonics.  Thus  far  nitric  acid  may  no  doubt  prove  useful ;  but 
much  more  is  claimed  for  it  by  the  practitioners  above  referred  to. 

Several  cases  of  spasmodic  asthma  very  promptly  yielded  to  the  use 
of  the  acid,  in  the  practice  of  Dr.  T.  S.  Hopkins,  of  Bethel,  Georgia. 
Most  if  not  all  of  the  cases  were  of  young  children.  He  gave  from 
three  to  five  drops  of  the  acid  three  times  daily.  (Am.  Journ.  of  Med. 
Sci.,  N.  S.,  xx.  549.) 

As  an  antililhic,  Ike  remarks  made  upon  sulphuric  acid  are  precisely 
applicable  to  the  nitric.     It  will  be  remembered  that  it  is  in  the  phos- 
phatic  diathesis  that  the  remedy  is  specially  indicated. 
VOL.  i. — 24 


370  GENERAL    STIMULANTS.  [PART  II. 

As  a  local  remedy,  nitric  acid  has  been  used  to  stimulate  feeble  ulcers, 
to  remove  the  callous  edges  of  the  obstinate,  and  to  correct  the  morbid 
action  of  the  ill-conditioned  and  phagedenic.  It  has  also  been  recently 
employed,  with  great  asserted  advantage,  as  an  application  to  prolapsed 
anus  and  piles.*  Sir  B.  Brodie  succeeded  in  dissolving  a  phosphatic 
calculus,  by  injecting  into  the  bladder,  every  two  or  three  days,  for  a  time 
varying  from  fifteen  to  thirty  minutes,  water  acidulated  with  nitric  acid, 
in  the  proportion  of  two  and  a  half  minims  to  a  fluidounce. 

Administration.  The  dose  of  the  officinal  acid  is  from  three  to  seven 
drops;  but,  as  kept  in  the  shops,  it  is  often  of  less  than  the  officinal 
strength ;  and  no  precise  rule  can  be  given  under  the  circumstances.  I 
have  found,  however,  that  the  above  quantity  of  the  officinal  acid  makes 
a  large  wineglassful  of  water  rather  disagreeably  sour;  and  enough, 
therefore,  of  any  specimen  employed  should  be  added  to  water  to  pro- 
duce this  effect.  In  the  uncertainty  as  to  the  strength  of  the  acid,  a 
small  dose  should  be  given  at  first,  to  be  gradually  increased  until  it 
produces  some  sensible  effect  upon  the  stomach,  a  little  pain  for  example, 
and  then  to  be  somewhat  diminished.  The  water  may  be  sweetened,  if 
so  preferred  by  the  patient.  Special  care  should  betaken  to  avoid  injury 
to  the  teeth.  (See  Diluted  Sulphuric  Acid,  page  364.) 

As  a  wash  for  ulcers,  from  twenty  to  forty  minims  of  the  strong  acid 
may  be  added  to  a  pint  or  a  quart  of  water. 

Incompatibles.  The  acid  should  not  be  administered  with  uncombined 
inetals,  alkalies,  alkaline  earths,  or  their  carbonates,  nor  with  soaps  or 
sulphurets.  Caution  should  always  be  observed  not  to  drop  it  into  a 
silver  spoon,  as  it  would  thus  form  nitrate  of  silver,  or  lunar  caustic.  It 
should  be  administered  from  a  glass  or  porcelain  vessel. 

Diluted  Nitric  Acid  (ACIDUM  Nmiicot  DILUTUM.  ('.  &,,  Br.}  is  an 
officinal  preparation.  The  present  Pharmacopoeia  directs  three  troy- 
ounces  of  the  officinal  acid  (sp.  gr.  1.4-2)  to  be  mixed  with  sufficient  dis- 
tilled water  to  make  the  Diluted  Acid  measure  a  pint ;  but,  in  order  that 
the  preparation  may  be  of  uniform  strength,  the  apothecary,  if  unable  to 
obtain  a  strong  acid  of  the  officinal  specific  gravity,  should  make  the  re- 
quisite allowance,  and  increase  the  proportion  of  the  acid  sufficiently  to 
compensate  for  its  feebleness.  This  he  will  be  enabled  to  do  by  consult- 
ing the  table  of  Dr.  lire  (see  U.  S.  Dispensatory),  from  which  he  can 
learn  the  quantity  of  strong  acid  in  any  specimen  of  a  given  specific 
gravity.  The  dose  of  the  diluted  acid  is  from  twenty  to  forty  drops, 
which  should  be  taken  in  a  large  proportion  of  water.  The  preparation 
may  be  applied  ^diluted,  by  means  of  a  camel's-hair  pencil,  to  pseudo- 

*  In  reference  to  the  surgical  use  of  nitric  acid,  as  an  escharotic  in  piles  and 
prolapsed  rectum,  see  the  Lond.  Med.  Timtt  and  Gaz.,  April,  1853,  p.  343;  Aug. 
1854,  p.  184;  and  Dec.  1865,  p.  560. 


CHAP.  I.]  MINERAL   TONICS. — MURIATIC   ACID.  371 

membranous  exudations,  and  certain  indolent  and  insusceptible  ulcers ; 
care  being  taken  not  to  allow  the  application  to  extend  beyond  the  sur- 
face affected. 

An  ointment  of  nitric  acid  was  formerly  officinal ;  but  has  been  omitted 
in  recent  editions  of  the  pharmacopeias.  It  was  made,  according  to  the 
Dublin  process,  by  melting  together  a  pound  of  olive  oil  and  four  ounces 
of  lard,  and  adding,  upon  the  commencement  of  concretion,  five  and  a 
half  drachms  of  the  acid.  The  resulting  ointment,  which  was  yellow 
and  of  a  firm  consistence,  was  used  in  cutaneous  affections,  more  espe- 
cially porrigo  and  impetigo. 


III.  MURIATIC  ACID. 

ACIDUM  MURIATICUM.  U.  S.—  ACIDUM  HYDROCHLORICUM.  Br. 
Syn. — Hydrochloric  Acid. — Chlorohydric  Acid. 

Origin.  Muriatic  acid  was  described  by  Basil  Valentine  in  the  fifteenth 
century.  To  the  older  chemists  it  was  known  by  the  name  of  spirit  of 
sea  salt;  when  better  understood,  but  before  its  composition  had  been 
discovered,  it  was  called  muriatic  acid;  at  present,  chemists  usually 
denominate  it  hydrochloric  or  chlorohydric  acid.  In  the  U.  S.  Pharma- 
copoeia the  name  of  muriatic  acid  has  been  retained  as  sufficiently  ex- 
pressive, and  best  adapted  for  a  medical  and  pharmaceutical  title,  until 
chemists  shall  adopt  one  upon  which  all  can  unite.  The  term  is  applied 
to  the  liquid  acid  obtained  by  acting  upon  chloride  of  sodium  with  sul- 
phuric acid  and  a  little  water,  and  receiving  the  hydrochloric  acid  gas 
given  off  in  distilled  water,  which  condenses  it.  The  U.  S.  Pharmacopoeia 
directs  that  it  should  have  the  sp.  gr.  1.16. 

Properties.  Muriatic  acid  when  pure  is  a  colourless  liquid,  but  is  often 
somewhat  yellowish  as  in  the  shops.  It  emits  a  vapour  which  forms 
a  white  cloud  in  contact  with  the  air.  Its  smell  is  strong,  pungent,  and 
peculiar;  its  taste,  when  diluted,  extremely  sour.  It  yields  with  nitrate 
of  silver  a  white  precipitate,  insoluble  in  nitric  acid,  but  readily  dissolved 
by  solution  of  ammonia.  Undiluted,  it  is  corrosive  or  escharotic. 

Effects  on  the  System.  So  far  as  regards  its  action  upon  the  digestive 
function,  it  closely  resembles  sulphuric  and  nitric  acids.  Like  them,  too, 
when  given  largely,  it  produces  heat  and  pain  in  the  stomach,  and  occa- 
sionally disturbs  the  bowels.  In  very  large  quantity,  or  in  a  concen- 
trated state,  it  operates  as  a  corrosive  poison,  with  symptoms  similar  to 
those  produced  by  the  acids  just  named;  but  distinguishable,  it  is  said, 
by  the  emission  of  its  peculiar  odour  from  the  mouth.  At  least  this  effect 


372  GENERAL   STIMULANTS.  [PART  IT. 

has  been  observed,  when  it  has  been  given  in  poisonous  quantities  to  the 
lower  animals.  The  treatment  of  its  poisonous  effects  is  the  same  as  that 
indicated  for  the  other  mineral  acids.  (See  page  358.) 

Therapeutic  Application.  Muriatic  acid  may  be  used  as  a  tonic  to  the 
digestive  organs,  and  indirectly  to  the  system,  under  the  same  circum- 
stances as  the  sulphuric  and  nitric.  From  the  fact  that,  mixed  with  gas- 
tric mucus,  it  will  dissolve  food,  and  from  the  supposition,  at  one  time 
entertained,  that  it  was  an  essential  agent  in  the  solution  of  the  food  in 
the  stomach,  the  inference  seemed  reasonable,  that  it  would  prove  pecu- 
liarly useful  in  facilitating  digestion  when  impaired.  It  certainly  has 
this  effect  occasionally ;  but  experience  has  not  proved  it  to  possess  any 
superiority  over  the  other  mineral  acids.  Dr.  Paris  considers  it,  when 
taken  in  connection  with  strong  infusion  of  quassia,  as  one  of  the  best 
preventives  of  the  reproduction  of  worms,  after  they  have  been  ex- 
pelled from  the  bowels.  The  acid  has  been  much  used  in  typhus,  malig- 
nant scarlatina,  and  other  fevers  of  a  malignant  character,  partly  under 
an  impression  of  its  antiseptic  qualities;  and  much  has  been  said  of  its 
efficiency  in  these  affections.  It  has  also  been  considered  specially  use- 
ful in  scrofulous  and  syphilitic  complaints  and  cutaneous  eruptions. 
But  there  may  be  some  doubt  whether  it  acts  in  all  these  cases  by  any 
other  than  its  tonic  powers.  It  has  been  used,  like  the  other  mineral 
acids,  to  correct  the  phosphatic  urinary  deposits,  and  probably  acts  in  a 
similar  manner. 

Administration.  The  dose  of  the  undiluted  acid  is  from  five  to  twenty 
drops,  which  may  be  given  in  half  a  tumblerful  of  sweetened  water,  and 
repeated  more  or  less  frequently  according  to  the  nature  of  the  case ; 
every  two  or  three  hours,  for  example,  in  acute  cases,  and  two  or  three 
times  a  day  in  chronic.  The  same  caution  should  be  observed  us  with 
the  other  acids,  to  prevent  injury  to  the  teeth.  (See  page  364.) 

To  the  incompatibles,  mentioned  under  nitric  acid,  may  be  added,  for 
the  muriatic,  the  soluble  salts  of  silver  and  lead. 

The  acid  is  sometimes  used  locally.  Applied  carefully,  without  dilu- 
tion, to  diphtheritic  or  pseudomcmbranous  surfaces,  it  will  effectually 
change  the  morbid  action ;  but,  though  strongly  recommended  for  this 
purpose  by  Bretonneau,  it  is  probably  in  no  respect  superior  to  the  nitrate 
of  silver,  while  it  is  less  convenient.  In  ulceration  of  the  mouth  and 
fauces,  it  has  been  used,  largely  diluted,  as  a  mouth-wash  or  gargle.  For 
this  purpose,  from  one  to  two  fluidrachms  may  be  added  to  eight  fluid- 
ounces  of  water. 

There  is  an  officinal  Diluted  Muriatic  Acid  (AciDUM  MURIATICUM 
DILUTUM,  U.  &),  containing,  according  to  the  directions  of  the  present 
U.  S.  Pharmacopoeia,  four  troyounces  in  a  pint  of  the  diluted  acid,  the 
remainder  being  distilled  water.  The  dose  is  from  fifteen  to  sixty  droj». 


CHAP.  I.]  MINERAL  TONICS. — NITROMURIATIC   ACID.  373 

IV.  NITROMURIATIC  ACID. 
ACIDUM  NITROMURIATICUM.   U.  S. 

Origin,  etc.  This  combination  first  attracted  notice  as  a  solvent  for 
gold,  whence  it  received  the  name  of  aqua  regia.  It  is  said  to  have 
been  known  to  Geber,  who  lived  in  the  seventh  century;  but  its  intro- 
duction into  medicine  dates  only  from  the  early  part  of  the  present. 
According-  to  the  strict  chemical  nomenclature  of  the  day,  it  is  named 
nitro-chlorohydric,  or  nitro-hydrochloric  acid.  It  is  prepared,  accord- 
ing to  the  present  Pharmacopoeia,  by  mixing  three  troyounces  of  nitric 
acid  with  five  troyounces  of  muriatic  acid.  When  the  acids  are  of  suffi- 
cient strength,  a  reaction  takes  place,  which  Davy  supposed  to  result 
in  the  production  of  nitrous  acid,  water,  and  chlorine.  But  M.  Baudri- 
mont  found,  upon  collecting  the  vapours  rising  from  the  mixture,  that 
they  did  not  consist  of  chlorine,  but  of  a  combination  of  this  element 
with  hyponitrous  acid,  in  the  proportion  of  two  equivalents  of  the  former 
to  one  of  the  latter;  and  he  gave  the  name  of  chlorazotic  gas  (chloro- 
nitric  gas)  to  the  new  compound.  Gay-Lussac  afterwards  investigated 
the  subject,  and  states  as  the  result  of  his  examination,  that  two  new 
products  are  formed,  consisting  of  nitric  oxide  and  chlorine,  which  may 
be  deemed  to  have  been  produced,  the  one  from  hyponitrous  acid  by  re- 
placing one  equivalent  of  its  oxygen  with  one  of  chlorine,  the  other  from 
nitrous  acid  by  a  similar  substitution  of  two  equivalents  of  chlorine  for 
two  of  oxygen  ;  but  Gay-Lussac  admits  also  the  evolution  of  free  chlo- 
rine. It  is  seen,  therefore,  that  the  compound  is  no  longer  a  mixture  of 
the  nitric  and  muriatic  acids,  but  of  certain  new  substances,  having  dis- 
tinct chemical  properties,  and  probably  an  entirely  different  physiological 
action.  As  the  medicine  is  officinally  prepared,  it  contains  a  considera- 
ble excess  of  nitric  acid ;  so  that  its  effects  must  be  those  conjointly  of 
that  acid  and  the  new  products. 

It  is  a  fact  worthy  of  particular  attention,  that  nitric  and  muriatic 
acids  will  not  react  on  each  other  so  as  to  produce  the  changes  above 
referred  to,  which  are  essential  to  the  distinctive  medicinal  character  of 
the  compound,  unless  in  a  certain  degree  of  concentration.  If  the  acids 
employed  be  weak,  they  wilLstill  remain  nitric  and  muriatic  acids  in  the 
mixture,  and  will  exercise  on  the  system  only  the  effects  of  these  acids. 
It  is  probably  from  this  cause,  in  part  at  least,  that  the  disappointment  in 
the  effects  of  nitromuriatic  acid  has  proceeded,  which  has  led  to  its  aban- 
donment by  many  practitioners,  and  to  the  slighting  notices  of  it  given 
by  some  of  the  recent  English  writers.  I  have  used  it  much,  have  taken 
care  to  guard  against  this  source  of  failure,  and  have  had  every  reason  to 


374  GENERAL   STIMULANTS.  [PART  II. 

be  satisfied  of  its  great  efficiency.     Indeed,  I  consider  nitroruuriatic  acid 
as  among  our  most  valuable  remedies. 

When  the  strong  acids  cannot  be  obtained,  reaction  may  be  speedily 
brought  about  by  the  addition  of  a  little  sulphuric  acid,  which  probably 
operates  by  concentrating  the  weak  acids  through  its  affinity  for  water. 
At  present  there  is  little  occasion  for  this  expedient,  as  the  acids  are  gen- 
erally to  be  found  of  sufficient  strength  ;  but  it  was  not  always  so  ;  and 
I  have  repeatedly  made  this  addition  with  satisfactory  results. 

Properties. — When  reaction  has  but  partially  taken  place  between  the 
constituents,  the  colour  of  the  mixture  is  yellow  ;  but  it  deepens  as  the 
changes  go  on ;  and  at  length,  when  they  are  completed,  is  reddish  or 
orange.  The  odour  closely  resembles  that  of  chlorine,  but  is  somewhat 
different.  The  taste,  upon  dilution  so  as  to  render  the  medicine  support- 
able in  the  mouth,  is  intensely  sour,  and  somewhat  peculiar.  Care 
should  be  taken  that  the  preparation  is  kept  in  a  cool  place,  and  excluded 
from  the  light. 

Effects  on  the  System. — Nitromuriatic  acid  promotes  the  appetite,  and 
in  other  respects  operates  as  a  tonic  to  the  digestive  function,  in  the 
same  manner  as  nitric  acid.  Like  that  acid,  too,  it  is  irritant  to  the  ali- 
mentary mucous  membrane  in  over-doses ;  and,  when  swallowed  in 
great  excess,  or  in  a  concentrated  state,  apts  as  a  corrosive  poison,  with 
the  same  phenomena  as  those  already  described  as  the  result  of  poison- 
ing by  the  mineral  acids.  The  antidotes  and  remedies  are  also  the  same. 
(See  pages  357-8.) 

But  this  medicine  produces  other  and  very  important  effects  upon  the 
system.  It  is  certainly  not  absorbed  precisely  as  administered;  for  the 
nitric  acid,  which,  as  before  stated,  is  contained  in  it  in  excess,  probably 
never  enters  the  circulation  unchanged.  There  can  hardly,  however,  be 
a  doubt  that  one  or  more  of  the  new  bodies,  resulting  from  the  reaction 
of  the  ingredients,  is  really  absorbed.  This  can  scarcely  be  the  chlorine; 
for  the  chemical  affinities  of  that  element  are  so  powerful,  that  it  could 
not  remain  long  enough  in  the  primse  vise,  or  in  contact  with  the  tissues 
through  which  it  must  pass,  without  satisfying  those  affinities  by  union 
with  some  other  body  elementary  or  compound.  May  it  not  be,  that  the 
new  compound  noticed  by  M.  Baudrimont,  or  one  or  both  of  those  which 
offered  themselves  to  Gay-Lussac's  research,  are  capable  of  absorption, 
and  of  producing  all  the  peculiar  effects  of  the  medicine  upon  the  blood, 
and  upon  the  tissues  to  winch  they  are  conveyed  by  the  blood? 

An  evidence  of  this  action  through  the  circulation  is  presented  in  the 
increased  secretion  of  bile,  causing  not  unfrequently  bilious  evacuations 
from  the  bowels,  and  in  the  fact  that  this  occurrence  takes  pla<v  as  well 
from  the  external  as  from  the  internal  use  of  the  medicine,  proving  that 
it  is  not  merely  an  irritation  propagated  from  the  intestinal  mucous 
membrane  through  the  gall-ducts  to  the  liver.  Another  evidence  of  the 


CHAP.  I.]  MINERAL    TONICS. — NITROMURIATIC   ACID.  375 

same  kind  is  the  occasional  salivation  and  sore  mouth  which  follow  the 
use  of  the  medicine,  whether  swallowed  or  applied  to  the  skin ;  effects, 
to  the  reality  of  which,  though  they  are  by  no  means  constant,  I  can 
myself  bear  witness.  Further  proofs  are  offered  by  the  therapeutic  in- 
fluence of  the  medicine  in  correcting  fetid  breath,  and  modifying  the 
urinary  secretion  so  as  to  prevent  the  elimination  of  oxalate  of  lime.  It 
probably  acts,  in  both  of  these  instances,  by  decomposing  and  destroy- 
ing substances  in  the  blood  which  cause  these  morbid  phenomena,  while 
it  leaves  the  normal  constitution  of  that  fluid  unaffected. 

It  is  in  vain  to  speculate  upon  the  precise  method  in  which  these 
purifying  effects  are  produced.  We  have  not  yet  light  enough  to  justify 
even  an  attempt  to  form  an  explanatory  theory  on  the  subject;  though 
we  may  reasonably  appeal  to  facts  for  proof  of  the  reality  of  the  effects 
referred  to. 

Therapeutic  Application.  Like  the  mineral  acids  generally,  the  nitro- 
muriatic  may  often  be  used  advantageously  in  general  debility  with 
enfeebled  digestion.  For  the  special  affections  in  which  it  may  be  thus 
employed  as  a  tonic  to  the  digestive  organs,  the  reader  is  referred  to  the 
therapeutic  applications  of  sulphuric  acid.  (See  page  359.)  The  condition 
under  which,  in  these  affections,  it  may  be  employed  preferably  to  other 
acids,  is  when,  with  the  general  debility,  and  that  of  the  stomach  in 
particular,  there  is  conjoined  a  torpid  condition  of  the  liver,  as  evinced 
by  the  want  of  bile  or  its  deficiency  in  the  feces.  In  other  respects, 
acting  in  these  cases  probably  through  the  excess  of  the  nitric  acid  it 
contains,  it  is  identical  in  its  effects  with  that  remedy  separately  admin- 
istered. 

I  am  much  in  the  habit  of  using  nitromuriatic  acid  in  certain  cases  of 
diarrhoea,  chronic  enteritis,  and  dysentery,  and  find  it  occasionally  ex- 
tremely useful.  The  disease,  after  lingering  long  under  various  treatment, 
speedily^  begins  to  amend,  and  goes  on  regularly  to  convalescence,  under 
the  use  of  the  remedy,  which  I  generally  give  combined  with  an  opiate. 
That  the  result  is  not  due  exclusively  to  the  latter,  is  proved  by  the  fact 
that  it  has  been  given  previously,  and  in  other  forms  of  combination, 
without  any  curative  effect.  The  cases  referred  to  are  unattended  with 
fever  or  heat  of  skin,  and  are  characterized  by  a  relaxed  condition  of  the 
system,  and  apparently  of  the  alimentary  canal,  which  appears  to  indi- 
cate a  tonic  treatment.  I  am  disposed  to  think,  however,  that  the  remedy 
operates,  in  these  cases,  not  only  as  a  tonic,  but  also  by  an  alterative  in- 
fluence on  the  mucous  surface,  and  perhaps  upon  the  blood,  the  nature  of 
which  is  not  yet  understood. 

The  applicability  of  nitromuriatic  acid  to  the  treatment  of  diseases  of 
the  liver  was  a  beautiful  discovery  of  Dr.  N.  Scott,  of  Bombay.  That 
practitioner,  having  obtained  very  beneficial  effects  from  nitric  acid  in 
hepatic  affections,  and  made  known  the  results  of  his  treatment,  and 


376  GENERAL   STIMULANTS.  [PART  II. 

being  surprised  at  a  want  of  coincidence  in  the  experience  of  other  prac- 
titioners with  his  own,  was  led  to  make  particular  inquiries  into  the 
cause.  He  found  that  the  nitre,  out  of  which  the  acid  employed  by  him 
in  India  was  prepared,  contained  a  considerable  proportion  of  chloride 
of  sodium,  and  consequently  yielded  muriatic  acid  along  with  the  nitric; 
so  that  in  fact  he  had  been  using  nitromuriatic  acid  in  his  cases,  and  not 
the  pure  nitric.  He  was,  therefore,  induced  to  try  the  compound  acid, 
and  found  his  conjecture  verified  by  the  result. 

Nitromuriatic  acid  appears  to  act  as  a  stimulant  to  the  secretory  func- 
tion of  the  liver,  and  as  an  alterative  in  its  morbid  conditions,  very  much 
in  the  manner  of  mercury,  though  in  an  inferior  degree.  It  differs  from 
that  remedy  in  being  wholly  inapplicable  to  acute  inflammatory  affections, 
or  high  vascular  irritation,  with  active  congestion  of  the  organ  But 
when  the  secretory  function  is  deficient,  or  wholly  suspended,  in  con- 
sequence of  mere  torpor  or  debility  of  the  gland,  nitromuriatic  acid  acts 
often  very  advantageously;  and  if,  with  this  condition  of  the  liver,  there 
are  conjoined  considerable  general  debility,  an  anemic  or  otherwise  de- 
praved state  of  the  blood,  and  depression  of  the  digestive  function,  it 
should  even  be  preferred  to  the  mercurials,  as  it  tends  to  repair,  instead 
of  aggravating,  as  the  latter  remedies  too  often  do,  the  coincident  affec- 
tions. In  chronic  inflammation  of  the  liver,  also,  the  remedy  is  pecu- 
liarly useful,  under  the  same  circumstances.  In  cases,  moreover,  in  which 
mercury  has  been  tried  without  satisfactory  results,  or  insurmountable 
prejudice  exists  against  it,  or  idiosyncrasy  of  the  patient  forbids  its  use, 
nitromuriatic  acid  should  be  resorted  to  as  the  best  substitute.  In  the 
suppurative  stage  of  acute  hepatitis,  the  same  remark  is  applicable.  Of 
course,  in  the  jaundice,  dropsical  affections,  and  general  cachectic  state 
of  system,  so  often  associated  with,  and  in  givat  measure  dependent  on 
hepatic  disease,  much  good  may  be  expected  from  the  remedy,  properly 
employed,  and  sufficiently  long  continued.  One  practical  remark  is 
applicable  in  all  these  cases ;  namely,  that  nitromuriatic  acid  and  mer- 
cury, however  apparently  coindicated,  should  never  be  administered  to- 
gether, at  least  with  any  quantity  of  the  mercurial  larger  than  a  small 
fraction  of  a  grain;  for  there  is  danger  of  the  production  of  corrosive 
sublimate,  and,  consequently,  of  all  the  mischief  which  that  poison  is 
capable  of  producing.  I  have  been  informed,  on  suttieient  authority,  of 
a  case  of  death  which  speedily  followed  the  joint  exhibition  of  nitromu- 
riatic acid  and  calomel,  with  violent  pains  in  the  stomach  and  bowels, 
vomiting,  purging,  etc. 

As  a  purifier  of  the  blood,  nitromuriatic  acid  may  be  u>ed  advan- 
tageously in  depraved  states. of  health,  attended  with  ul<:erative  affec- 
tions of  the  skin,  or  certain  eruptions,  as  ecthyma,  rupia,  porrigo,  etc.; 
in  the  purulent  infection  consequent  on  the  absorption  of  degraded  and 
disintegrated  pus,  and  in  the  .somewhat  similar  condition  of  the  system 


CHAP.  I.]  MINERAL   TONICS. — NITROMURIATIC   ACID.  377 

in  gangrene.  In  all  these  cases,  it  probably  acts  jointly  by  the  tonic 
influence  of  its  acid  ingredient  on  digestion,  and  the  general  alterative 
influence  of  the  portion  absorbed. 

In  the  oxalic  lilhiaxis  it  is  certainly  an  admirable  remedy.  Suggested 
first,  I  believe,  by  the  late  Dr.  Bird,  of  London,  instead  of  the  nitric  acid 
recommended  by  Dr.  Prout,  it  has  come  into  general  use,  and  often  pro- 
duces the  happiest  results.  I  have  repeatedly  used  it  in  cases  char- 
acterized by  an  abundance  of  oxalate  of  lime  in  the  urine ;  and,  I  believe, 
in  no  instance  have  known  it  to  fail  in  correcting,  or  much  diminishing 
that  symptom;  while,  at  the  same  time,  the  constitutional  symptoms 
have  often  undergone  a  similar  amelioration. 

There  is  a  special  morbid  condition,  which  I  have  occasionally  met 
with,  and  have  for  many  years  been  in  the  habit  of  combating,  by  means 
of  this  remedy,  with  the  happiest  success.  I  do  not  know  that  I  can 
convey  an  accurate  idea  of  this  condition  to  the  reader,  but  it  is  suffi- 
ciently well  characterized  to  my  own  observation.  There  is  a  failure  of 
the  appetite,  a  slight  fur  upon  the  tongue,  which,  however,  remains 
moist,  a  tendency  to  constipation,  a  cool,  moist,  and  relaxed  surface,  and 
a  pulse  rather  feebler,  perhaps,  than  in  health,  sometimes  a  little  accel- 
erated, but  not  strikingly  abnormal  in  any  way.  With  these  symptoms 
are  frequently  conjoined  an  offensive  breath,  general  languor,  and  a  re- 
markable and  apparently  causeless  depression  of  spirits,  with  perverted 
feeling,  sometimes  almost  approaching  insanity.  I  have  attributed  this 
condition  to  a  depraved  state  of  the  blood,  dependent  probably  on  de- 
fective digestion  and  assimilation.  It  may  continue  for  weeks  without 
abatement;  but,  under  the  use  of  nitromuriatic  acid,  begins  to  improve  in 
a  few  days,  and,  in  a  period  of  time  varying  from  two  or  three  weeks  to 
some  months,  often  yields  entirely.  Since  the  practice  of  chemical  and 
microscopical  investigation  of  the  urine  has  come  into  vogue,  circum- 
stances have  prevented  me  from  investigating  the  state  of  the  secretion 
in  this  affection  unless  in  a  few  instances ;  and,  in  all  of  these,  oxalate  of 
lime  was  noticed  in  the  urine. 

Administration.  The  dose  of  the  acid  is  from  two  to  ten  drops,  accord- 
ing to  its  strength.  About  five  drops  is  a  medium  dose,  which  may  be 
given  in  from  two  to  four  fluidounces  of  sweetened  water,  and  repeated 
two,  three,  or  four  times  in  twenty- four  hours.  As  the  medicine,  in 
large  doses,  is  apt  to  induce  colicky  pains,  it  is  best  to  begin  with  a 
small  dose,  and  increase  till  it  evinces  some  sign  of  acting.  The  same 
caution  should  be  observed  as  with  the  other  acids,  to  guard  the  teeth 
against  injury.  Care  should  be  taken,  in  opening  the  bottle  in  which  the 
acid  may  be  contained,  to  avoid  exposing  the  face  to  the  jet  of  gaseous 
vapour,  which  sometimes  suddenly  escapes,  especially  when  the  bottle 
has  been  kept  in  a  warm  place,  and  which  may  endanger  the  eyes,  if 
not  guarded.  When  the  patient,  or  a  nurse,  mixes  the  acids,  particular 


378  GENERAL   STIMULANTS.  [PART  II. 

direction  should  be  given  that  they  should  not  be  dropped  into  water 
before  they  have  been  mingled,  and  full  time  has  been  allowed  for  mu- 
tual reaction.  In  fact,  it  is  best  that  the  mixture  should  be  made  by  the 
apothecary,  and,  after  sufficient  reaction  has  taken  place,  should  be  di- 
luted before  being  dispensed.  I  frequently  thus  prescribe  the  remedy, 
directing  it  to  be  diluted  with  camphor  water,  in  such  proportion  that  a 
tablespoonful  of  the  preparation  shall  constitute  a  dose,  to  be  afterwards 
further  diluted  by  the  patient.  To  this  mixture  a  portion  of  laudanum 
may  be  added,  whenever  indicated. 

The  incompatibleK  are  so  numerous,  that  the  safest  plan  is  to  give  the 
acid  without  other  accompaniments  than  those  just  mentioned.  It  should 
be  administered  from  a  wineglass,  or  by  means  of  some  other  glass  or 
porcelain  instrument,  and  never  from  a  metallic  spoon,  especially  one  of 
silver. 

So  far  as  concerns  the  effects  of  the  medicine  on  the  liver,  it  has  been 
thought  that  its  external  use  is  scarcely  less  efficient  than  the  internal. 
At  least,  the  two  methods  may  often  be  advantageously  conjoined;  or 
the  outward  application  may  be  resorted  to  when  the  medicine  operates 
offensively  on  the  alimentary  canal.  It  may  be  employed  externally  in 
the  form  of  lotion,  footbath,  or  full  bath.  For  the  purpose  first  men- 
tioned, it  may  be  added  to  water,  in  the  proportion  of  two  fluidrachms 
to  a  pint,  and  applied  by  means  of  a  sponge.  For  a  footbath,  from  one 
to  two  fluidounces  may  be  used  to  the  gallon  of  water;  for  a  bath, 
about  one  fluidounce  to  the  same  quantity.  Both  the  bath  and  footbath 
should  be  at  the  temperature  of  about  96°  F.,  and  should  be  prepared  in 
wooden  vessels.  The  application  may  be  continued  from  ten  to  thirty 
minutes,  or  till  a  tingling  or  pricking  sensation  begins  to  be  felt  in  the 
skin.  It  may  be  repeated  daily,  or  twice  a  day. 


V.  PHOSPHORIC  ACID. 

ACIDUM  PHOSPHORICUM. 

There  are  three  isomeric  conditions  of  phosphoric  acid,  identical  in 
composition,  but  differing  in  their  relation  to  bases,  of  which  one  unites 
with  one  equivalent,  the  second  with  two  eqs.,  and  the  third  with  three; 
and  hence  they  are  distinguished  by  the  names  of  monobasic,  bibasic, 
and  tnbasic  phosphoric  acid;  water  when  combined  with  these  being 
considered  in  the  state  of  a  base.  With  these  preliminary  remarks,  I 
must  be  content  with  referring  to  the  U.  S.  Dispensatory  (12th  ed.,  p.  51), 
for  the  chemistry  of  this  acid.  Two  forms  of  phosphoric  acid  are  now 
officinal,  the  glacial,  namely,  and  the  diluted,  both  of  which  were  intro- 
duced into  the  U.  S.  Pharmacopeia,  for  the  first  time,  at  its  late  revision. 


CHAP.  I.]  MINERAL   TONICS. — PHOSPHORIC   ACID.  379 

1.  GLACIAL  PHOSPHORIC  ACID.  — ACIBUM  PHOSPHORIC UM  GLA- 
CFALE.  U.  S. — Syn.  Monobasic  Phosphoric  Acid.  —  Meta  phosphoric 
Acid. — Phosphate  of  Water.  This  is  the  first  of  the  three  varieties  just 
named,  being  always  combined  with  one  cq.  of  water,  and  represented  by 
the  formula  HO,P05;  the  anhydrous  acid  consisting  of  one  eq.  of  phos- 
phorus and  five  eqs.  of  oxygen.  It  results  when  the  product  of  the 
combustion  of  phosphorus  is  introduced  into  water;  but  is  commonly 
obtained  from  calcined  bones,  by  treating  them  with  sulphuric  acid,  which 
produces  a  superphosphate  of  lime,  dissolving  this  out  by  water,  adding 
carbonate  of  ammonia,  and  exposing  the  resulting  phosphate  of  ammo- 
nia first  to  an  evaporating  heat,  and  then  to  calcination,  by  which  the 
ammonia  is  driven  off,  and  the  glacial  acid  is  left.  (See  U.  S.  D.)  This 
variety,  however,  of  phosphoric  acid  is  generally  imported,  being  seldom 
made  in  our  chemical  laboratories. 

The  glacial  phosphoric  acid  is  a  transparent,  white  or  colourless,  fusible 
solid,  inodorous,  sour  to  the  taste,  slowly  deliquescent,  and  soluble  in 
water  and  alcohol.  It  is  chemically  characterized  by  producing  precipi- 
tates with  soluble  salts  of  lime,  baryta,  and  silver;  the  precipitate  with 
chloride  of  barium  being  redissolved  by  an  excess  of  the  acid ;  and  is 
distinguished  from  the  other  states  of  the  acid  by  coagulating  albumen. 

Though  capable  of  producing  all  the  effects  of  phosphoric  acid  upon  the 
system,  this  variety  is  seldom  prescribed,  being  always  first  brought  to 
the  state  of  the  officinal  diluted  acid.  Indeed,  it  was  introduced  into  the 
Pharmacopoeia,  as  affording  a  ready  means  of  preparing  that  officinal. 

2.  DILUTED  PHOSPHORIC  ACID.  — ACIDUM  PHOSPIIORICUM  Di- 
LUTUM.  U.S.,  Br.  This  is  prepared,  according  to  both  the  United  States 
and  British  Pharmacopoeias,  by  carefully  heating  together  phosphorus, 
nitric  acid,  and  water.  The  phosphorus  is  oxidized  and  converted  into 
phosphoric  acid  at  the  expense  of  the  nitric  acid;  and,  having  been 
obtained  in  a  somewhat  concentrated  liquid  form,  is  afterwards  diluted 
with  water  to  the  officinal  strength.  Our  Pharmacopoeia  also  permits  it 
to  be  prepared  by  dissolving  a  troyounce  of  the  glacial  acid  in  three 
fluidounces  of  distilled  water,  adding  a  little  nitric  acid,  boiling  until  the 
whole  of  the- latter  acid  is  driven  off,  and  then  adding  distilled  water  till 
the  diluted  acid  measures  twelve  fluidounces  and  a  half.  The  object  of 
boiling  with  the  nitric  acid  is  to  convert  the  glacial  or  monobasic  into  the 
tribasic,  which  is  the  proper  officinal  ac.id  ;  the  nitric  acid  appearing  to 
act,  in  facilitating  the  change,  simply  by  its  presence;  as  no  decompo- 
sition takes  place.  The  strength  was  intended  to  be  as  nearly  as  pos- 
sible the  same  as  that  of  the  diluted  acid,  prepared  according  to  the 
other  formula.  The  sp.  gr.  of  the  U.  S.  diluted  acid  is  1.056,  that  of  the 
British  officinal  preparation  1.08;  the  latter,  therefore,  being  considera- 
bly stronger.  This  should  be  recollected  in  estimating  the  value  of  the 
doses  of  this  acid  given  by  British  writers. 


380  GENERAL    STIMULANTS.  [PART  II. 

Properties.  Diluted  phosphoric  acid  is  a  colourless  liquid,  without 
smell,  extremely  sour,  and  possessed  of  strong  acid  properties.  Though 
much  less  corrosive,  even  in  a  concentrated  state,  than  sulphuric  acid, 
it  is  yet  capable  in  that  state  of  destroying  life.  Orfila  has  seen  fatal 
gastritis  produced  in  a  dog  by  thirty  grains  of  it  dissolved  in  a  very  little 
water. 

Medical  Uses.  As  a  medicine,  it  has  been  more  used,  till  of  late,  on  the 
continent  of  Europe,  particularly  Germany,  than  either  in  Great  Britain 
or  this  country.  Having  never  prescribed  it,  or  seen  it  prescribed,  I 
am  not  entitled  to  give  an  authoritative  opinion  upon  its  properties  or 
value  as  a  medicine ;  but,  from  all  that  has  been  written  upon  the  sub- 
ject, though  some  writers  claim  for  it  special  and  extraordinary  virtues, 
there  seems  to  be  good  reason  to  believe  that  it  resembles  the  other 
acids  in  its  effects,  and  can  do  little  more  than  they.  It  is  thought  espe- 
cially to  resemble  sulphuric  acid  in  tonic  virtues,  and,  though  not  so 
energetic,  has  the  advantage  that  its  taste  is  somewhat  more  agreeable, 
and  its  tendency  to  produce  gastric  and  intestinal  irritation  less.  It 
may,  therefore,  be  employed  to  promote  the  appetite  and  invigorate 
digestion  in  debilitated  states  of  the  system.  Scrofulous  affections, 
passive  hemorrhages,  colliquative  sweats,  excessive  suppuration,  low 
febrile  diseases,  caries  of  the  bones,  ulcerous  and  eruptive  affections  with 
depraved  blood,  are  complaints  in  which  it  has  been  recommended,  and 
in  which  its  tonic  properties  may  have  rendered  it  useful.  Its  property 
of  dissolving  phosphate  of  lime  out  of  the  body  has  led  to  its  employ- 
ment in  ossification  of  the  heart  and  blood-vessels,  and  in  cases  of  phos- 
phatic  deposits  in  the  urine,  in  the  hope  that  it  might  dissolve  the  abnor- 
mal bony  matter,  and  calculous  formations  within  the  tody.  In  the 
urinary  affection,  it  may  operate  beneficially  in  the  same  manner  as 
sulphuric  acid.  It  has  been  supposed  to  possess  the  power  of  greatly 
reducing  vital  irritability,  and  has  been  employed,  in  reference  to  this 
property,  in  hysteria  and  convulsive  disorders.  On  the  contrary,  from 
an  imagined  excitant  influence  over  the  generative  organs,  it  has  been 
used  in  impotence  in  males.  As  a  local  application,  it  has  been  espe- 
cially recommended  in  caries,  in  which  it  corrects  the  fetor,  dissolves 
and  aids  in  the  separation  of  the  dead  portions  of  bone,  and  otherwise 
favours  the  healing  process.  It  is  said  also  to  have  proved  beneficial  in 
offensive  cancerous  ulcers. 

It  might  be  supposed  that  phosphoric  acid  would  occasionally  prove 
useful  by  supplying  a  deficiency  of  phosphorus  or  the  phosphates  in  the 
tissues.  There  can  be  no  doubt  that  it  forms  \vitli  tin-  saliliable  bases  it 
meets  with  in  the  alimentary  canal,  as  lime,  soda,  etc.,  salts  which  may 
enter  the  circulation,  and  thus  produce  all  the  effects  which  it  has  of  late 
been  somewhat  fashionable  to  ascribe  to  the  phosphates.  But  when  it 
is  considered  that  there  is  always  more  or  less,  of  the  phosphates  in  the 


CHAP.  I.]         MINERAL   TONICS. — CARBONIC   ACID   WATER.  381 

blood  and  in  the  urine,  resulting  probably  from  the  disintegration  of  the 
tissues,  and  in  part,  possibly,  from  the  food  taken,  it  is  obvious  that  it  is 
not  the  presence  of  the  phosphates  that  is  wanted,  but  the  due  power  of 
appropriating  them.  I  have  never,  therefore,  been  disposed  to  ascribe 
much  virtue  to  the  phosphates  used  in  medicine,  merely  with  the  object 
of  supplying  a  supposed  deficiency  of  phosphorus  in  the  nervous  tissue, 
or  of  phosphate  of  lime  in  the  bones. 

The  dose  for  internal  use  is  from  ten  minims  to  a  fluidrachm,  which 
should  be  given  largely  diluted.  For  external  use,  the  officinal  acid  may 
be  diluted  with  nine  or  ten  times  its  bulk  of  water. 


VI.  CARBONIC  ACID  WATER. 
AQUA  ACIDI  CARBONIC!.  U.  S. 

Syn.  Artificial  Seltzer  Water. — Artificial  Mineral  Water. 

Preparation.  Carbonic  acid  water  is  prepared,  according  to  the  U.  S. 
Pharmacopoeia,  by  forcing  into  water  five  times  its  bulk  of  carbonic  acid 
gas,  obtained  by  the  reaction  between  marble  and  dilute  sulphuric  acid. 

Water,  under  the  ordinary  atmospheric  pressure,  and  at  ordinary  tem- 
peratures, absorbs  about  its  own  volume  of  carbonic  acid  gas,  and  may 
be  made  to  take  up  any  additional  quantity  that  may  be  required  by 
increasing  the  pressure;  the  quantity  absorbed  being  directly  propor- 
tionate to  the  augmentation  of  the  pressure.  Thus,  if  with  the  pressure 
of  the  atmosphere  it  will  absorb  its  own  volume,  with  a  pressure  double 
that  of  the  air  it  will  absorb  two  volumes,  with  triple  the  pressure  three 
volumes,  etc.  As  kept  in  the  shops,  the  solution  has  not  always  the 
officinal  strength;  being  sometimes  stronger  and  sometimes  weaker.  I 
am  told  that  the  preparation  generally  kept  by  the  druggists  of  Phila- 
delphia contains  about  seven  or  eight  times  its  bulk  of  the  acid  gas. 
This  statement,  however,  applies  only  to  the  water  first  drawn  from  the 
fountains;  as.  being  driven  out  by  the  pressure  of  its  own  escaped  air, 
it  gradually  becomes  weaker  as  the  fountain  is  exhausted,  and  towards 
the  close  must  be  much  more  so  than  at  first.  The  colder  it  is,  the  more 
gas  it  is  capable  of  containing.  To  maintain  its  proper  strength,  it  must 
be  kept  under  steady  pressure;  and  hence  the  best  plan  is  to  have  it  bot- 
tled by  the  manufacturer ;  in  which  case,  it  retains  an  equable  strength 
for  an  indefinite  length  of  time,  if  well  secured. 

Properties  and  Im}>«ri(ii>s.  Carbonic  acid  water  is  an  effervescing, 
sparkling,  colourless  liquid,  of  an  acidulous,  pungent,  agreeable  taste; 
often  producing,  when  swallowed,  considerable  irritation  in  the  fauces. 
It  reddens  litmus  paper,  and  precipitates  lime-water. 


332  GENERAL    STIMULANTS.  [PART  II. 

From  the  mode  in  which  it  is  prepared  and  kept,  it  is  liable  to  two 
impurities,  which  very  much  interfere  with  its  beneficial  operation.  Not 
unfrequently  the  fountains  or  reservoirs  containing  it  are  furnished  with 
a  leaden  tube  of  exit,  so  that  a  portion  of  the  water,  drawn  at  any  one 
time,  must  have  been  for  a  longer  or  shorter  period  in  contact  with  lead, 
and  is  liable  to  be  more  or  less  impregnated  with  the  carbonate  of  that 
metal.  Should  it  be  frequently  drawn,  there  will  be  no  appreciable 
quantity  of  the  salt  of  lead;  but  if  not,  the  impregnation  may  be  con- 
siderable. The  water  which  has  remained  over  night  in  the  exit  pipe 
often  contains  it;  and  I  have  known  of  two  instances  of  colicapictonum, 
induced  by  the  habit  of  drinking  every  morning  the  first  draught  of  the 
water  from  the  fountain. 

Another  impregnation  is  copper,  derived  from  the  fountain,  which  is 
usually  made  of  that  metal.  The  copper  fountains  are,  it  is  true,  tinned 
in  the  interior ;  but  the  process  is  not  always  well  performed,  or  the  tin 
coating  is  worn  off  in  spots;  and  thus  it  very  frequently  happens  that 
more  or  less  copper  is  dissolved.  Sometimes  the  solution  is  so  strong 
as  to  be  obvious  to  the  taste. 

It  is  highly  important,  for  medical  purposes,  that  the  water  should  be 
quite  free  from  these  impurities.  Their  presence  may  easily  be  detected. 
If  lead  is  contained  in  the  preparation,  it  will  be  evinced  by  the  pro- 
duction of  a  dark  discoloration  on  the  addition  of  hydrosulphatc  of  am- 
monia;  if  copper,  by  a  brown  precipitate  with  ferrocyanide  of  potassium. 
This  latter  test  is  so  delicate,  that  one  part  of  copper,  dissolved  in  56,000 
parts  of  the  water,  may  be  detected  by  the  reddish  tinge  it  produces. 

Medical  Effects  and  Uses.  Carbonic  acid  is  at  first  locally  irritant. 
This  is  perceived  on  attempting  to  inspire  the  pure  gas,  when  a  strong 
irritant  impression  is  felt  in  the  throat  and  air-passages,  so  strong,  indeed, 
that  the  glottis  closes  spasmodically,  and  refuses  to  admit  it  unless 
diluted.  Applied  to  the  skin  for  a  short  time,  it  produces  a  feeling  of 
warmth  and  tingling  or  prickling,  which  is  said  to  be  sometimes  posi- 
tively painful.  When  the  strongly  impregnated  liquid  is  swallowed,  it 
is  often  so  irritant  to  the  fauces,  us  \vitli  some  persons  to  render  it  almost 
impossible  to  take  a  large  draught  of  it  without  interruption.  It  exer- 
cises a  similar  excitant  influence  on  the  stomach  itself,  and  this  is  proba- 
bly one  cause  of  its  medicinal  effects.  In  other  words,  it  is  a  gentle  gas- 
tric stimulant,  operating  in  a  manner  more  analogous  to  that  of  the 
milder  aromatics  than  of  any  other  medicines.  It  is  said  to  be  refrig- 
erant, and  to  excite  perspiration  and  diuresis.  But  I  I  it-Hove  it  owes 
these  effects  to  the  water  with  which  it  is  taken;  and  one  of  its  advant- 
ages is  that,  by  the  gentle  stimulation  of  the  acid,  it  prevents  injurious 
effects  from  tin-  lanr<i  draughts  of  very  cold  water  swallowed  with  it.  I 
do  not  think  that  of  itself  it  is  stimulant  to  the  secretions.  It  is  probably 
not  absorbed  into  the  circulation  as  carbonic  acid  from  the  alimentary 


CHAP.  I.]        MINERAL   TONICS. — CARBONIC    ACID   WATER.  383 

canal,  for  the  tendencies  of  the  blood  are  everywhere  to  give  out  rather 
than  to  take  in  that  substance.  Its  first  stimulant  impression  appears 
to  be  followed,  as  is  known  to  be  the  case  with  the  gas  locally  applied, 
by  a  sedative  influence  on  the  nervous  tissue. 

The  gently  stimulant  action  of  carbonic  acid  water  renders  it  useful 
as  a  tonic  in  dyspepsia  and  other  states  of  gastric  debility,  if  not  used 
so  largely  and  so  frequently,  as  on  the  one  hand  to  produce  inflammation 
of  the  stomach,  and  on  the  other  to  exhaust  its  excitability.  The  dys- 
peptic patient  will  find  advantage  in  taking  a  moderate  draught  of  it 
twice  a  day.  Another  great  advantage  is  the  one,  already  referred  to, 
of  obviating  too  great  a  depressing  effect  from  cold  water,  and  of  ren- 
dering it  acceptable  to  the  stomach,  when  it  might  otherwise  prove  op- 
pressive, possibly  excite  gastric  spasm,  or  be  rejected.  Hence,  when 
heated  and  perspiring,  we  may  much  more  safely  take  a  draught  of  cold 
carbonic  acid  water,  than  an  equal  amount  of  equally  cold  water  not 
similarly  protected.  Hence,  too,  in  febrile  diseases,  carbonic  acid  water 
very  cold  may  be  given  happily  as  a  refreshing  and  refrigerating  drink, 
when  cold  water  in  the  same  quantity  might  oppress  the  stomach.  It 
thus,  too,  enables  the  liquid  to  act  as  a  diluent,  and,  by  entrance  into 
the  circulation,  and  passing  off  with  the  secretions,  to  relieve  febrile 
excitement. 

But  the  most  useful  remedial  effect  of  carbonic  acid  is  the  relief  of 
nausea  and  vomiting.  There  are  few  means  more  efficient  for  this 
purpose,  when  th'e  nausea  is  not  dependent  on  positive  inflammation  of 
the  stomach.  It  is  one  of  our  very  best  resources  in  the  irritable 
stomach  of  fevers.  Most  frequently,  perhaps,  the  effect  of  carbonic 
acid,  under  these  circumstances,  is  obtained  through  the  medium  of  the 
effervescing  draught ;  because  there  is  usually,  at  the  same  time,  an  in- 
dication for  the  diaphoretic  and  refrigerant  influence  of  the  citrate  of 
potassa.  But  the  carbonic  acid  water  is  also  much  used,  and  is  very 
efficient.  The  best  method  of  employing  it  is  to  have  a  number  of  small 
bottles,  each  containing  about  two  fluidounces,  filled  with  the  liquid,  then 
well  closed,  and  kept  in  ice-cold  water.  The  contents  of  one  of  these 
may  be  taken,  as  wanted,  every  half  hour,  every  hour,  or  less  frequently; 
and  the  preparation  remains  unimpaired  ;  whereas,  if  the  liquid  is  used 
in  successive  draughts  from  one  large  bottle,  the  strength  of  it  becomes 
exhausted  before  the  bottle  is  emptied.  It  is  not  only  the  nausea  of  febrile 
disease  that  may  be  thus  treated ;  but  that  also  of  cholera  morbus, 
cholera  infantum,  and  all  other  disorders  in  which  the  affection  is  prop- 
erly gastric,  and  not  positively  inflammatory. 

As  a  vehicle  for  laxative,  diuretic,  and  diaphoretic  medicines,  in  order 
to  obviate  any  nauseating  effect  from  them,  and  to  render  them  accepta- 
ble to  the  stomach,  carbonic  acid  water  is  much  used.  It  is  an  excellent 
menstruum  for  su'^hato  of  magnesia,  citrate  of  magnesia,  or  any  other 


384  GENERAL   STIMULANTS.  [PART  II. 

of  the  more  soluble  saline  cathartics,  of  the  citrates  of  potassa  and  am- 
monia as  diaphoretics,  and  of  the  alkaline  carbonates  as  diuretics  and 
antilithics.  It  is  also  sometimes  useful  as  a  solvent  for  substances  not 
soluble  in  water  alone.  The  carbonate  of  iron  and  carbonate  of  mag- 
nesia are  soluble  to  a  certain  extent  in  carbonic  acid  water,  which 
thus  offers  the  means  of  agreeably  administering  these  substances  in 
solution. 

The  dose  of  the  preparation  is  not  precise.  The  patient  may,  in  gen- 
eral, be  left  to  his  own  discretion  ;  but  it  is  best  on  the  whole  to  give  it 
in  small  quantities,  as  of  a  wineglassful,  repeated  frequently,  than  very 
largely  at  once.  Seldom  more  than  from  four  to  eight  fluidounces  should 
be  taken  at  one  draught.  It  is  often  advisable  to  flavour  it  with  some 
agreeable  syrup  ;  as,  in  febrile  cases,  with  lemon  syrup,  and  in  dyspep- 
sia with  ginger  syrup ;  but  in  nausea  and  vomiting,  it  is  usually  more 
effective  when  taken  alone. 

Considerable  use  has  been  made  of  carbonic  acid  water  topically,  as  a 
gently  stimulant  agent.  Applied  by  means  of  cloths,  it  has  been  em- 
ployed advantageously  in  cancerous,  sloughing,  and  other  ill-conditioned 
ulcers,  of  which  it  relieves  the  pain,  improves  the  secretions,  and  checks 
the  gangrenous  tendency.  Fermenting  poultices  have  been  used  for  the 
same  purpose.  They  owe  their  efficacy  to  the  carbonic  acid  evolved. 

Many  natural  mineral  waters  contain  carbonic  acid  gas,  which  adds 
greatly  to  their  usefulness,  by  rendering  them  more  palatable  and  more 
acceptable  to  the  stomach. 

CARBONIC  ACID  GAS. 

Much  attention  has  been  recently  bestowed  on  the  medical  properties 
and  uses  of  carbonic  acid  in  its  pure  gaseous  form.  Towards  the  close 
of  the  last  century,  it  was  brought  into  notice,  as  an  anaesthetic  agent, 
by  an  experiment  of  Ingenhousz,  who  found  that  a  finger,  deprived  of  its 
cuticle,  and  introduced  into  oxygen  gas.  became  more  painful;  whereas, 
by  immersion  in  carbonic  acid  gas,  the  pain  was  relieved.  Acting  upon 
this  hint,  several  English  physicians  employed  it  remedially,  injecting  it 
into  the  rectum  in  dysentery,  and  applying  it  to  painful  and  ill-condi- 
tioned ulcers  on  the  surface;  and  Mr.  10 wart,  a  surgeon  of  Bath,  obtained 
great  benefit  from  it  in  cancer  of  the  breast.  The  direet  application, 
however,  of  the  pure  gas  seems  to  have  fallen  into  entire  neglect;  though 
it  has  ever  since  continued  to  be  employed,  in  the  form  of  effervescing 
draughts,  for  the  relief  of  irritable  stomach,  and  in  that  of  fermenting 
poultices,  for  gangrenous  ulcers.  In  1834,  M.  Mojon,  of  Genoa,  recom- 
mended the  injection  of  the  gas  into  the  vagina  in  dysmeborrhoBa,  and 
other  painful  affections  of  the  uterus;  and  the  practice  seems  to  have 
been  imitated  by  other  Italian  physicians.  About  the  same  time,  it 
was  employed  at  certain  mineral  springs  in  Germany  and  France,  in  the 


CHAP.  I.]  CARBONIC    ACID    GAS.  385 

form  of  air-bath  and  of  the  air-douche,  for  rheumatic  pains  and  various 
other  affections ;  the  gas  being  used  as  it  issued  from  the  natural  fount- 
ains. But  it  is  to  Sir  J.  Y.  Simpson,  of  Edinburgh,  that  we  are  mainly 
indebted  for  the  revival  of  this  remedy,  and  the  much  more  extended  use 
now  made  of  it,  Having  seen  a  notice  of  its  efficacy  in  a  case  of  uterine 
disease,  under  the  care  of  Dr.  Rossi,  of  Italy,  he  was  induced  to  give  it 
a  trial,  and  made  his  experience  with  it  public,  in  an  essay  upon  the 
subject,  written,  in  1856,  for  the  New  York  Academy  of  Medicine. 

Properties.  When  a  stream  of  carbonic  acid  gas  is  directed  upon  a 
sensitive  surface,  as  of  the  mucous  membranes,  or  the  skin  denuded  of 
the  cuticle,  it  produces  at  first  an  irritation,  variable  in  degree  according 
to  the  sensitiveness  of  the  surface,  and  sometimes  very  painful,  especially 
in  the  conjunctiva,  which,  it  is  said,  cannot  support  the  application  longer 
than  4  or  5  seconds.  In  the  nasal  passages  it  produces  an  effect  analogous 
to  that  of  ammonia,  and,  when  the  attempt  is  made  to  inhale  it,  either 
unmixed,  or  diluted  with  50  per  cent,  or  less  of  atmospheric  air,  it  causes 
so  much  irritation  in  the  larynx  that  the  glottis  closes  spasmodically,  and 
its  entrance  into  the  lungs  is  prevented.  (Herpin,  Ann.de  Therap.,  1859, 
p.  60.)  This  property  of  carbonic  acid  gas  has  been  long  known  ;  and  I 
once  convinced  myself  of  its  reality  by  cautiously  attempting  to  inhale 
the  air  over  the  surface  of  the  fermenting  liquid,  in  a  large  brewers'  vat. 
It  has  been  denied  by  Sir  J.  Y.  Simpson,  probably  from  the  circumstance 
that,  in  the  cases  in  which  he  applied  the  gas  to  the  air-passages,  it  was 
much  diluted  with  atmospherffc  air.  (See  Brailhwaite's  Retrospect,  xxxviii. 
p.  260.)  When  mixed  with  80or  90  per  cent,  of  atmospheric  air,  it  is  in- 
haled readily,  and  without  inconvenience.  Its  first  irritant  impression 
on  the  part  to  which  it  is  applied  is  soon  followed  by  a  sedative  effect 
upon  the  nervous  tissue,  by  which  pain,  if  present,  is  often  entirely  re- 
lieved. Even  ordinary  sensation  is  after  a  time  much  diminished,  as 
shown  by  an  experiment  of  Dr.  T.  A.  Demme,  of  Philadelphia,  who  im- 
mersed his  naked  arm  in  the  gas,  and,  after  ten  minutes,  found  the  skin 
so  much  benumbed  that  it  could  be  violently  pinched  without  causing 
pain.  (Med.  and  Surg.  Reporter,  Feb.  26,  1859,  p.  380.)  When  inhaled, 
in  the  diluted,  state,  the  gas  is  said  to  accelerate  the  circulation,  though 
acting  as  a  sedative  to  the  nerves.  After  a  short  continuance  of  inhala- 
tion, it  causes  a  state  of  somnolence  and  anaesthesia,  which,  according  to 
Messrs.  Faure  and  Ozanan,  who  experimented  with  it  on  the  lower  ani- 
mals, may  be  kept  up,  without  danger  to  life,  for  10,  20,  or  even  30 
minutes,  so  as  to  give  ample  time  for  the  performance  of  any  ordinary 
surgical  operation.  Though,  in  its  concentrated  state,  it  causes  speedy 
suffocation  by  excluding  air  from  the  lungs,  yet,  when  mixed  with  so 
large  a  proportion  of  common  air  as  to  be  readily  inhaled,  it  is  said  not 
to  occasion  sudden  death,  but  to  induce  insensibility  gradually,  and  with- 
out any  violent  symptoms  (Herpin,  Ann.  de  Therap.,  he.  cit.)  If  these 
VOL.  i. — 25  • 


386  GENERAL    STIMULANTS.  [PART  II. 

results  should  be  satisfactorily  confirmed  by  experiment,  carbonic  acid 
gas  would  be  a  safer  surgical  anaesthetic  than  chloroform. 

Dr.  Cl.  Bernard,  of  Paris,  has  observed  that  the  injection  of  carbonic 
acid  into  the  vagina  is  not  unfrequently  attended  with  constitutional 
effects,  similar  to  those  produced  by  its  inhalation.  The  symptoms  are 
headache,  giddiness,  abnormal  sounds  in  the  ear,  nausea,  somnolence, 
languor  and  prostration,  and  even  involuntary  discharges  of  urine;  and 
he  has  sometimes  found  them  so  threatening  as  to  preclude  the  use  of  the 
remedy.  He  noticed  the  effect  as  well  in  cases  in  which  the  surface  of 
the  vagina  retained  its  integrity,  as  in  those  in  which  there  was  ulcer- 
ation. 

Prom  a  series  of  experiments  by  MM.  Ch.  Leconte  and  J.  Dcmarquay, 
of  Paris,  on  the  effect  of  gases  injected  into  the  subcutaneous  cellular  or 
areolar  tissue,  or  cavity  of  the  peritoneum,  it  has  been  satisfactorily  de- 
termined that  carbonic  acid  thus  injected  produces  no  injurious  effect ; 
being  absorbed  in  forty-five  minutes ;  and  that,  consequently,  no  hesita- 
tion need  be  felt  in  applying  it  in  this  way,  when  from  any  cause  indicated. 
(Arch.  Gen.,  Oct.  1859,  p.  568.)  Now,  as  carbonic  acid  gas  has  pro\ed 
anaesthetic  under  various  circumstances  of  application,  it  would  probably 
be  found  so  if  injected  into  the  areolar  tissue.  At  least  it  might  be  worth 
the  trial,  in  cases  of  obstinate  local  pains  which  have  resisted  other  anes- 
thetics, or  in  which  there  may  be  some  objection  to  their  use.  MM.  Leconte 
and  Demarquay  also  ascertained  that  this  gas,  brought  into  contact  with 
divided  tendons,  facilitated  their  union. 

Uses.  The  affections  in  which  the  gas  has  been  found  most  useful, 
when  topically  applied,  are  painful  states  of  the  uterus  and  vagina,  with 
or  without  ulceration.  Great  relief  is  afforded  in  cancerous  cases;  and 
sometimes  ulcers  of  this  character,  at  the  neck  of  the  womb,  are  said  to 
have  been  much  benefited,  and  even  healed  under  its  influence.  (Cl. 
Bernard,  loc.  cit.)  The  anodyne  influence  of  the  gas  is  sometimes  pre- 
ceded by  severe  burning  pain,  which  is  diffused  through  the  pelvis;  and 
this  is  said  occasionally  to  be  so  inconvenient  as  to  prevent  the  use  of 
the  remedy.  But  in  general  the  uneasiness,  if  produced,  soon  subsides, 
and  is  followed  by  the  anaesthetic  effect.  The  application  may  be  re- 
peated twice  or  three  times  daily;  and  each  time  may  continue  fifteen 
minutes  or  longer;  but  should  always  lie  suspended  on  the  occiirrenee 
of  constitutional  symptoms. 

.Much  relief  is  also  asserted  to  have  been  obtained  from  the  remedy  in 
irritable  stales  of  the  bladder,  with  painful  micturition.  It  is  injected 
through  the  urethra,  by  means  of  a  double  catheter,  by  which  injurious 
accumulation  and  distension  of  the  vi.-eus  are  prevented.  Sometimes, 
as  from  injections  into  the  vagina,  the  pain  is  very  severe.  According 
to  Dr.  Robert  Johns,  of  Ireland,  who  has  had  considerable  experience 
with  the  remedy,  it  should  not  be  repeated,  as  a  general  rule,  oftener 


CHAP.  I.]  CARBONIC   ACID    GAS.  387 

than  once  daily,  and  the  bladder  should  be  well  washed  out  with  warm 
water  before  the  application.  (See  Am.  Journ.  of  Med.  Sci.,  N.  S.,  xxxvi. 
561.) 

In  the  tenesmus  of  dysentery  relief  may  be  expected  from  the  injec- 
tion of  carbonic  acid  gas  into  the  bowels ;  and  it  has  been  already  stated 
that  this  use  of  the  remedy  was  made  before  the  commencement  of  the 
present  century. 

The  same  is  true  of  its  employment  in  external  cancer  and  other  ill- 
conditioned  ulcers;  and  Sir  J.  Y.  Simpson  recommends  it  in  wound? 
and  burns.  It  is  said  not  only  to  relieve  the  pain  of  these  ulcers,  but  to 
promote  their  cure. 

In  the  photophobia  attendant  upon  scrofulous  disease  of  the  conjunc- 
tiva, a  stream  of  the  gas  properly  diluted  has  been  found  useful ;  but  its 
intensely  irritating  effect,  when  too  concentrated,  must  be  borne  in  mind. 
Good  might  be  expected  from  it  in  that  not  uncommon,  and  very  painful 
affection,  in  which  exposure  to  light  produces  great  suffering,  from  an 
over-sensitive  state  of  the  retina.  In  a  case  of  severe  earache,  Dr. 
Demme  obtained  very  favourable  effects  from  the  introduction  of  the  gae 
into  the  external  meatus.  (Med.  and  Surg.  Reporter,  loc.  cit.) 

Employed,  in  a  much  diluted  state,  by  inhalation,  it  is  said  to  have 
proved  useful  in  chronic  bronchitis,  laryngitis,  and  pharyngitis,  and  in 
asthma  and  irritable  cough.  In  this  way  it  has  been  employed,  to  a 
considerable  extent,  by  Bischoff  and  others  in  Germany;  and,  as  as- 
serted, without  unpleasant  effects.  It  is  not,  however,  considered  appli- 
cable to  acute  inflammation  of  the  air-passages,  or  to  phthisis.  (See  Am. 
Journ.  of  Med.  Sci.,  April,  1859,  p.  543.)  Should  the  remedy  be  used 
by  inhalation,  its  application  should  be  watched  by  skilful  persons,  and 
the  danger  of  fatal  asphyxia  be  most  carefully  guarded  against.  The 
physician  could  not  be  held  unaccountable,  should  serious  consequences 
occur,  either  through  his  own  carelessness,  or  the  ignorance  of  those  to 
whom  he  may  entrust  the  use  of  the  remedy. 

Mode  of  Application.  The  most  convenient  method  of  applying  the 
gas,  is  by  means  of  a  flexible  caoutchouc  or  gutta  percha  tube,  proceed- 
ing from  a  bottle  in  which  it  is  generated.  A  Wolfe's  bottle  may  be  used 
having  three  tubulures,  into  one  of  which  the  exit  tube  is  inserted,  in 
another  a  safety  tube  with  its  lower  end  beneath  the  surface  of  liquid  in 
the  bottle,  and  in  the  third  a  stopper  removable  at  pleasure.  A  mixture 
of  five  drachms  of  bicarbonate  of  soda  and  four  of  bisulphate  of  potassa, 
in  the  form  of  powder,  is  first  introduced,  and,  when  the  instrument  is  to 
be  used,  water  is  poured  in  sufficient  to  cover  them.  Sir  J.  Y.  Simpson 
uses  eight  drachms  of  crystallized  bicarbonate  of  soda,  six  drachms  of 
crystallized  tartaric  acid,  and  four  or  five  ounces  of  water.  When  the 
evolution  of  the  gas  begins  to  slacken,  it  may  be  increased  by  shaking 
the  bottle. 


388  GENERAL   STIMULANTS.  [PART  II. 


2.  Mineral  Tonics  Acting  on  the  System  generally, 
through  Us  Vital  Properties. 

It  is  at  present  no  longer  doubted  that  the  medicines  belonging  to  this 
subdivision  enter  the  circulation,  and  thus  come  into  contact  with  all  the 
tissues.  They  operate  primarily  on  the  alimentary  mucous  membrane, 
in  a  manner  closely  analogous  to  that  of  the  mineral  acids ;  that  is,  they 
moderately  stimulate  or  excite  the  function  of  the  membrane,  or,  in  other 
words,  act  as  tonics.  But  they  are  all,  moreover,  somewhat  astringent, 
causing  a  contraction  of  the  tissues,  like  alum  or  acetate  of  lead,  though 
in  a  less  degree ;  for  a  very  energetic  contraction  would  interfere  \vith 
the  functions  of  the  membrane,  and  thus  prevent  the  proper  tonic  effect 
Jt  is  highly  probable  that  they  operate,  in  a  manner  precisely  analogous, 
upon  the  various  tissues  of  the  body  which  they  reach  through  the  blood. 
Producing  a  slight  increase  of  the  vital  cohesion  of  the  molecules  of  the 
tissues,  they  give  them  a  greater  power,  while,  by  a  gentle  excitation, 
they  call  this  power  into  a  somewhat  higher  exercise.  But,  while  thus 
generally  tonic  and  astringent,  they  are  disposed  to  act  more  especially 
upon  the  nervous  centres ;  or,  to  speak  more  precisely,  the  organized 
nervous  substance  of  these  centres  seems  to  be  peculiarly  susceptible  to 
be  impressed  by  them,  and  to  take  on,  under  their  influence,  a  condition 
of  greater  firmness  or  compactness,  which  enables  them,  if  previously 
weakened,  to  perform  their  proper  function  more  efficiently.  Here  we 
have  the  secret  of  one  of  the  most  important  therapeutic  effects  of  this 
set  of  tonics;  that,  namely,  of  controlling  the  irritability  of  the  nervous 
centres,  and  thus  obviating  various  nervous  disorders,  and  especially 
muscular  spasm.  From  their  influence  in  this  way,  they  have  not  unfre- 
quently  been  considered  as  antispasmodic,  and  been  so  denominated. 
Spasm,  as  well  as  most  other  irregular  nervous  phenomena,  depends 
upon  a  disturbance  in  the  nervous  centres,  produced  generally  from  some 
source  extraneous  to  themselves.  The  more  movable  or  excitable  these 
centres  are,  the  more  liable  will  they  be  to  give  rise  to  these  irregular 
phenomena  under  irritating  influence.  Now  the  tonics  here  referred  to, 
by  increasing  the  vital  cohesion  of  their  molecules,  and  rendering  their 
structure  firmer,  enable  them  better  to  resist  disturbing  causes;  at  the 
same  time  supporting  due  action  in  them  by  a  gentle  stimulation.  The 
disordered  phenomena  cease  ;  and,  by  a  sufficient  persistence  in  the  use 
of  the  remedy,  the  centres  may  acquire  a  permanent  capacity  of  resist- 
ance, which  may  lead  to  a  permanent  cure.  Hence,  it  is  in  the  various 
nervous  diseases,  such  as  hysteria,  chorea,  and  epilepsy,  that  these  tonics 
have  acquired  the  highest  reputation,  and  are  most  extensively  used. 


CHAP.  I.]  MINERAL   TONICS. — SILVER.  389 

Some  suppose  that  they  act  by  entering  into  chemical  combination  with 
the  constituents  of  the  tissue,  and  thus  forming  a  part  of  the  organiza- 
tion itself;  and  that  their  effects  are  to  be  explained  by  the  new  qualities 
which  the  tissues  acquire  through  this  change  of  structure.  They  sup- 
port this  opinion  by  the  fact,  that  the  metallic  ingredient  of  these  medi- 
cines is  found  in  the  very  substance  of  the  organs,  from  which  it  can  be 
separated  after  death,  supposing  the  patient  to  have  died  while  under 
their  influence.  But  this  is  no  proof  whatever,  and  scarcely  even  in  any 
degree  confirmatory  of  the  notion  of  a  chemical  union.  The  metal  may 
be  in  the  capillaries  of  the  organ ;  it  may  be  deposited  in  the  very  sub- 
stance of  the  tissue ;  it  may  even  be  there  combined  with  some  organic 
principle  derived  from  the  blood  or  from  the  tissue;  but  even  admitting 
all  this,  it  does  not  follow  that  it  is  chemically  combined  with  the  con- 
stituents of  the  tissue  in  their  organized  state;  and  it  is  not  easy  to  con- 
ceive how  a  foreign  body,  thus  thrust  into  the  constitution  of  the  nucleus 
or  cell,  which  performs  the  office  of  the  tissue,  would  enable  it  to  perform 
that  office  more  effectively.  We  may  conceive  that  a  metallic  substance 
may  possibly  enter  into  such  a  union ;  but  it  would  be  to  impair,  not  to 
improve  the  function  ;  it  would  be  to  produce  the  effects  of  a  poison,  and 
not  those  of  a  remedy.  Indeed,  it  is  not  improbable  that  some  metallic 
poisons  operate  in  this  way ;  but  more  positive  proof  must  be  adduced, 
before  we  can  admit  that  medicines  produce  their  curative  effect  through 
such  a  combination,  and  especially  medicines  whose  immediate  opera- 
tion is  to  improve  and  to  invigorate. 


I.  SILVER, 

ARGENTUM.  U.  S. 

REFINED  SILVER.  Br.  Appendix. 

Metallic  silver  is  quite  inert,  and  may  lie  for  a  long  time  in  the  ali- 
mentary canal  without  sensible  effect.  It  is  only  in  chemical  combina- 
tion that  it  becomes  efficient.  As  all  the  constitutional  effects  of  its  pre- 
parations can  be  obtained  by  the  exhibition  of  the  nitrate,  and  as  this  is 
generally  preferred  in  practice,  it  may  conveniently  represent  the  metal 
in  its  relations  to  the  system  at  large ;  and  all  that  it  is  necessary  to  say, 
in  reference  to  the  operation  and  uses  of  silver  as  a  medicine,  may  be 
included  in  our  consideration  of  that  salt.  Afterwards,  nothing  need  be 
noticed,  in  relation  to  the  other  preparations,  except  what  may  be  pecu- 
liar to  them  severally. 


390  GENERAL    STIMULANTS.  [PART  II. 

NITRATE  OF  SILVER.— ARQENTI  NITRAS.  U.  S.,  Br.  —  Lunar 
Caustic. 

Origin.  This  salt  has  been  known  since  the  times  of  Gebev,  who  de- 
scribed the  mode  of  preparing  it.  I  propose  to  treat  of  it,  in  this  place, 
solely  in  reference  to  its  internal  use.  As  an  external  remedy,  it  is 
among  the  most  valuable;  but  the  consideration  of  it,  in  this  capacity, 
belongs  to  another  part  of  the  work.  (See  Escharotics  and  Protectives.) 
It  is  kept  in  two  forms;  one,  that  of  cylindrical  sticks,  adapted  for  topi- 
cal use,  and  frequently  called  lunar  caustic;  the  second,  that  of  crystals, 
which  are  preferred  when  the  medicine  is  to  be  given  internally.  It  is 
to  the  latter  that  the  following  remarks  apply. 

The  crystals  of  nitrate  of  silver  are  prepared  by  dissolving  silver  in 
nitric  acid  with  a  little  water,  and  then  evaporating,,  so  that  crystalliza- 
tion may  take  place  upon  the  cooling  of  the  liquid.  They  should  be 
kept  in  well-stopped  bottles,  from  the  interior  of  which  everything  or- 
ganic should  be  excluded. 

Composition.  Crystallized  nitrate  of  silver  consists  of  one  equivalent 
of  nitric  acid  and  one  of  protoxide  of  silver,  without  water  of  crystal- 
lization. 

Properties.  The  crystals  are  colourless,  transparent,  and  in  the  form 
of  rhomboidal  plates.  They  are  inodorous,  but  of  a  strong,  bitter, 
metallic,  peculiar,  extremely  disagreeable,  and  adhesive  taste.  Water 
and  alcohol  dissolve  them  freely,  especially  the  former,  which  takes  up 
its  own  weight  of  the  salt.  At  a  moderate  heat  they  melt,  and  at  a 
strong  heat  are  decomposed.  In  contact  with  the  smallest  portion  of 
organic  matter,  they  blacken  on  exposure  to  light;  but  they  remain  un- 
changed, even  by  the  sun's  rays,  in  the  entire  absence  of  such  matter. 
Their  solution  in  pure  distilled  water  is  similarly  unaffected  by  sunlight, 
unless  organic  matter  is  present,  in  which  case  it  is  darkened.  The 
change  of  colour  is  owing  to  a  partial  reduction  of  the  silver. 

Incompalibles.  Nitrate  of  silver  is  decomposed,  with  the  formation  of 
insoluble  products,  or  such  as  are  but  slightly  soluble,  by  the  alkalies, 
alkaline  earths,  their  carbonates,  and  soap ;  by  sulphuric,  muriatic,  hy- 
driodic,  phosphoric,  hydrosulphuric,  and  tartaric  acids,  and  all  the  soluble 
salts  formed  by  the  reaction  of  these  acids  with  sail  liable  bases,  conse- 
quently by  the  soluble  sulphates,  muriates,  phosphates,  tartratcs,  chlo- 
rides, iodides,  and  sulphurets;  and  by  astringent  vegetable  infusions,  in 
consequence  of  their  tannic  acid.  With  albumen  and  fibrin  it  unites, 
forming  compounds  insoluble  in  water;  but  it  is  a  fact  of  sonic  import- 
ance, in  explanation  of  the  operation  of  the  salt  on  the  system,  that  the 
albuminate  of  the  nitrate  of  silver  thus  formed  is  soluble  in  an  excess  of 
albumen.  Of  like  significance  is  also  the  fact,  that  the  insoluble  chloride 
of  silver,  which  is  formed  whenever  the  nitrate  comes  into  contact  with 


CHAP.  I.]  MINERAL   TONICS. — NITRATE   OF   SILVER.  391 

muriatic  acid  or  a  soluble  chloride,  is  rendered  soluble  by  an  excess  of 
chloride  of  sodium  or  potassium.* 

In  consequence  of  the  great  number  of  substances  which  decompose 
the  nitrate,  or  combine  with  it,  and  the  constant  presence  in  the  stomach 
of  one  or  more  of  these  substances,  especially  albumen,  muriatic  acid,  or 
a  chloride,  it  is  scarcely  possible  that  it  can  long  retain  its  integrity  after 
having  been  swallowed ;  though  it  may  do  so  sufficiently  long  to  exert 
a  direct  influence  on  the  mucous  coat.  That  it  should  enter  the  small 
intestines  as  nitrate  of  silver,  appears  to  me  to  be  clearly  impossible, 
unless  swallowed  in  quantities  so  large  as  to  be  poisonous,  or  unless  so 
incorporated  with  other  substances  in  the  form  of  pill,  that,  in  this  shape, 
it  may  pass  through  the  stomach  before  the  pill  is  broken  up,  and  its 
interior  exposed  to  the  reagents  there  existing. 

Effects  on  the  System.  Locally,  nitrate  of  silver  is  powerfully  irritant, 
and,  in  a  concentrated  state,  acts  as  an  escharotic  by  combining  with  the 
albuminous  matter  of  the  tissues,  and  thus  disorganizing  them.  When 
in  contact  with  the  mucous  membranes,  with  ulcers,  or  with  the  skin 
deprived  of  the  cuticle,  it  combines  with  the  albumen  of  the  secreted 
matters,  and  often  with  that  of  the  tissue  itself,  forming  a  white  and  insol- 
uble compound,  which  covers  the  surface ;  and  this  happens  as  well  in 
the  gastric  and  intestinal  mucous  membranes,  as  in  those  visible  from 
without.  Applied  to  the  skin,  it  soon  produces  a  black  stain,  in  conse- 
quence of  the  partial  reduction  of  the  silver  by  reaction  with  the  cuticle. 
This  black  stain  usually  remains  until  the  cuticle  separates,  either  grad- 
ually, or  at  once  completely,  as  in  vesication.  It  may  be  removed, 
however,  by  applying  to  the  spot  the  tincture  of  iodine,  and  following 
this  with  a  solution  of  hyposulphite  of  soda;  or  by  the  similar  applica- 
tion of  a  solution  of  cyanide  or  of  iodo- cyanide  of  potassium.  (Journ. 
de  Pharm.,  Nov.  1865,  p.  414.)  These  remarks,  in  reference  to  the  local 
effects  of  nitrate  of  silver,  will  be  extended  in  a  subsequent  account  of 
the  escharotic  and  protective  operation  of  the  salt.  At  present,  they 
seemed  necessary  to  explain  the  effects  of  the  medicine  upon  the  stomach. 

In  very  small  doses,  repeated  two  or  three  times  a  day,  nitrate  of 
silver  produces  no  other  observable  effects  than  those  of  a  gentle  tonic 
and  astringent;  as  improved  appetite,  invigorated  digestion,  and  per- 
haps a  tendency  to  costiveness.  Taken  more  largely,  it  causes  warmth 
of  stomach,  and  some  gastric  uneasiness,  indicating  an  irritant  action, 

*  Some  doubt  is  thrown  upon  the  uniform  occurrence  of  the  chemical  reaction 
here  referred  to,  by  an  experiment  of  Professor  Procter,  performed  at  my  request. 
A  drop  of  solution  of  nitrate  of  silver  was  made  to  fall  into  a  solution  of  chloride  of 
sodium,  and  produced  a  precipitate;  yet,  after  long  contact  of  this  precipitate  with 
the  supernatant  solution,  the  latter,  when  filtered  off.  gave  no  evidence  of  the  pres- 
ence of  silver  when  applied  to  bright  copper,  and  touched  with  bright  iron;  and  the 
taste  was  purely  saline. 


392  GENERAL   STIMULANTS.  [PART  II. 

which,  upon  a  still  further  increase  of  the  quantity,  is  evinced  by  gastric 
pains,  sometimes  nausea  and  vomiting,  and  occasionally  also  by  griping 
pains  in  the  bowels,  with  either  diarrhoea  or  constipation.  As  to  the 
degree  of  irritant  effect,  much  depends  on  the  mode  of  administration, 
and  the  condition  of  the  stomach  at  the  time.  It  has  been  repeatedly 
observed  that,  in  the  form  of  pill,  large  doses  produce  little  irritation; 
while  a  smaller  quantity  will  violently  irritate,  if  given  in  solution.  Dr. 
Powell  found  that  he  could  sometimes  give  fifteen  grains  in  pill,  while 
five  grains  in  solution  could  rarely  be  borne  by  the  stomach,  (llfed.-chir. 
Trans.,  ix.  238.)  The  result  is  obviously  owing,  in  the  instance  of  the 
solution,  to  the  whole  quantity  being  brought  at  once  into  contact  with 
the  surface  of  the  stomach,  before  time  has  been  allowed  for  decompo- 
sition ;  while,  in  the  pilular  form,  dissolving  gradually,  it  acts  also  grad- 
ually, and  is  more  liable  to  decomposition  before  it  can  act  at  all.  When 
the  stomach  is  full  of  food,  the  medicine  would  be  much  more  exposed 
to  decomposing  reagencies  than  when  it  is  empty,  and  would  con- 
sequently be  less  likely  to  irritate;  for  all  the  insoluble  substances  re- 
sulting from  the  chemical  changes  of  the  nitrate  in  the  stomach  arc 
much  less  irritant  than  the  salt  itself.  Thus,  the  chloride  of  silver,  which 
must  be  among  the  most  common  products,  may  be  given  in  large  doses, 
without  observable  effect. 

How  far  nitrate  of  silver  would  operate  as  a  deadly  poison,  in  exces- 
sive amount  in  the  human  subject,  is  left  very  much  to  inference;  for  few 
cases  of  acute  and  fatal  poisoning  from  this  substance  have  been  re- 
corded. Boerhaavc  mentions  the  case  of  a  pharmaceutical  student, 
who,  having  swallowed  a  portion  of  lunar  caustic,  died  from  gangrene 
of  the  first  passages.  But  this  is  the  only  case  of  the  kind  that  1  have 
met  with  in  the  books.  In  the  Bulletin  Generale  de  Therap.  (Sept. 
1839),  the  case  of  a  young  man  is  related,  who,  after  having  taken  a  large 
quantity  of  the  salt  in  solution,  an  ounce,  according  to  his  own  account 
after  recovery,  was  carried  to  the  Hospital  St.  Louis,  in  Paris,  quite  in- 
sensible in  all  parts  of  the  body,  with  convulsive  movements  of  the  face 
and  upper  limbs,  jaws  firmly  closed,  eyes  rolled  up,  and  pupils  dilated 
and  insensible  to  light.  Common  salt  was  li'iven  freely,  and  afterwards 
emollient  drink.-!.  When  sensibility  began  to  return,  the  patient  suffered 
from  violent  epigastric  pains.  He  ultimately  recovered  without  serious 
consequences.  The  effects  upon  the  nervous  system  may  have  been 
sympathetic  with  those  upon  the  stomach,  which  was,  no  doubt,  in- 
tensely irritated.  (See  Am.  Journ.  of  Med.  Sci.,  N.  S.,  xxvi.  239.)  Orfila 
found  that  from  twenty  to  thirty-six  grains,  introduced  into  the  stomach 
of  a  dog,  caused  death  with  I  lie  phenomena  of  corrosive  poisoning,  and 
that  ulceration  in  the  alimentary  canal  was  produced.  The  fact  proba- 
bly is,  that  large  doses  may  be  borne  without  immediately  fatal  conse- 
quences, partly  from  the  rapid  chemical  change  which  the  salt  under- 


CHAP.  I.]  MINERAL   TONICS. — NITRATE   OF    SILVER.  393 

goes,  and  partly  from  its  superficial  caustic  operation,  by  which  an 
extremely  thin  layer  of  epithelium  is  disorganized,  and,  forming  with  it 
an  impermeable  film,  protects  the  deeper  and  more  vital  parts  of  the 
membrane  from  destruction.  But,  admitting  this,  it  must  be  allowed 
that  a  frequent  repetition  of  these  large  doses  might  gradually  corrode 
into  the  deeper  structure,  and  death  ensue  at  last  from  the  slow  and 
continued  operation  of  the  poison.  Esquirol  mentions  a  case,  in  which 
nitrate  of  silver  was  given  freely  during  a  period  of  eighteen  months,  at 
the  end  of  which  time  the  patient  died,  and  the  stomach  was  found  des- 
titute of  the  mucous  coat  over  one-half  of  the  inner  surface,  with  several 
points  of  corrosion  to  the  peritoneal  coat. 

Nitrate  of  silver,  therefore,  must  be  ranked  among  the  corrosive  pois- 
ons. In  acute  cases  of  its  poisonous  operation,  the  treatment  should 
consist  in  the  use  of  common  salt,  or,  if  this  is  wanting,  of  the  white  of 
eggs,  and  a  thorough  washing  out  of  the  stomach  by  diluent  drinks,  or 
other  means  if  necessary.  Opiates  should  afterwards  be  administered, 
in  the  form  of  enema,  to  quiet  irritation  ;  and  the  resulting  inflammation 
must  be  treated  on  general  principles;  care  being  taken  not  to  exhaust 
the  patient  by  too  copious  depletion. 

Hitherto  I  have  considered  only  the  local  operation  of  the  medicine 
on  the  alimentary  canal.  It  acts  also  on  the  system  at  large,  through 
the  circulation.  Of  its  absorption,  or  rather  of  the  absorption  of  the 
metal  in  one  form  or  another,  there  can  be  no  reasonable  doubt.  Leaving 
out  of  view  the  statements  made  as  to  the  discovery  of  metallic  silver 
in  the  pancreas  after  death,  wre  have  Orfila's  declaration  that  he  has 
found  it  in  the  liver  of  animals  to  which  the  nitrate  has  been  adminis- 
tered for  some  time  (see  Lond.  Med.  Times  and  Gaz.,  March,  1852, 
p.  279);  and,  in  addition  to  this,  the  indisputable  evidence  of  the  discol- 
oration of  skin  produced  by  it.  In  any  dose  in  which  it  is  ordinarily 
given,  its  physiological  influence  upon  the  general  functions  is  not  strik- 
ing. There  may  possibly  be  some  increase  in  the  frequency  or  force  of 
the  pulse,  and  the  general  temperature;  but  these  results  are  much  less 
observable  than  from  the  more  powerful  of  the  vegetable  tonics.  Sali- 
vation is  said  to  have  been  sometimes  produced,  and  writers  speak  of  an 
eruption  upon  the  skin;  but  I  am  not  certain  that  I  have  witnessed 
either.  One  effect,  however,  is  very  striking.  When  the  medicine  is 
given  in  large  doses,  and  long  persevered  with,  a  darkening  of  the  skin 
is  sometimes  produced,  which  gradually  deepens,  till  the  whole  surface 
of  the  body  assumes  a  bluish-slate  colour,  extremely  disagreeable  to  the 
eye,  as  totally  differing  from  any  natural  tint.  The  discoloration  is 
deepest  in  the  parts  exposed  to  light;  but  is  said  also  to  have  been  ob- 
served in  the  interior  tissues,  and  in  one  instance  to  have  pervaded  the 
whole  body;  though  this  last  statement  may  be  considered  as  wanting 
confirmation.  It  is  asserted  that,  in  many  instances,  it  does  not  occur 


394  GENERAL    STIMULANTS.  [PART  II. 

uutil  months  after  the  medicine  has  been  discontinued,  and  its  favourable 
effects  experienced.  (Sigmund,  London  Lancet.  March  31,  1838.)  In  con- 
nection with  this  fact,  may  be  mentioned  the  detection  by  Orfila  of  silver  in 
the  liver  of  animals,  to  which  the  nitrate  had  been  given,  six  months  after 
its  administration,  showing  that  it  is  apt  to  become  fixed  in  the  tissues. 
In  seven  months,  however,  it  had  disappeared,  and  he  could  find  no  evi- 
dence of  its  existence  in  any  part  of  the  body.  (Lond  Jled.  Times  and 
Gaz  ,  March.  1852,  p.  279.)  So  far  as  any  inference  can  be  drawn  from 
this  fact,  it  is  that  a  patient  cannot  be  considered  free  from  the  danger  of 
discoloration  in  less  than  seven  months  after  the  omission  of  the  medi- 
cine. The  discoloration  is  generally  permanent ;  but  is  said  to  have  m 
siimc  instances  diminished  with  time,  or  under  the  operation  of  certain 
remedial  measures.  The  seat  of  it  is  the  true  skin  ;  for  it  remains  unaf- 
fected when  the  cuticle  is  removed  by  a  blister.  The  obvious  explanation 
of  the  phenomenon  is,  that  the  preparation  of  silver  circulating  with  the 
blood,  when  it  enters  the  tissue  of  the  true  skin,  and  is  thus  exposed  more 
or  less  to  exterior  influences,  as  of  light  and  the  air,  undergoes  decomposi- 
tion, with  the  deposition  of  the  partially  reduced  metal,  probably  in  the 
state  of  a  suboxide.  This  being  insoluble  in  the  blood,  or  in  any  liquid 
which  the  parts  can  generate,  remains  unabsorbed  in  the  tissue.  Happily, 
before  the  skin  begins  to  exhibit  this  hue,  a  similar  dark  discoloration  usu- 
ally appears  upon  the  gums  and  tongue  and  in  the  fauces,  and  serves,  if 
observed,  to  put  the  practitioner  upon  his  guard.  It  is  said  that  the  dis- 
coloration has  disappeared  under  a  steady  course  of  cream  of  tartar.  Dr. 
Pereira  states,  in  his  work  on  Materia  Medica  (3d  ed.,  page  886),  that 
he  has  been  informed  of  a  case  in  which  washes  of  dilute  nitric  acid 
diminished  it.  Iodide  of  potassium  has  been  proposed  as  a  remedy;  but 
has  proved  ineii'ectiuil. 

From  what  has  been  already  said  of  the  facility  with  which  nitrate  of 
silver  is  either  decomposed,  or  otherwise  rendered  insoluble  by  chemical 
reaction,  it  is  highly  improbable  that  it  ever  enters  the  circulation  with- 
out change.  There  are,  however,  two  known  states  of  combination,  in 
which  the  metal  may  possibly  be  absorbed  when  the  nitrate  is  adminis- 
tered. One  of  these  is  in  the  compound  of  nitrate  of  silver  with  albumen, 
which  is  soluble  in  an  excess  of  albumen,  and  consequently  in  the  blood, 
and  the  other  in  the  double  compound  of  chloride  of  silver  and  sodium, 
which  is  said  to  be  soluble  in  water.  (See  pages  o'JO-1.)  As  the  albu- 
minate  undergoes  the  darkening  process  out  of  the  body  on  exposure,  it  is 
highly  probable  that  it  undergoes  the  same  change  in  the  tissue  of  the 
skin,  with  a  less  degree  of  the  same  exposure. 

Therapeutic  Application.  Besides  the  uses  of  the  nitrate  as  an  ex- 
ternal remedy,  which  will  be  noticed  elsewhere,  it  is  employed  for  two 
distinct  purposes;  the  one,  for  its  direct  influence  on  the  alimentary 


CHAP.  I.]  MINERAL   TONICS. — NITRATE   OF   SILVER.  395 

mucous  membrane,  the  other,  for  its  effects  upon  the  system  at  large 
through  the  circulation. 

1.  For  its  influence  on  the  stomach  and  bowels,  it  might  be  employed, 
in  minute  doses,  as  a  tonic,  in  debilitated  states  of  their  functions;  but 
other  remedies  answer  the  indications  so  much  more  conveniently  and 
effectively,  that  it  is  very  seldom  used  for  this  special  purpose.  Still,  as 
it  has  been  supposed  to  exercise  a  peculiar  influence  over  the  nervous 
tissue,  it  has  been  recommended  in  certain  painful  affections  sometimes 
dependent  on  dyspepsia,  as  gastrodynia  and  pyrosis;  and  it  has  been 
found  useful  in  morbid  sensitiveness  of  the  stomach.  But  it  is  vastly 
more  beneficial,  given  rather  freely,  through  its  alterative  action  upon 
the  mucous  membrane  in  a  state  of  chronic  inflammation  or  ulceration; 
and  has  been  strenuously  recommended  even  in  active  irritation  or  acute 
inflammation  of  the  same  tissue. 

In  chronic  gastritis  of  the  worst  kind,  I  know  of  no  remedy  so  effectual 
as  nitrate  of  silver.  Recommended  originally,  so  far  as  I  am  aware,  by 
Dr.  Hudson,  of  Dublin,  in  this  affection,  it  has  been  employed  by  me 
habitually  since  the  first  published  notice,  and  with  the  happiest  effects 
in  most  obstinate  cases.  I  have  not  been  in  the  habit  of  using  it  in  mild 
cases,  which  yield  readily  to  a  regulated  diet,  with  other  suitable  hygienic 
measures,  and  with  little  aid  from  medicine ;  but,  in  those  severe  and 
obstinate  forms  of  the  affection,  which  have  set  all  ordinary  means  at 
defiance,  I  have  found  it  a  most  valuable  resource.  The  cases  in  which 
it  has  appeared  to  me  to  do  most  good  are  those  attended  with  incessant 
vomiting  of  food,  and  often  with  a  smooth  dryish  tongue,  apparently 
destitute  of  the  papillary  structure.  I  have  used  it,  too,  whenever  I  sus- 
pected the  existence  of  ulcers  in  the  stomach.  One  case  of  yeasty  vomit- 
ing, of  a  most  obstinate  character,  and  probably  dependent  on  an  ulcer 
near  the  pylorus,  yielded  in  the  course  of  two  or  three  months  to  this 
remedy.  One  most  striking  instance,  in  which  I  have  little  doubt  that 
it  was  the  means  of  saving  life,  was  that  of  a  female  patient  in  the 
Pennsylvania  Hospital,  who  had  been  reduced^to  the  last  degree  of 
emaciation  and  debility,  and  whose  death  I  was  looking  for  from  hour 
to  hour.  The  stomach  had  long  refused  to  retain  food,  and  the  slightest 
nutriment  induced  vomiting.  I  directed  that  nothing  whatever  should 
be  taken  into  the  stomach,  except  a  little  cold  water,  and  pills  of  nitrate 
of  silver  with  opium,  repeated  three  or  four  times  a  day;  life  being  sus- 
tained by  the  injection  of  rich  soups  with  laudanum  into  the  bowels. 
The  vomiting  ceased  under  this  treatment;  in  a  few  days  a  disposition 
for  food  returned,  which  was  very  cautiously  indulged ;  and  the  patient 
went  on  gradually  improving,  until  her  health  was  perfectly  re-estab- 
lished after  many  months  of  illness.  I  believe  the  remedy  acts,  in  these 
cases,  very  much  as  it  does  upon  the  visible  mucous  surfaces  when  in- 
flamed. Combining  with  the  outer  layer  of  the  epithelium,  or  of  the 


396  GENERAL   STIMULANTS.  [PART  II. 

ulcerated  surface,  it  forms  a  thin  coating,  which  protects  the  diseased 
tissue  beneath  from  irritating  matters  in  the  stomach,  whether  derived 
from  its  own  secretion  or  from  without,  and  at  the  same  time,  by  its 
astringent  and  tonic  properties,  imparts  a  healthy  contraction  and  tone 
to  the  expanded  vessels.  To  produce  this  effect,  it  must  be  in  the  state 
of  the  nitrate.  The  oxide  or  the  chloride  will  not  at  all  answer  as  a  sub- 
stitute. Hence  the  importance  of  giving  the  medicine  upon  an  empty 
stomach,  when  it  will  be  less  likely  to  encounter  decomposing  substances, 
and  will  thus  be  enabled  to  exert  its  full  influence  on  the  diseased  mem- 
brane. In  these  cases,  I  have  never  administered  large  doses  of  the  salt 
Beginning  with  one-quarter  or  one-third  of  a  grain,  combined  with  from 
an  eighth  to  half  of  a  grain  of  opium,  repeated  three  or  four  times  a 
day,  I  have  very  gradually  increased,  if  the  symptoms  otherwise  refused 
to  yield,  up  to  one  grain  at  each  dose;  but  have  never  exceeded  that 
quantity. 

In  chronic  enteritis,  also,  great  benefit  is  said  to  have  accrued  from 
the  nitrate  of  silver;  though,  in  the  trials  I  have  made  with  it,  the  results 
have  been  much  less  favourable  than  in  the  gastric  cases.  It  probably 
seldom  enters  the  small  intestines,  or  at  least  penetrates  far  into  them, 
without  being  decomposed,  and  thus  rendered  unable  to  act  on  the  sur- 
face of  the  bowel  in  the  method  above  referred  to.  In  ulcerative  affections 
and  chronic  inflammation  of  the  small  intestines,  it  has  appeared  to  me 
less  effective  than  sulphate  of  copper.  Nevertheless,  much  testimony 
might  be  adduced  in  its  favour,  not  only  in  chronic,  but  even  in  acute 
inflammation  of  the  alimentary  mucous  membrane. 

Trousseau  strongly  commends  its  use  in  acute  dysentery,  giving  half 
a  grain  of  the  nitrate  of  silver,  and  the  same  quantity  of  nitre,  made  into 
a  pill  with  starch,  repeated  every  half  hour  till  it  begins  to  purge;  at  the 
same  time  administering,  twice  a  day,  an  enema  composed  of  a  pint  of 
distilled  water  holding  from  three  to  ten  grains  of  the  salt  of  silver  in 
solution.  (Trousseau  et  Pidoux,  Traite  de  Therap.,  4e  ed.,  i.  354.)  The 
latter  part  of  the  treatment,  that,  namely,  by  injection  into  the  rectum, 
has  been  imitated  with  great  asserted  success  in  some  severe  cases  of 
the  disease;  though  the  measure  has  failed  in  many  others.  Of  the  uso 
of  nitrate  of  silver  by  the  mouth,  in  this  complaint,  I  have  had  no 
experience. 

The  same  practitioner  has  found  the  medicine  very  useful  in  infantile 
diarrhoea.  In  cases  attended  with  tormina,  and  glairy  or  bloody  stools, 
he  gives,  morning  and  evening,  an  enema  consisting  of  eight  ounces  of 
distilled  water  with  one  or  two  grains  of  the  nitrate,  according  to  the 
age;  in  other  cases,  characterized  by  nausea,  and  serous,  green,  or  lien- 
teric  passages,  he  administers  by  the  mouth  from  the  twentieth  to  tin- 
fifth  of  a  grain  dissolved  in  sweetened  water.  (Ibid.,  p.  355  )  The  same 
practice  has  been  employed  with  success  in  our  indigenous  cholera  in- 


CHAP.  I.]  MINERAL   TONICS. — NITRATE   OF   SILVER.  397 

fanlum,  when  there  was  good  reason  to  suspect  the  existence  of  ulcera- 
tion  of  the  bowels;  and  it  is  certainly  among  the  measures  to  which  the 
prudent  practitioner  would  be  justified  in  resorting,  in  obstinate  cases  of 
the  disease. 

By  M.  Boudin,  of  Marseilles,  the  nitrate  was  recommended  so  long 
since  as  the  year  183(5  (Gazette  Med.,  No.  51,  1836),  in  enteric  or  typhoid 
fever,  with  a  view  to  its  curative  influence  upon  the  intestinal  ulceration 
of  that  affection.  He  gave  it  either  by  the  mouth  or  by  the  rectum,  ac- 
cording as  the  disease  appeared  to  be  seated  higher  or  lower  in  the  ali- 
mentary canal ;  and  sometimes  he  united  both  methods.  He  adminis- 
tered from  a  quarter  to  half  a  grain  by  the  mouth,  in  the  form  of  pill,  and 
three  or  four  grains,  by  enema,  night  and  morning,  dissolved  in  six  fluid- 
ounces  of  water.  This  practice  has  been  imitated  by  other  physicians, 
but  has  not  been  generally  adopted.  I  entertain  strong  doubts  of  its 
efficacy ;  as  I  do  not  believe  that  the  nitrate,  when  swallowed,  will  reach 
the  seat  of  the  local  disease  unchanged  ;  and  they  who  are  familiar  with 
the  position  of  the  ulcerated  surfaces,  extending  often  throughout  the 
whole  length  of  the  ileum,  would  scarcely  admit  that  six  ounces  of  fluid, 
thrown  into  the  rectum  of  an  adult,  would  come  in  contact  with  them. 

In  the  diarrhoea  of  phlhiais  the  medicine  has  been  used  with  supposed 
advanUitiv;  but  experience  has  not  proved  it  to  be  more  efficacious  in  this 
affection  than  other  medicines  habitually  employed. 

The  late  Dr.  J.  F.  Peebles,  of  Virginia,  found  it  remarkably  efficient 
in  certain  cases  of  jaundice  connected  with  an  irritated  condition  of  the 
stomach  and  small  intestines.  He  gave  from  three-quarters,  of  a  grain 
to  a  grain  twice  a  day,  on  an  empty  stomach.  (Am.  Journ.  of  Med.  Sci., 
N.  S.,  xviii.  59.) 

In  reference  to  the  cathartic  effect  which  the  nitrate  of  silver  some- 
times produces,  it  was  recommended  by  Boerhaave  in  dropsy ;  and  the 
medicine  is  said  to  have  been  used  advantageously  in  worms;  but  these 
applications  of  it  are  now  seldom  or  never  made. 

2.  For  its  effects  upon  the  system  at  large,  njgpte  of  silver  has  been 
employed  chiefly  in  nervous  affections.  In  some  of  these  it  has  been 
carried  to  an  enormous  extent,  with  the  effect  probably  sometimes  of 
seriously  injuring  the  coats  of  the  stomach,  and,  in  not  a  few  instances, 
three  of  which  at  least  have  come  under  my  own  observation,  of  produc- 
ing the  indelible  discoloration  of  the  skin  already  described.  Nor  does 
this  excessive  use  of  the  medicine,  probably,  contribute  to  the  end  in 
view.  When  given  largely,  the  very  irritation  of  the  mucous  membrane 
induced  must  interfere  to  some  extent  with  its  absorption ;  and  by  far 
the  largest  proportion  is  converted  into  chloride  of  silver,  and  passes 
out  with  the  feces  in  this  state,  as  proved  by  the  experiments  of  Dr. 
Heller.  In  one  instance,  a  boy  aged  thirteen  took  twelve  grains  daily 
for  three  months,  without  any  effect  on  the  system,  or  discoloration  of 


GENERAL   STIMULANTS.  [PART  II. 

the  skin  ;  and  no  trace  of  silver  could  be  discovered  in  the  blood  or  the 
urine;  while  the  whole  amount  of  the  metal  was  found  in  the  evacua- 
tions from  the  bowels.  (See  Am.  Journ.  of  Hed.  Sci.,  N.  S.,  xii.  476.) 
Nevertheless,  that  the  silver  does  occasionally  enter  the  circulation  is,  I 
think,  certain ;  and  it  may  be  presumed  to  do  so  generally,  though  in 
minute  quantities.  As  the  absorption  depends  upon  the  solubility  of  the 
compound  of  silver  formed  in  the  bowels,  and  as  this  probably  depends 
on  the  presence  of  an  excess  of  albumen  or  an  alkaline  chloride  in  the 
alimentary  canal,  the  less  the  amount  of  the  nitrate  given,  the  greater 
will  be  the  excess  of  the  solvent  agents,  and  the  consequent  probability 
of  its  absorption.  The  practical  inference  from  these  views,  is.  that  the 
physician  should  limit  himself  to  moderate  doses  of  the  medicine,  as 
being  at  once  safer,  and  likely  to  prove  not  less  effectual.  I  have  before 
endeavoured  to  explain  the  nature  of  the  action,  by  which  this  medicine, 
and  others  belonging  to  the  same  subdivision,  prove  useful  in  nervous 
diseases.  (Seepage  388.)  It  will  be  sufficient  to  repeat,  in  this  place, 
that  the  silver  probably  acts  by  increasing  the  vital  power  of  resistance 
of  the  nervous  centres  to  irritant  influences,  and  thus  preventing 
the  effects  of  their  irritation,  as  exhibited  in  spasms  and  other  irregular 
movements,  and  in  neuralgic  pain.  The  long  period  during  which, 
according  to  the  experiments  of  Orfila  before  referred  to,  silver  continues 
to  adhere  to  the  tissues  after  its  administration  has  been  omitted,  may 
serve  in  some  measure  to  explain  the  permanency  of  its  effects  in  nerv- 
ous diseases. 

Epilepsy  is  that  one  of  the  nervous  affections  in  which  the  nitrate  of 
silver  has  been  given  most  frequently,  and  in  the  treatment  of  which  it 
has  the  highest  reputation.  It  is  certainly  among  the  remedies  which 
have  proved  most  effectual,  so  far  as  testimony  can  avail  to  decide  the 
question.  Every  one  knows  that  epilepsy,  from  the  very  nature  of  its 
sustaining  cause,  is  often  quite  incurable.  That  the  nitrate  of  silver, 
therefore,  should  very  frequently  fail,  is  nothing  more  than  might  be  ex- 
pected. The  great  olptacle  to  its  general  use  is  its  liability  to  cause 
discoloration  of  the  skin,  which  is  even  more  objectionable  to  most  per- 
sons than  the  disease  itself.  The  physician,  dreading  the  responsibility 
of  such  a  result,  if  he  employ  the  remedy  at  all,  is  apt  to  do  so  inefli- 
cientlv;  either  using  it  in  too  small  a  quantity,  or  not  continuing  it  suffi- 
ciently long.  Upon  this  point,  however,  he  should  always  guard  him- 
self, by  informing  the  patient  or  his  friends  of  the  possible  result,  and 
leaving  the  decision  with  them.  The  risk  of  the  discoloration  may  be,  con- 
sidered as  extremely  small,  when  proper  precautions  are  taken.  These 
will  be  mentioned. 

Other  nervous  affections,  in  the  treatment  of  which  nitrate  of  silver 
has  enjoyed  considerable  reputation,  are  chorea  and  angina  pectoris. 
The  former  disease,  however,  is  so  readily  curable  by  other  less  objec- 


CHAP.  I.]  MINERAL   TONICS. — NITRATE   OF    SILVER.  399 

tionable  remedies,  that  it  would  not  be  justifiable  to  expose  the  patient  to 
the  risk,  however  small,  of  the  cutaneous  discoloration.  But  in  angina 
pectoris,  as  in  the  cases  of  epilepsy,  the  choice  may  well  be  left  to  the 
patient;  though  the  chances  of  a  cure  from  the  remedy  are  so  slight, 
that  little  encouragement  should  be  offered.  To  its  use  in  hysteria, 
asthma,  and  pertussis,  in  which  it  might  be  considered  as  indicated  by 
its  influence  on  the  nervous  centres,  the  liability  above  alluded  to  should 
be  deemed  an  all-sufficient  objection. 

A  few  years  since  it  was  employed  by  Wunderlich,  with  remarkable 
success,  in  a  disease  now  known  as  locomotor-  ataxy ;  and  MM.  Vulpian 
and  Charcot  have  subsequently  ascertained  that,  given  in  small  doses, 
rarely  exceeding  half  a  grain  in  the  day,  it  exercises  a  most  favourable 
influence  over  this  exceedingly  intractable  disease.  The  great  drawback, 
in  this,  as  in  all  the  other  nervous  diseases  requiring  a  long  continuance 
of  the  remedy,  is  the  liability  of  the  patient  to  the  very  repulsive  discol- 
oration of  the  surface.  It  would  be  an  unspeakable  benefit  to  humanity, 
could  means  be  found  of  preventing  or  removing  this  effect  of  nitrate  of 
silver,  without  impairing  its  therapeutic-  virtues.  The  remedy  has  been 
used  by  M.  Buchut,  with  entire  success,  in  a  case  of  idiopathic  infantile 
paraplegia  (Ann.  de  Therap.,  18(U,  p.  225);  and  the  same  physician 
asserts  that  general  progressive  palsy,  whether  of  the  insane,  or  not  thus 
complicated,  sometimes  gets  well  under  the  use  of  this  remedy,  in  the  dose 
of  from  one-third  of  a  grain  to  about  a  grain  daily.  (Ibid.,  1866,  p.  2H.) 

Administration.  When  the  effects  of  nitrate  of  silver  upon  the  system 
generally  are  desired,  it  should  be  given  preferably  in  the  form  of  pill; 
as  a  larger  dose  can  thus  be  taken,  without  irritating  the  stomach,  than 
in  solution.  The  same  form  is  also  preferable  when  it  is  given  by  the 
mouth  for  intestinal  affections;  as  there  may  be  some  hope  that  it  may 
thus,  in  part  at  least,  escape  decomposition  by  the  gastric  contents. 
For  its  alterative  influence  on  the  stomach,  it  may  be  given  in  either 
form ;  but  the  solution  would  probably  be  most  effective  if  well  borne. 
When  taken  in  pill,  it  should  be  mixed  up  with  flour,  starch,  or  pow- 
dered gum,  with  syrup.  The  crumb  of  bread,  often  used,  is  objectiona- 
ble on  account  of  the  common  salt  it  contains.  If  given  in  solution, 
distilled  water  should  be  employed  as  the  menstruum ;  the  taste  being 
covered,  if  deemed  advisable,  by  a  little  oil  of  mint  or  peppermint.  In 
either  case,  the  preparation  should  not  be  long  kept  before  being  used. 

The  dose  to  begin  with,  at  least  in  delicate  states  of  the  stomach, 
should  not  exceed  one-quarter  or  one-third  of  a  grain,  three  times  a  day, 
which  may  be  gradually  increased  to  one,  two,  or  even  three  grains, 
should  no  irritant  effect  be  experienced.  Some  have  pushed  the  medi- 
cine much  further,  even  so  far  as  fifteen  or  twenty  grains,  and  with  im- 
punity ;  for  there  are  generally  in  the  stomach  substances,  especially  the 
chloride  of  sodium,  which  render  it  inert  by  decomposition;  and  it  might 


400  GENERAL   STIMULANTS.  [PART  II. 

unite  with  the  albumen  of  the  mucus,  or  even  superficially  with  that  of 
the  epithelium  itself,  without  serious  injury.  But  these  decomposing 
substances  might  be  wanting,  or  the  mucous  coat  might  be  unprotected 
by  its  ordinary  secretion,  and  the  medicine  come  into  contact  with  some 
exposed  point  with  too  great  intensity;  in  short,  experience  has  shown 
that  the  salt  may  prove  highly  irritant,  and  even  poisonous;  and  there 
is  no  occasion  to  incur  any  risk,  for,  as  before  stated,  these  large  doses 
are  almost  wholly  decomposed,  and  pass  out  of  the  bowels;  a  very  small 
portion  only  being  absorbed;  so  that,  when  not  mischievouspthey  will 
probably  be  useless. 

The  great  point  will  be  to  guard  against  the  discoloration  of  the  skin. 
For  this  purpose,  the  mouth  should  be  carefully  and  frequently  observed, 
and  the  least  appearance  of  a  dark  blueness  in  the  gums  should  be  con- 
sidered as  a  signal  for  discontinuing  the  medicine  until  this  has  disap- 
peared. As  the  nitrate  in  solution  might  have  the  effect  of  darkening 
the  surface  of  the  mouth  by  its  direct  contact,  the  discoloration  thus  pro- 
duced must  not  be  mistaken  for  that  resulting  from  the  absorption  of  the 
medicine.  Dr.  James  Johnson  states  that  no  case  of  discoloration  is  on 
record,  in  which  the  use  of  the  medicine  has  not  been  continued  beyond 
three  months.*  It  would,  therefore,  be  a  good  rule,  after  having  em- 
ployed it  continuously  for  that  length  of  time,  to  suspend  it  for  a  period, 
say  one  or  two  months ;  and  there  is  some  ground  for  this  suspension  in 
the  long  retention  of  the  medicine  in  the  tissues,  as  shown  by  the  exper- 
iments of  Orfila;  so  that,  though  it  should  be  omitted,  that  already 
taken  and  absorbed  might  still  be  acting. 

The  medicine  should  be  taken  on  an  empty  stomach,  and  the  caution 
should  be  observed  that  nothing  containing  common  salt,  or  any  other 
substance  having  the  property  of  decomposing  the  nitrate,  should  be 
swallowed  within  a  short  time,  either  antecedent  or  subsequent  to  its 
administration. 

The  following  are  preparations  of  silver  derived  from  the  nitrate. 

1.  OXIDE  OP  SIBVER. — ARGENTI  OXIDUM.   U.  S.,  Br. 

This  is  prepared  by  adding  solution  of  potassa  to  a  solution  of  nitrate 
of  silver,  the  oxide  being  precipitated.  It  is  an  olive-brown  powder,  in- 
odorous, nearly  tasteless,  and  very  slightly  soluble  in  water;  and  consists 
of  one  equivalent  of  silver  and  one  of  oxygen.  Though  used  as  a  med- 
icine, on  the  continent  of  Europe,  during  the  last  century,  it  attracted 
little  notice  until  proposed  by  Dr.  Butler  Lane,  as  a  substitute  for  the 
nitrate,  in  the  various  diseases  in  which  that  remedy  has  been  used. 

Oxide  of  silver  acts  locally  as  a  slight  irritant  and  astringent,  but  is 

*  A  case  is  recorded  in  which  the  daily  use  of  half  a  grain,  for  eight  months  con- 
secutively, produced  a  striking  and  universal  discoloration  of  the  surface.  ( Archive* 
Glntrale*,  5e  ser.,  ix.  358.) 


CHAP.  I.]  MINERAL   TONICS. —  CHLORIDE   OF    SILVER.  401 

wholly  destitute  of  the  property,  which  renders  the  nitrate  so  valuable, 
of  combining  with  the  tissues.  Taken  into  the  stomach,  it  is  either  ab- 
sorbed, or  forms  soluble  compounds  which  are  absorbed;  for  it  produces 
occasional  soreness  of  the  gums  and  salivation,  and  has  even  caused  dis- 
coloration of  the  skin. 

It  was  substituted  for  the  nitrate  as  a  milder  remedy,  and  capable  of 
producing  its  constitutional  impression,  with  less  danger  of  affecting  the 
skin ;  but  the  want  of  the  property  of  combining  with  the  superficial 
part  of  the  tissues,  incapacitates  it  for  those  local  alterative  effects  on 
diseased  surfaces  which  give  its  highest  value  to  the  nitrate;  and,  in 
proportion  as  it  may  be  less  liable  to  discolour  the  skin,  it  will  probably 
prove  less  efficacious  as  a  medicine  ;  the  liability  to  produce  that  effect 
being  incidental  to  the  absorption  of  the  silver,  no  matter  in  what  form 
it  may  be  taken  up,  and  consequently  in  some  degree  a  test  of  its  con- 
stitutional influence.  It  seems  to  me,  therefore,  that  little  is  gained  by 
the  substitution.  Nevertheless,  the  oxide  has  been  found  useful,  by  Dr. 
Lane  and  others,  in  gastralgia,  pyrosis,  gnteralgia,  dysentery,  diar- 
rhoea, idiopathic  night-sweats,  dysmenorrhcea,  leucorrhcea,  and  uterine 
hemorrhage.  In  the  last-mentioned  affection,  the  favourable  report  of 
Dr.  Lane  is  supported  by  the  experience  of  Dr.  Golding  Bird  ;  and  Dr. 
Thweatt,  of  Petersburg,  Va.,  published  several  cases  of  menorrhagia, 
in  which  the  medicine  appeared  to  have  proved  efficacious.  (Am.  Journ. 
of  Med.  Sci.,  X.  S.,  xviii.  69.)  The  oxide  would  seem  to  promise  most 
fairly  as  a  substitute  for  the  nitrate  in  epilepsy,  and  other  spasmodic 
complaints;  but,  though  it  may  probably  be  given  with  less  risk  in  large 
doses,  experience  has  not  proved  that  it  possesses  superior  advantages 
as  a  remedy.  It  is  said  to  have  been  used  successfully  in  trenia. 

The  dose  is  a  grain,  repeated  twice  or  three  times  a  day,  which  may 
be  gradually  increased  to  two  grains.  In  the  larger  quantity,  it  some- 
times occasions  a  little  griping  and  tenesmus,  which  may  be  checked  by 
an  anodyne  enema.  (Thweatt,  Ibid.)  The  same  caution  is  requisite,  in 
relation  to  the  continuance  of  the  dose,  as  when  the  nitrate  is  employed. 
It  may  be  given  in  powder  or  pill. 

The  oxide  has  been  used  also  externally,  in  powder  or  ointment,  in 
ophthalmia,  excoriated  nipples,  irritable  ulcers,  and  venereal  sores  ; 
and,  smeared  on  a  bougie,  has  been  employed  in  gonorrhoea.  The  oint- 
ment may  be  prepared  with  a  drachm  of  the  powder  and  an  ounce  of  lard. 

2.  CHLORIDE  OF  SILVER.  —  ARGENTI  CHLORIDUM. 

This  is  made  by  adding  muriatic  acid,  or  a  solution  of  chloride  of  so- 
dium, to  a  solution  of  nitrate  of  silver.  The  chloride  of  silver  is  pre- 
cipitated as  a  white  curdy  substance,  which,  when  washed  and  dried,  is 
ready  for  use.  Though  white  at  first,  it  soon  begins  to  darken  on  expo- 
sure. It  is  insoluble  in  water.  The  circumstance  that  nitrate  of  silver 
YOL.  i.— 26 


402  GENERAL    STIMULANTS.  [PART  II. 

is  often  converted  into  the  chloride  in  the  stomach,  has  led  to  the  em- 
ployment of  the  latter,  as  likely  to  produce  the  same  effects  on  the  sys- 
tem, while  much  less  irritant.  Many  years  since,  I  was  induced  myself, 
by  this  consideration,  to  try  it  in  epilepsy;  but,  meeting  with  no  en- 
couraging success,  I  soon  abandoned  it.  Dr.  Perry  used  it  in  the  Blockley 
Hospital  of  Philadelphia,  and  obtained  advantage  from  it  in  chronic 
dysentery.  It  has  been  employed  also  in  syphilis,  and  in  other  diseases 
in  which  the  nitrate  is  recommended  ;  but  it  has  not  come  into  general 
use.  The  dose  is  from  one  to  three  grains,  or  more,  three  or  four  times 
a  day.  Twelve  grains  have  been  given  daily  for  three  months,  without 
unpleasant  symptoms.  A  dose  of  thirty  grains  has  produced  vomiting. 

3.  IODIDE  OF  SILVER.  —  ARGENTI  IODITHM. 

This  may  be  prepared  by  mixing  solutions  of  nitrate  of  silver  aud 
iodide  of  potassium  ;  the  iodide  of  silver  being  thrown  down  as  an  insol- 
uble, greenish-yellow  powder.  Dr.  Charles  Patterson,  of  Dublin,  having 
convinced  himself,  by  experiment,  that  this  preparation  does  not  change 
colour  on  exposure  to  the  liglit,  even  in  contact  with  organized  matter, 
conceived  that  it  might  be  advantageously  substituted  for  nitrate  of  sil- 
ver, on  the  ground  that  it  would  not  be  liable  to  cause  discoloration  of 
the  skin.  In  order  to  determine  how  far  it  might  possess  the  therapeutic 
virtues  of  the  nitrate,  he  tried  the  medicine  in  various  diseases;  and, 
though  he  succeeded  in  curing  a  gastric  affection  of  the  Irish  peasantry, 
in  which  the  nitrate  had  been  found  useful,  in  ameliorating  pertussis, 
and  in  relieving  a  case  of  dysmenorrhoea,  his  experience  \v;vs  certainly 
not,  upon  the  whole,  very  satisfactory;  and  a  much  more  extensive  sc- 
ries of  observations  would  be  necessary,  to  establish  the  claim  of  the 
iodide  of  silver  to  be  used  as  a  substitute  for  the  nitrate.  Nor  is  it  by 
any  means  certain  that  it  might  not  cause  discoloration  of  the  skin;  for 
though,  if  absorbed  unchanged,  it  might  not  thus  act,  the  probability  is 
that,  before  entering  the  circulation,  it  would  be  chemically  altered,  and 
that  the  compound  of  silver  really  absorbed  would  be  liable  to  the  same 
changes  in  the  system,  as  that  which  enters  the  blood-vessels  when  the 
nitrate  is  administered.  Nevertheless,  the  iodide  is  perhaps  worthy  of 
further  trial;  as,  if  found  to  be  possessed  of  the  virtues  of  the  nitrate, 
without  its  disadvantages,  it  would  be  a  most  valuable  addition  to  the 
Materia  Medica.  From  one  to  three  grains  may  be  given  three  times  a 
day,  and  gradually  increased  till  some  disagreeable  effect  upon  the  stom- 
ach or  bowels  is  produced. 


CHAP.  I.]  MINERAL   TOXICS. — COPPER.  403 

II.  COPPER. 
CUPRUM. 

In  the  metallic  state,  copper  is  quite  inert.  Instances  are  on  record 
in  which  copper  coins  have  remained  long  in  the  stomach  without  any 
observable  effect;  and  animals  which  have  been  made  to  swallow  filings 
of  the  metal,  to  the  amount  even  of  an  ounce,  have  in  no  degree  sensibly 
suffered  from  them.  Yet  other  cases  have  occurred,  in  which  local 
injury  to  the  stomach,  or  some  derangement  of  the  system  has  followed, 
under  similar  circumstances.  The  result  in  these  instances  has,  no 
doubt,  depended  on  chemical  changes,  by  which  the  metal  has  been  oxi- 
dized, and  converted  into  a  salt  through  the  agency  of  the  gastric  acids; 
so  that  it  was  not  the  copper  itself,  but  one  of  its  soluble  compounds, 
probably  the  chloride,  that  acted. 

Copper  may  generally  be  detected  in  minute  quantities  in  the  blood 
of  persons  in  health,  and  has  been  repeatedly  found  in  the  tissues,  when 
no  preparation  of  the  metal  was  known  to  have  been  taken.  It  has 
hence  been  inferred  that,  like  iron,  it  forms  an  essential  constituent  of 
the  blood;  and  Millon  supposed  it  to  enter  into  the  normal  constitution 
of  the  red  corpuscles.  But  so  much  copper  is  taken  into  the  system  in 
various  ways  with  our  food,  that  the  exceedingly  minute  portion  which 
a  delicate  chemical  analysis  can  detect,  has  its  origin  probably  in  this 
source,  and  is  only  accidentally  present  in  the  blood,  which  would  in  no 
degree  suffer  from  the  want  'of  it,  as  it  does  from  the  want  of  iron. 
Wackenroder  has  confirmed  this  view  by  showing  that  the  blood  of 
domestic  animals,  living  on  pure  vegetable  food,  is  quite  destitute  of  it  : 
while  it  may  readily  be  discovered  in  the  blood  of  the  same  animals  and 
of  man,  when  fed  on  a  mixed  diet.  (Chem.  Gaz.,  May  1,  1854,  p.  175.) 
It  may  be  inferred,  however,  from  these  facts,  that  a  proportion  of  cop- 
per large  enough  to  be  sensible  to  chemical  research,  may  exist  in  our 
economy  without  impairing  health. 

Effects  on  the  System.  The  preparations  of  copper  are  locally  irritant, 
and  most  of  them,  in  a  concentrated  state,  corrosive.  Taken  internally, 
in  moderate  doses,  they  operate  as  gentle  excitants  to  the  mucous  sur- 
face of  the  stomach,  increasing  the  appetite,  and  producing  other  effect* 
characteristic  of  tonic  medicines.  In  over-doses  they  become  irritant ; 
but  happily  provoke  vomiting  very  promptly;  so  that,  being  discharged 
from  the  stomach,  they  have  not  time  allowed  them  to  produce  serious 
and  permanent  effects,  unless  taken  very  largely.  In  this  latter  event, 
as  will  be  seen  directly,  they  are  capable  of  producing  fatal  inflammation 
and  corrosion  of  the  alimentary  mucous  membrane.  Like  nitrate  of  sil- 
ver, they  decompose  the  superficial  parts  of  the  tissue,  forming  com- 
pounds with  albumen,  which  are  of  a  greenish-blue  colour,  and,  accord- 


404  GENERAL    STIMULANTS.  [PART  II. 

ing  to  Mialhe,  soluble  in  an  excess  of  the  salt,  when  its  acid  is  of  vege- 
table origin,  but  not  when  it  is  mineral. 

But  the  preparations  of  copper  also  act  on'  the  system  generally. 
This  they  are  enabled  to  do  by  the  facility  with  which  they  enter  the 
circulation.  They  appear,  indeed,  to  be  among  the  metallic  substances 
most  easily  absorbed.  After  one  of  the  salts  of  copper  has  been  taken 
for  a  short  time,  the  metal  may  be  sought  for  in  vain  in  the  alimentary 
canal,  but  will  be  found  in  the  blood,  the  substance  of  the  liver,  and  other 
tissues.  When  absorbed,  moreover,  it  holds  its  place  in  the  organism 
with  great  tenacity.  Orfila  states  that  it  may  be  detected  in  the  liver,  in- 
testinal coats,  and  bones,  eight  months  after  having  been  taken  into  the 
stomach.  (Lond.  Med.  Times  and  Gaz.,  March,  1852,  p.  279.) 

No  observable  effects  upon  the  system,  in  health,  are  produced  by 
small  medicinal  doses  of  the  salts  of  copper;  but  the  results  of  their  use 
in  disease  prove  that,  even  in  these  quantities,  they  are  not  without 
efficiency.  Their  action  appears  to  be  that  of  a  tonic,  especially  on  the 
nervous  centres,  which  they  strengthen  against  irritating  influences,  as 
explained  in  the  general  observations  on  this  subdivision  of  mineral 
tonics.  (See  page  388.)  When  taken  too  largely,  or  too  long,  they  give 
unmistakable  evidence  of  their  effects,  which  may  even  be  poisonous, 
independently  of  their  direct  action  on  the  alimentary  mucous  membrane. 

The  poisonous  operation  of  the  salts  of  copper  is  of  two  kinds,  either 
rapid  from  a  large  quantity  given  at  once,  or  slow  from  too  long  a  con- 
tinuance of  relatively  small  quantities.  In  both  of  these  modes  of  action, 
moreover,  there  appears  to  be  a  union  o/  a  local  influence  on  the 
mentary  mucous  membrane,  with  a  general  influence  dependent  on  ab- 
sorption. 

1.  Acute  poisoning  from  a  large  quantity  is  attended  with  a  coppery 
taste  in  the  mouth,  nausea,  ineessant  vomiting,  violent  pains  in  the  stom- 
ach and  bowels,  purging  sometimes  profuse,  severe  headache,  cramps  in 
the  lower  extremities,  and,  in  fatal  cases,  convulsions,  palsy  of  the  limbs, 
and  coma.  In  the  lower  animals,  Orlila  noticed,  among  the  last  phe- 
nomena before  death,  rigidity  of  the  museles,  and  even  tetanus.  Occa- 
sional salivation  is  also  mentioned;  and  jaundice  is  not  uncommon,  gen- 
erally appearing  during  life,  but  sometimes  not  until  after  death.  The 
first  series  of  the  symptoms  here  detailed  arc  evidently  tin-  direct  result 
of  the  irritant  action  on  the  stomach  and  bowels;  those  which  succeed 
depend  on  a  systemic  influence  directed  more  especially  to  the  nervous 
centres,  but  sometimes  exerted  on  the  salivary  glands,  and  not  unfre- 
(juently  upon  the  blood,  as  evinced  by  the  jaundice,  which  probably 
arises  from  the  destruction  of  the  red  corpuscles,  and  the  alteration  of 
their  colouring  matter.  That  the  nervous  symptoms  are  not  merely 
sympathetic  with  the  gastric  disorder  is  proved  by  the  facts,  first,  that 
after  death  the  mucous  membrane  of  the  stomach  and  bowels  is,  in  some 


CHAP.  I.]  MINERAL   TONICS. — COPPER.  405 

instances,  found  to  all  appearance  quite  healthy,  especially  after  speedy 
death;  secondly,  that  the  nervous  symptoms  sometimes  precede  the  gas- 
tric and  intestinal,  and  thirdly,  that  similar  phenomena  have  resulted 
from  the  poison  injected  into  the  veins,  or  applied  to  awoumlod  surface. 
The  ordinary  post-mortem  phenomena  are  signs  of  severe  inflammation 
in  the  stomach  and  bowels,  gangrenous  patches  here  and  there,  corrosion 
and  sometimes  even  perforation  of  the  intestinal  mucous  membrane,  and 
green  discoloration  of  the  tissue  to  a  greater  or  less  extent.  The  lungs 
are  said  also  to  have  been  seen  inflamed;  but  this  may  have  been  an 
accidental  coincidence. 

2.  The  slow  poisoning,  according  to  Dr.  Corrigan,  of  Dublin,  who  has 
drawn  up  his  summary  from  an  observation  of  several  cases,  is  attended 
with  emaciation,  a  cachectic  appearance,  muscular  weakness,  colicky 
pains,  cough  without  discoverable  pectoral  disease,  "and  a  peculiar 
characteristic  retraction  of  the  gums,  with  a  purple,  not  a  blue  edge;" 
without  the  severe  colic,  constipation,  and  local  palsy,  which  result  from 
lead.  (Braithwaite,  xxx.  303,  from  Dub.  Hosp.  Gaz.,  Sept.  1853,  p.  232.)* 
Besides  these  phenomena,  loss  of  appetite  and  diarrhoea  are  mentioned 

*  In  July,  1855,  Dr.  Pietra-Santa,  who  had  been  favourably  situated  for  observ- 
ing the  effects  of  copper  on  the  system,  read  a  memoir  before  the  Academy  of  Medi- 
cine of  Paris,  in  which  he  stated  that,  after  three  years  of  observation,  he  had  come 
to  the  following  conclusions; — "1.  that  a  person  may  live  in  an  atmosphere  loaded 
with  the  dust  of  copper,  without  any  appreciable  alteration  of  health;  2.  that  the 
introduction  of  powder  of  copper  into  the  stomach  occasions  only  some  slight  dis- 
turbances of  health;  3.  that  the  colic  of  copper,  as  previously  described  by  authors, 
does  not  exist;  4.  that  the  phenomena  described  by  authors  must  be  attributed  to 
other  contemporaneous  causes ;  and  5.  that  the  purple  edging  of  the  gums,  mentioned 
by  Dr.  Corrigan  as  characteristic  of  copper  poisoning,  is  not  so  constant  or  general 
as  he  supposes."  (Arch.  Gen.,  5e  s6r.,  vi.  354;  and  Journ.  dePharm.  et  de  Chim.,  Avril, 
1858,  p.  313.)— Note  to  the  second  edition. 

A  case  of  copper-colic,  with  the  stain  on  the  gums  as  described  by  Dr.  Corrigan, 
is  reported  by  Dr.  Harley,  whose  patient  was  a  copper-plate  printer,  and  had  on 
one  occasion  been  peculiai-ly  exposed  to  the  inhalation  of  one  of  the  salts  of  copper, 
while  cleaning  some  old  plates,  from  which  a  dust  arose  like  verdigris.  He  had 
suffered  twice  before  in  the  same  way.  The  symptoms  were  a  sudden  and  violent 
pain  in  the  abdomen  as  if  from  a  blow,  somewhat  abating  and  increasing,  aug- 
mented by  pressure  rather  than  diminished,  no  diarrhoea,  and  no  constipation. 
There  was  a  sallow,  almost  clay-coloured  complexion,  with  anxious  expression,  livid 
lips,  and  sunken  eyes.  He  rapidly  recovered  under  the  use  of  spirit  of  nitric  ether, 
and  dilute  sulphuric  acid,  with  a  little  sulphate  of  magnesia  and  laudanum,  taken  in 
camphor  mixture.  (Med  T.  and  Gaz.,  Aug.  18G3,  p.  129.)  It  is  difficult  to  recon- 
cile these  opposite  observations  of  Drs.  Pietra-Santa  and  Harley,  unless  upon  the 
supposition,  that  the  "dust  of  the  copper"  of  the  former  was  the  metal  itself  in  a 
state  of  minute  division  ;  while  the  powder,  which  was  the  poisonous  agent  in  the 
case  described  by  the  latter,  consisted  of  a  salt  of  the  metal.  The  uncombined  metal 
is  innoxious,  while  its  saline  compounds  may  be  extremely  poisonous.  (Note  to  the 
third  edition.) 


406  GENERAL   STIMULANTS.  [PART  II. 

by  other  observers.  I  have  seen  no  account  of  death  from  this  slow 
poisoning.  The  symptoms  are  probably  due  partly  to  a  chronic  irritation 
of  the  alimentary  canal,  partly  to  a  direct  action  upon  the  system. 

Poisoning  by  copper  sometimes  results  from  the  accidental  swallowing 
of  one  of  its  preparations  used  in  medicine  or  the  arts,  but  more  fre- 
quently from  food  or  drink  prepared  or  kept  in  copper  vessels,  which, 
even  though  protected  by  tinning,  are  nevertheless  apt  to  lose  this  pro- 
tection, and  to  communicate  deleterious  properties  to  substances  con- 
tained in  them,  especially  when  these  substances  are  in  any  degree  acid. 
There  is  reason  to  believe  that  much  injury  has  thus  been  produced  in 
the  digestive  organs,  if  not  in  the  general  system,  by  the  habitual  use  of 
carbonic  acid  water,  prepared  and  long  kept  in  copper  fountains. 

The  treatment  of  the  acute  poisoning  consists  mainly  in  the  free  use 
of  the  white  of  egg  mixed  with  water,  which  forms  an  insoluble  com- 
pound with  the  poison,  and  at  the  same  time  facilitates  the  cleansing  of 
the  stomach.  Should  this  not  be  at  hand,  recourse  may  be  had  to  milk, 
or  even  wheat  flour  mixed  with  water.  Ferrocyanide  of  potassium  ha* 
also  been  recommended  as  an  antidote ;  but,  according  to  results  obtained 
by  Dr.  Scharder,  of  Gottingen,  it  must  be  considered  of  doubtful  efficacy. 
Hydrated  protosulphuret  of  iron,  recommended  by  Mialhe,  hydrate  of 
magnesia,  and  sugar,  proved  inefficacious  in  the  hands  of  the  same  ex- 
perimenter. (Deutsche  Klinik,  1855,  No.  4.)  Should  free  emesis  not  take 
place,  the  stomach  should  be  thoroughly  washed  out  by  the  stomach- 
pump.  Afterwards  the  antidote  should  be  administered  with  a  cathartic, 
in  order  that  it  may  reach  any  portion  of  the  poison  that  may  have 
entered  the  bowels.  The  irritation  of  the  stomach  and  bowels  may  then 
be  quieted  by  opiates;  and  the  case  otherwise  treated  on  general  prin- 
ciples. 

The  therapeutic  applications  of  copper  will  be  most  conveniently  treated 
of,  under  the  heads  of  its  several  preparations. 

I.  SULPHATE  OF  COPPER.— CUPRI  SULPHAS.  U.  S.,Br.— 
Blue  Vitriol. 

Origin.  Sulphate  of  copper  exists  in  solution  in  the  water  running 
from  copper  mines,  from  which  it  is  obtained  by  evaporation  and  crys- 
tallization. But  it  is  more  frequently  prepared  artificially;  and  the 
method  usually  employed  in  this  country  is  by  the  direct  action  of  sul- 
phuric acid  on  copper  or  its  oxide. 

Composition.  It  consists  of  one  equivalent  of  oxide  of  copper,  one  of 
sulphuric  acid,  and  five  of  water  of  crystallization. 

Properties.  Sulphate  of  .copper  is  in  fine,  large,  deep-bint!,  transparent 
crystals,  inodorous,  of  a  strong,  harsh,  .styptic,  metallic,  and  very  dis- 
agreeable taste,  very  soluble  in  water,  and  insoluble  in  alcohol.  It  i« 
slightly  efflorescent  on  exposure.  By  heat  it  melts,  and  loses  its  water 


CHAP.  I.]     MINERAL  TONICS. — SULPHATE  OF  COPPER.        407 

of  crystallization,  becoming  white  and  opaque ;  and  by  an  intense  heat 
is  decomposed.  On  the  addition  of  ammonia  to  its  solution,  a  precipi- 
tate is  first  thrown  down,  which  is  dissolved  by  a  further  addition  of  the 
ammonia,  with  the  production  of  a  beautiful  deep  azure-blue  colour. 

Incompatibles.  The  fixed  alkalies  and  their  carbonates,  the  alkaline 
earths,  the  soluble  salts  of  lead,  lime,  and  baryta,  acetate  of  iron,  bichlo- 
ride of  mercury,  nitrate  of  silver,  borax,  tannic  acid,  and  the  astringent 
vegetable  substances  containing  it,  yield  precipitates  with  the  solution 
of  sulphate  of  copper,  and  are  therefore  incompatible  in  prescription. 

Effects  on  the  System.  The  effects  of  this  salt  are  those  already  de- 
scribed of  the  preparations  of  copper  in  general,  with  the  addition  of 
astringency,  in  which  it  much  exceeds  the  others.  In  short  terms,  it  may 
be  said,  in  relation  to  its  action  on  the  alimentary  canal,  to  be  tonic,  as- 
tringent, powerfully  emetic,  highly  irritant,  and  corrosive,  according  to 
the  quantity  swallowed  ;  in  relation  to  its  effects  upon  the  system,  to  be 
in  medicinal  doses  tonic  to  the  nervous  centres,  and  in  excessive  doses 
poisonous  by  an  overwhelming  influence  upon  those  centres.  Death, 
with  coma  and  convulsions,  has  resulted  from  two  drachms  of  ;t  swal- 
lowed. Besides  albumen,  magnesia  has  been  recommended  as  specially 
useful  in  poisoning  by  the  sulphate. 

Therapeutic  Application.  Sulphate  of  copper  is  thought  to  have  been 
employed  as  a  medicine  by  the  ancients.  In  regard  to  its  emetic  opera- 
tion, I  shall  treat  of  it  under  the  emetics,  and  as  an  external  remedy,  in 
which  capacity  it  is  much  used,  under  the  escharotics.  It  is  here  con- 
sidered solely  in  reference  to  its  tonic,  astringent,  and  alterative  action 
on  the  stomach  and  bowels,  and  its  general  influence  on  the  system. 

1.  It  is  seldom  employed  for  its  tonic  action  on  the  stomach ;  but  has 
been  highly  recommended  in  chronic  diarrhoea  and  dysentery  from  a 
supposed  astringent  effect.  In  certain  cases  of  this  kind,  it  is  certainly  an 
admirable  remedy.  No  doubt  its  astringency  renders  it  useful  in  some  of 
these  cases;  but  I  ascribe  its  efficacy  chiefly  to  a  stimulant  and  alterative 
influence  upon  the  ulcerated  surfaces,  similar  to  that  which  it  exerts  upon 
old  and  indolent  ulcers  externally.  It  has  the  great  advantage,  in  intes- 
tinal affections  of  this  kind,  over  nitrate  of  silver,  that  it  may  pass  un- 
decomposed  through  the  stomach  into  the  bowels,  and  thus  come  into 
contact  with  the  ulcei'S.  The  particular  condition  in  which  I  have  found 
it  specially  useful,  and  in  which,  so  far  as  my  experience  has  gone,  it  is 
equalled  by  no  other  remedy,  is  a  kind  of  chronic  enteritis,  attended 
with  diarrhoea,  distressing  pains  in  a  particular  part  of  the  abdomen,  with 
or  without  tenderness  on  pressure,  emaciation,  great  depression  of  spir- 
its, a  pulse  often,  though  not  necessarily  frequent,  and  a  moist  tongue. 
In  such  cases,  I  have  been  disposed  to  ascribe  the  obstinacy  which  they 
often  exhibit,  and  sometimes  in  an  extraordinary  degree,  to  the  existence, 
within  a  comparatively  small  extent  of  the  bowels,  of  a  chronic,  indolent 


408  GENERAL   STIMULANTS.  [PART  II. 

ulceration,  which  requires  a  strongly  excitant  and  alterative  impression 
to  enable  it  to  take  on  a  healing  tendency.  I  have  seen  them,  after  being 
treated  by  a  diversity  of  remedies,  opiates,  astringents,  etc.,  and  linger- 
ing month  after  month,  without  permanent  relief,  yield  most  happily  to 
the  persevering  use  of  this  remedy,  combined  with  a  little  opium  to  ren- 
der it  less  offensive  to  the  stomach.  A  beneficial  change  is  usually  ex- 
perienced in  a  few  days,  and  afterwards  regularly  advances  to  a  cure. 
The  only  adjuvants  which  have  seemed  to  me  advisable,  besides  the 
small  proportion  of  opium,  are  a  diet  exclusively  of  milk  and  farinaceous 
substances,  and  the  daily  use  of  the  hot  salt  bath.  In  somewhat  larger 
doses  than  an-  necessary  in  the  affection  just  mentioned,  I  have  no  doubt 
that  the  remedy  would  prove  highly  useful  also  in  certain  obstinate  cases 
of  chronic  dysentery,  with  ulceration  of  the  large  intestines.  In  the 
former  affection,  one-quarter  of  a  grain  of  the  sulphate,  with  the  same 
quantity  of  opium,  or  even  less,  may  be  given  four  times  a  day,  and 
gradually  increased,  if  necessary,  till  the  stomach  is  disturbed;  in  the 
latter,  one-half  a  grain  may  form  the  commencing  dose,  to  be  similarly 
increased.  The  necessity  of  the  larger  dose  in  the  dysenteric  affection 
is  that,  the  seat  of  ulceration  being  lower  in  the  bowels,  the  medicine 
will  have  been  to  a  greater  degree  diminished  by  absorption  before  reach- 
ing it.  Dr.  Pereira  states  that  he  has,  in  an  old  dysenteric  case,  increased 
the  dose  to  six  grains  three  times  a  day,  and  continued  this  for  several 
weeks,  with  no  other  obvious  effect  than  slight  nausea,  and  amelioration 
of  the  disease.  ( Mat.  Med.,  3d  ed.,  p.  802.) 

2.  For  its  effects  on  the  nervous  system,  sulphate  of  copper  has  been 
employed  in  epilepsy,  hysteria,  and  other  spasmodic,  convulsive,  or  ner- 
vous affections  ;  but  for  these  purposes  it  is  generally  less  esteemed  than 
the  ammoniated  copper,  to  which  the  reader  is  referred.  It  has  also  been 
recommended  in  intermiltents,  and  might  a  priori  be  deemed  useful  in 
these  complaints,  from  its  corroborative  influence  upon  the  nervous  cen- 
tres, rendering  them,  like  quinia.  insensible  to  the  irritant  impressions 
which  give  rise  to  the  paroxysms.  Though  much  less  efficient  than 
quinia,  it  might  be  used  as  a  substitute  for  that  remedy  when  circum- 
stances prevent  or  forbid  its  use ;  and  I  have  occasionally  employed  it  as 
an  adjuvant  in  obstinate  cases.* 

Besides  the  diseases  mentioned,  sulphate  of  copper  has  been  recom- 
mended in  dropsy,  worms,  chronic  catarrh  with  excessive  secretion  of 
mucus,  and  catarrh  of  the  bladder;  but  I  have  had  no  experience  with 
it  in  these  affections,  and  should  have  little  faith  in  its  efficacy. 


*  The  prescription  I  have  employed  is  as  follows.  Take  of  sulphate  of  copper 
one  grain,  sulphate  of  quinia  eight  grains,  opium  one  grain.  Form  with  syrup  of 
gum  arabic  into  a  mass,  to  be  divided  into  four  pills.  One  to  be  taken  four  times 
a  day. 


CHAP.  I.]  MINERAL   TONICS. — AMMONIATED    COPPER.  409 

Administration.  The  dose  of  sulphate  of  copper,  to  begin  with,  is 
one-quarter  of  a  grain,  three  or  four  times  a  day,  which  may  be  gradu- 
ally increased,  if  the  stomach  will  bear  it  well,  to  two  grains.  In  doses 
of  from  three  to  five  grains,  it  would  be  apt  to  vomit.  It  is  most  con- 
veniently given  in  the  form  of  pill,  which  may  be  made  with  crumb  of 
bread,  or  with  a  mixture  of  gum  and  syrup. 

II.  AMMONIATED  COPPER.— CUPRUM  AMMONIATUM.   U.S. 

Origin.  This  is  made  by  rubbing  together  carbonate  of  ammonia  and 
sulphate  of  copper.  A  reaction  takes  place,  attended  with  the  escape  of 
carbonic  acid,  and  resulting  in  the  formation  of  a  moist  deep-blue  mass, 
which,  when  dried,  constitutes  the  preparation  in  question. 

Composition.  Different  opinions  have  been  held  as  to  the  precise  com- 
position of  this  salt.  The  most  probable  is  that  which  considers  it  a 
compound  of  one  equivalent  of  sulphate  of  ammonia,  and  one  of  cuprate 
of  ammonia,  the  oxide  of  copper  performing  the  part  of  an  acid  in  the 
latter  salt. 

Properties.  It  is  in  the  form  of  a  coarse  powder,  having  a  beautiful 
deep  azure-blue  colour,  the  smell  of  ammonia,  and  an  astringent  metal- 
lic taste.  It  is  readily  soluble  in  water.  On  exposure  to  the  air,  it  is 
gradually  decomposed,  giving  out  ammonia,  and  assuming  a  greenish 
colour.  It  should,  therefore,  be  kept  in  well-stopped  bottles. 

Incompatibles.  These  are  the  same  as  in  the  case  of  the  sulphate, 
with  the  addition  of  the  acids. 

Effects  on  the  System.  Ammoniated  copper  has  the  physiological 
properties  of  the  preparations  of  copper  in  general;  being  less  astringent 
and  irritant  than  the  sulphate,  but  supposed  to  act  more  energetically  on 
the  nervous  centres.  In  over-doses,  it  is  capable  of  producing  poisonous 
eifects. 

Therapeutic  Application.  This  preparation  has  been  chiefly  used,  in 
reference  to  its  cllVcts  upon  the  nervous  system,  in  various  spasmodic 
convulsive,  and  neuralgic  affections.  In  epilepsy,  it  has  been  consider- 
ably employed,  and  is  among  the  remedies  which  have  been  most  effect- 
ual, and  are  at  present  most  relied  on.  In  these  respects,  it  probably 
stands  next  to  nitrate  of  silver,  over  which  it  has  the  great  advantage 
of  not  discolouring  the  skin.  To  sulphate  of  copper  it  is  preferable,  from 
being  somewhat  less  disposed  to  irritate  the  stomach,  and  perhaps  some- 
what more  effective  as  an  antispasmodic.  It  should  be  persevered  in 
for  a  long  time,  care  being  taken  to  guard  against  any  obvious  injurious 
effects  on  the  system.  In  chorea,  hysteria,  pertussis,  spasmodic  asthma, 
and  neuralgia,  it  has  been  recommended,  and  may  be  resorted  to  upon 
failure  with  other  less  irritant  substances.  It  has  been  used  also  in  in- 
termittent fever,  in  dropsy,  and  against  worms  in  the  bowels. 

Administration.  The  dose  is  half  a  grain,  three  or  four  times  a  day, 


410  GENERAL   STIMULANTS.  [PART  II. 

to  be  increased,  if  necessary  to  obtain  its  curative  effects,  to  four  or  five 
grains,  unless  it  should  prove  irritant  to  the  stomach.  It  is  most  con- 
veniently given  in  pills,  made  like  those  of  the  sulphate,  and  may  often 
be  usefully  associated  with  assafetida. 

A  solution  of  it  in  water  has  been  used  as  an  injection  in  gonorrhoea 
and  leucorrhcea,  a  collyrium  in  opacity  of  the  cornea,  a  wash  in  pru- 
rigo,  and  a  stimulant  application  to  indolent  ulcers.  According  to  the 
effect  desired,  the  strength  of  the  solution  may  vary  from  one  to  thirty 
grains  to  the  fluidounce  of  water. 


III.  ZINC. 
ZINCTJM.  U.S. 

Metallic  zinc  is  without  influence  on  the  system;  and  it  is  only  in 
chemical  combination  that  it  becomes  active.  The  effects  of  its  prepa- 
rations are  closely  analogous  to  those  of  the  preparations  of  copper, 
though  less  energetic.  In  relation  to  their  visible  topical  effects,  they 
are,  according  to  their  degree  of  solubility  and  concentration,  either 
mildly  excitant  and  astringent,  or  actively  irritant,  or  escharotic.  Taken 
internally,  they  operate  directly  on  the  alimentary  mucous  membrane, 
and,  through  absorption,  on  the  system  at  large.  In  reference  to  the 
former  of  these  seats  of  their  action,  they  are,  in  small  doses,  simply 
tonic  and  astringent;  in  larger,  promptly  and  powerfully  emetic;  in  still 
larger,  highly  irritant,  and  even  escharotic,  sometimes  causing  death  by 
inflammation  or  destruction  of  the  mucous  membrane.  This  higher 
grade  of  action  is  exercised  only  by  the  soluble  preparations.  TJpon  the 
system  at  large,  when  given  in  small  and  repeated  doses,  they  produce 
no  sensible  effect  in  health;  and  it  is  only  by  the  reliefer  cure  of  certain 
morbid  conditions,  that  they  are  inferred  to  exercise  a  tonic  or  corrobo- 
rant influence  on  the  nervous  centres,  analogous  to  that  of  silver  and 
copper.  That  they  are  absorbed  has  been  proved  beyond  question. 
After  having  been  swallowed,  they  have  been  found  in  the  secretions 
and  the  solid  tissues.  Dr.  Michaelis,  in  his  experiments  on  the  lower 
animals,  noticed  that,  though  zinc  was  found  in  the  urine,  after  the  in- 
ternal exhibition  of  the  oxide,  it  was  more  largely  eliminated  with  the 
bile  (Arch.  Oen.,  4e  ser.,  xxx.  481.)  Taken  in  poisonous  doses,  together 
with  the  local  injury  of  the  primaj  vise,  the  preparations  of  zinc  some- 
times occasion  symptoms  evincive  also  of  an  action  on  the  nervous 
centres,  as  coma,  convulsions,  and  paralysis. 

It  has  been  a  question,  the  decision  of  which  is  of  considerable  im- 
portance, whether  the  slow  and  continued  introduction  of  zinc  into  the 
system  is  capable  of  materially  deteriorating  the  health ;  in  other  words, 


CHAP.  I.]  MINERAL   TONICS. — ZINC.  411 

of  inducing  a  state  of  chronic  poisoning,  as  the  preparations  of  lead  and 
some  other  metals  are  known  to  do.  The  general  impunity  under  the 
long  use  of  zinc  as  a  medicine,  and  the  comparatively  little  inconvenience 
experienced  by.  those  engaged  in  the  various  manufactures  or  applica- 
tions of  the  metal,  would  seem  to  determine  this  question  in  the  nega- 
tive ;  but  facts  have  been  brought  forward,  which  appear  to  me  to  place 
beyond  doubt  the  occasional  action  of  the  preparations  of  zinc  in  the  way 
referred  to.  Thus,  a  patient  who  took  twenty  grains  daily,  for  several 
months,  of  the  oxide  of  zinc,  for  the  cure  of  epilepsy,  became  pale,  ema- 
ciated, and  almost  idiotic,  with  a  furred  tongue,  constipated  bowels, 
tumid  abdomen,  cold  extremities,  oedema  of  the  lower  limbs,  dry,  shriv- 
elled skin,  like  parchment,  and  a  slow,  small,  very  feeble  pulse;  symp- 
toms, however,  which  quickly  disappeared  upon  the  omission  of  the 
medicine,  and  the  use  of  cathartics,  with  a  tonic  and  supporting  treat- 
ment. (Brit,  and  For.  Med.  Rev.,  July,  1838,  p.  221.)  Several  men 
employed  in  barrelling  oxide  of  zinc,  and  exposed  for  some  days  to  an 
atmosphere  loaded  with  the  powder,  experienced,  from  the  beginning, 
loss  of  appetite,  clammy  taste  in  their  mouths,  and  colic;  and,  after  ten 
days,  were  attacked  with  vomiting,  constipation,  and  violent  colic,  not 
unlike  the  a  flection  produced  by  lead,  and  which,  as  that  usually  does, 
yielded  to  purging  and  opiates.  (See  Chem.  Gfaz.,  viii.  362.)  In  another 
instance,  workmen  exposed  to  the  powder  arising  from  beaten  zinc,  were 
affected  with  general  depression,  sore-throat,  angina,  ulceration  of  the 
tonsils,  white  pellicles  on  the  gums,  salivation,  fetid  breath,  nausea,  colic, 
and  diarrhoea.  The  symptoms  subsided,  upon  the  abandonment  of  the 
occupation,  in  less  than  a  week.  (Ibid.)  In  these  instances,  it  is  obvious 
that  large  quantities  of  the  powdered  oxide  must  have  been  swallowed; 
and  it  was  probably  from  this  source  that  the  symptoms  proceeded. 
They  were  mainly  such  as  result  from  a  direct  irritation  of  the  aliment- 
ary canal ;  and,  though  it  is  probable  that  some  of  them  arose  from  the 
absorption  of  the  metal,  they  were  of  little  importance.  They  moreover 
disappeared  rapidly,  on  the  removal  of  the  cause,  leaving  no  permanent 
effect  behind.  It  is  satisfactory  that  the  evil  from  this  cause  seems  so 
trivial,  when  compared  with  that  from  exposure  to  the  influence  of  lead,  for 
which  zinc  is  in  a  course  of  rapid  substitution  as  a  material  for  painting. 
Abundant  confirmation  has  recently  been  obtained  of  the  morbid  influ- 
ence of  zinc,  largely  introduced  into  the  system,  from  observations  made 
both  in  France  and  England,  upon  the  effects  of  exposure  to  the  fumes  of 
the  metal  by  the  brass-founders.  Workmen  thus  exposed,  and  especially 
those  who  have  inhaled  freely  the  fumes  of  oxide  of  zinc,  arising  from  the 
combustion  of  this  metal  when  heated  in  contact  with  the  air,  suffer 
much  and  often  from  a  certain  complication  of  symptoms,  which,  from  an 
imperfect  resemblance  to  intermittent  fever,  has  received  among  them 
the  name  of  brass-founders'  ague.  This  subject  has  been  carefully  in- 


412  GENERAL   STIMULANTS.  [PART  II. 

\vstigated  by  Dr.  E.  H.  Greenhow,  of  London;  and  an  essay  containing 
the  results  has  been  published  in  the  Medico-chirurgical  Transactions 
(A.D.  1862,  vol.  xlv.,  p.  ITT).  As  stated  by  him,  there  is  at  first  a  sense 
of  uneasiness  or  weariness,  and  of  constriction  of  the  chest,  followed  near 
bedtime  by  shivering  and  coldness,  which  ends  in  a  hot  stage,  often 
attended  with  headache  and  vomiting,  and  invariably  succeeded  by  pro- 
fuse sweating.  The  patient  is  better  the  next  day,  but  on  fresh  exposure 
is  liable  to  fresh  attacks,  which,  however,  are  quite  irregular  in  their  recur- 
rence, and  thus  differ  essentially  from  the  genuine  ague.  Indeed,  a  fe- 
brile paroxysm,  with  its  precursory  nervous  disorder,  its  cold,  hot,  and 
sweating  stages,  seems  to  have  been  developed  by  the  presence  in  the 
blood  of  an  absorbed  poison,  acting  especially  on  the  nervous  centres. 
It  is  said  that  men  engaged  in  this  business  are  seldom  long-lived,  and 
are  carried  off  in  the  end  by  the  development  of  a  pectoral  disease  called 
asthma,  which,  however,  according  to  Dr.  Greenhow,  is  chronic  bron- 
ehitis.  The  symptoms  might  also  be  ascribed  to  the  vapours  of  the  cop- 
per employed ;  but,  independently  of  the  fact  that  the  copper  gives  off 
vapours  with  much  greater  difficulty,  this  metal  does  not  cause  the  phe- 
nomena in  the  absence  of  zinc. 

In  poisoning  from  large  quantities  of  the  soluble  salts  of  zinc,  the  treat- 
ment should  consist  of  the  use  of  magnesia  or  one  of  the  alkalies  as  an 
antidote,  of  free  dilution  with  demulcent  drinks,  of  opium  to  quiet  irrita- 
tion of  the  stomach  and  bowels,  and  of  measures  to  combat  inflammation 
corresponding  with  the  exigencies  of  each  particular  case. 

Of  the  therapeutic  application  of  zinc  it  will  be  sufficient  to  treat  under 
its  several  preparations.  Of  these,  I  would  here  observe,  that,  for  inter- 
ual  use,  all  might  well  be  spared  except  the  sulphate  and  oxide,  from 
which  every  curative  eil'ect  can  probably  be  obtained  which  the  others 
are  capable  of  producing. 

I.  SULPHATE   OF  ZINC. — ZlNCI    SULPHAS.    U.  S.,  Br.  - 
White  Vitriol. 

Origin.  This  was  known  so  early  as  the  middle  of  the  sixteenth  cen- 
tury. It  is  prepared  by  acting  upon  metallic  zinc  with  dilute  sulphuric 
acid.  The  metal  is  oxidized  at  the  expense  of  the  water,  the  liberated 
hydrogen  escapes,  and  the  oxide  of  zinc  formed  unites  with  the  acid,  to 
produce  the  sulphate,  which  is  then  obtained  by  evaporation  and  crystal- 
lization. 

Composition.  The  crystallized  salt,  which  should  always  be  selected 
for  use,  consists  of  one  equivalent  of  sulphuric  acid,  one  of  oxide  of  zinc, 
and  seven  of  water.  On  exposure,  it  partially  effloresces,  and  loses  much 
of  its  water. 

Properties.  The  crystals  are  small,  slender,  transparent,  four-sided 
prisms,  and  in  mass  very  closely  resemble  those  of  Epsom  salt,  for  which 


CHAP.  I.]  MINERAL   TONICS. — SULPHATE    OF    ZINC.  413 

they  have  sometimes  been  mistaken.  They  are  inodorous,  of  a  styptic, 
metallic,  disagreeable  taste,  very  soluble  in  water  cold  or  hot,  and  insol- 
uble in  alcohol.  By  heat  they  are  dissolved  in  their  own  water  of  crys- 
tallization, which  gradually  escapes,  leaving  the  salt  in  the  form  of  a 
white  opaque  powder.  By  an  intense  heat  they  are  decomposed. 

Incompatibles.  Sulphate  of  zinc  is  decomposed,  with  insoluble  precip- 
itates, by  the  alkalies  and  alkaline  earths  and  their  carbonates,  by  the 
soluble  salts  of  lead,  of  lime  or  calcium,  and  of  baryta  or  barium,  by  sul- 
phuretted hydrogen  and  the  soluble  sulphurets,  and  by  astringent  vege- 
table infusions  through  their  tannic  acid. 

Effects  on  the  System.  These  are  such  as  have  been  described  in  the 
general  remarks  on  zinc,  and  do  not  require  to  be  repeated  particularly 
here.  It  is  sufficient  to  state  that  this  is  the  most  astringent  of  the  salts 
of  zinc,  and  one  of  the  most  energetic  in  its  effects  on  the  system,  whether 
medicinal  or  poisonous.  It  has  been  frequently  taken,  by  mistake  for 
sulphate  of  magnesia,  in  doses  of  an  ounce  or  more,  and  sometimes, 
though  very  rarely,  with  fatal  results.  Happily,  the  powerful  emetic 
properties  of  the  salt  usually  cause  the  whole  of  it  to  be  rejected,  before 
it  has  had  the  opportunity  to  produce  a  caustic  effect  upon  the  coats  of 
the  stomach.  In  a  case  of  the  kind  which  fell  under  my  kno\vledge,  one 
of  the  severest  symptoms  was  a  feeling  of  excessive  constriction  of  the 
mouth,  throat,  and  oesophagus;  but  the  patient,  who  was  a  young  woman, 
recovered  without  any  serious  consequences.  Generally,  along  with  in- 
cessant vomiting  and  retching,  there  is  violent  gastric  and  intestinal 
pain ;  and,  in  the  fatal  cases,  there  hare  been  observed,  in  addition, 
purging,  anxiety,  restlessness,  great  prostration,  and  ultimately  convul- 
sions. The  treatment  required  in  such  cases  has  been  already  stated. 

Therapeutic  Application.  As  an  emetic,  sulphate  of  zinc  will  be  con- 
sidered particularly  with  the  class  of  emetics.  First,  I  shall  treat  of  its 
internal,  and  afterwards  of  its  external  use. 

1.  For  its  direct  effects  on  the  alimentary  canal,  the  salt  has  been  used 
in  dyspepsia,  diarrhoea,  dysentery,  and  colica  pictonum.  As  a  gentle 
tonic,  in  very  small  doses,  it  is  sometimes  beneficial  in  simple  indiges- 
tion ;  but  it  is  seldom  used  in  that  affection.  To  diarrhoea  it  is  adapted 
by  its  strong  astringency ;  but  it  is  too  irritant  for  the  disease  in  its  acute 
form,  unless  associated  with  great  intestinal  relaxation.  It  is  to  chronic 
diarrhoea  that  it  is  best  adapted,  and  especially  to  those  cases  in  which 
there  may  be  a  suspicion  of  ulcers  in  the  small  intestines.  In  these  cases, 
associated  with  opium  in  small  doses,  it  is  sometimes  very  useful,  though 
less  effective,  I  think,  than  the  corresponding  salt  of  copper.  In  acute 
dysentery  it  should  not  be  used  by  the  mouth,  except,  sometimes,  in  the 
very  advanced  stages;  but  it  may  at  any  time  be  tried  in  the  chronic 
form  of  the  disease,  when  the  tongue  remains  moist,  and  the  ordinary 
measures  have  been  employed  in  vain.  There  is  a  condition  of  dysen- 


414  GENERAL   STIMULANTS.  [PART  II. 

lery  in  which  it  may  often  be  used  with  very  great  benefit,  I  allude  to 
-  in  which  the  rectum  is  the  part  mainly  affected,  whether  the  case 
be  subacute  or  chronic.  In  instances  of  the  latter  kind,  the  patient  will 
often  suffer  long  with  the  most  harassing  tencsmus;  and  though,  from 
the  want  of  constitutional  sympathy,  his  general  health  may  suitor  less 
than  when  the  higher  portions  of  the  large  intestines  are  inflamed  or 
ulcerated,  yet  the  local  distress  and  inconvenience  are  so  great  that  life 
is  rendered  burdensome.  The  remedy  should  here  be  used  by  injection, 
.»<>  as  to  bring  it  into  direct  contact  with  the  ulcerated  surface.  I  have 
been  for  many  years  in  the  habit  of  resorting  to  this  measure  in  the  class 
of  cases  mentioned ;  and,  though  the  disease  may  have  been  of  several 
months' duration,  and,  in  one  instance  which  I  remember,  had  continued 
a  year,  they  have  speedily  begun  to  improve,  and  generally  marched  on 
steadily  to  convalescence.  I  usually  direct  from  four  to  eight  fluidouncee 
of  water,  holding  two  grains  of  the  sulphate  in  solution  for  each  fluid- 
ounce,  with  the  addition  of  thirty  or  forty  drops  of  laudanum,  to  be 
thrown  up  the  bowel  twice  a  day.  With  the  use  of  the  salt  in  colica 
pictonum  I  have  no  experience;  and  I  should  not  be  disposed  to  rely  on 
it,  while  medicines  known  to  be  efficient  are  at  command. 

2.  In  reference  to  its  tonic  effects  upon  the  system  generally,  and  on 
the  nervous  centres  more  especially,  the  medicine  has  been  given  in  most 
of  the  chronic  nervous  diseases  to  which  the  metallic  tonics  are  thought 
to  be  peculiarly  applicable.  Epilepsy,  hysteria,  hooping-cou'jh ,  and 
asthma  are  among  these  complaints;  but  the  one  in  which  ii  has  the 
highest  reputation,  and  in  which  experience  has  shown  it  to  be  most 
efficacious  is  chorea,  or  St.  Vitus's  dance.  It  is  certainly  among  the 
remedies  which  I  have  found  most  effectual  in  that  complaint,  especially 
when  used  in  connection  with  occasional  purging.  Upon  the  same 
principle,  it  will  sometimes  succeed  in  interrupting  the  paroxysms  of 
intermittent  fever ,  though  probably  less  efficacious  in  this  affection  than 
sulphate  of  copper,  and  incomparably  less  so  than  sulphate  of  quinia,  or 
the  arsenical  preparations.  It  is  asserted  to  have  proved  useful  in  ob- 
stinate chronic  gleet  and  leucorrhoea;  and  Dr.  Christison,  in  his  Dis- 
pensatory, states  that,  in  the  dose  of  from  three  to  six  grains  twice  or 
thrice  daily,  he  had  frequently  been  successful  with  it  in  such  cases.  It 
would  appear  to  operate  by  something  more  than  a  mere  a.-tringency. 
It  may  possibly  exert  an  alterative  influence  over  the  mucous  mem- 
branes, and  thus  prove  useful  also  in  chronic  bronchitis  with  profuse 
expectoration,  in  which  it  has  been  recommended. 

Administration.  The  dose,  to  begin  with,  is  one  or  two  grains,  twice 
or  three  times  a  day,  which  may  be  gradually  increased,  if  requisite,  as 
the  stomach  is  found  to  tolerate  it  without  inconvenience.  Dr.  Uabing- 
ton  has  increased  to  thirty-six  grains  three  times  a  day;  but  this  can 
rarely  be  necessary;  and  it  is  probable  that  all  that  the  medicine  can 


CHAP.  I.]  MINERAL   TONICS. — SULPHATE    OF    ZINC.  415 

effect  may  be  obtained  from  much  smaller  quantities.  It  may  be  given 
in  pill  or  solution. 

External  Use.  There  arc  few  more  valuable  medicines  for  external 
use  than  sulphate  of  zinc.  Being  at  once  excitant  and  decidedly  astrin- 
gent, it  serves  to  stimulate  enfeebled  surfaces,  and,  by  contracting  their 
blood-vessels,  to  obviate  inflammation  in  them.  But  there  is  something, 
also,  in  its  mode  of  operation,  which  we  do  not  exactly  understand,  by 
which  it  changes  the  condition  of  parts  even  specifically  diseased,  and 
disposes  them  to  take  on  a  healthy  action,  to  which  otherwise  they 
would  have  no  tendency.  In  other  words,  it  is  alterative,  as  well  as 
tonic  and  astringent,  in  its  local  influence. 

It  has  been  used  as  a  simple  styptic  to  bleeding  surfaces,  though 
probably  inferior  in  this  respect  to  some  other  astringents,  such  as  alum 
and  acetate  of  lead. 

As  a  collyrium  in  the  very  commencement  of  inflammation  of  the 
conjunctiva,  in  slight  affections  of  the  kind  at  any  stage,  in  chronic  cases 
or  the  declining  stages  of  the  acute,  and  whenever  the  blood-vessels 
appear  to  be  merely  passively  dilated,  it  is  among  the  safest  and  most 
efficient  remedies.  For  this  purpose,  it  may  be  dissolved  in  rose-water, 
or  in  pure  distilled  water,  in  the  proportion  of  one  grain  to  the  fluid- 
ounce,  or  even  less  when  the  eye  is  very  sensitive.  The  solution  may 
be  applied  twice  a  day,  and  gradually  strengthened,  if  requisite.  In 
very  slight  cases,  which,  however,  are  sometimes  troublesome  by  inter- 
fering with  the  use  of  the  eyes,  a  single  application  often  proves  sufficient. 

In  gonorrhoea,  in  any  stage,  unless  when  the  inflammation  is  very 
high,  and  involves  more  than  the  mucous  membrane,  it  is  a  very  efficient 
remedy,  if  properly  used.  At  the  very  commencement  of  an  attack,  it 
will  sometimes  almost  immediately  arrest  the  affection.  The  strength 
of  the  solution  should  not  at  first  exceed  twro  grains  to  the  fluidounce  of 
water,  and  it  may  be  even  weaker  in  very  sensitive  conditions  of  the 
urethra.  To  be  successful,  the  injection  must  be  very  frequently  re- 
peated, so  as  not  to  allow  the  impression  to  subside  before  it  is  renewed; 
every  three  or  four  hours  for  example,  or  six  or  eight  times  in  the  twenty- 
four  hours. 

In  leucorrhosa  the  same  injection  will  often  prove  highly  useful,  em- 
ployed two,  three,  or  four  times  in  the  twenty-four  hours;  but  little  good 
can  be  expected  from  it  when  the  discharge  is  sustained,  as  it  too  fre- 
quently is,  by  organic  disease. 

In  chronic  injlammation  of  the  rectum,  with  mucous  discharges,  it 
is  an  invaluable  remedy;  whether  this  condition  be  original,  or  a  mere 
accompaniment  or  consequence  of  dysentery.  The  method  of  adminis- 
tration has  been  mentioned  in  the  remarks  made  on  the  use  of  the  remedy 
in  that  affection. 

Chronic  purulent  discharges  from  the  ears,  and  the  same  affection 


416  GENERAL   STIMULANTS.  [PART  II. 

of  the  nostrils  known  under  the  name  of  ozxna,  are  other  complaints  in 
which  sulphate  of  zinc  is  often  extremely  useful.  In  these  cases,  the 
strength  of  the  solution,  at  first  only  two  or  three  grains  to  the  fluid- 
ounce,  should  be  increased,  as  the  parts  will  bear  it,  to  five  or  even  ten 
grains.  Whenever  the  immediate  seat  of  the  discharge  can  be  seen,  as 
sometimes  when  an  ulcer  exists,  even  a  stronger  solution  than  the  strong- 
est mentioned,  may  be  directly  applied  to  the  diseased  surface  by  means 
of  a  camel's-hair  pencil,  leaving  the  sound  parts  untouched. 

But  perhaps  the  local  affections  most  amenable  to  the  remedy,  are 
ulcers  and  pseudomembranous  patches  in  the  mouth  and  fauces. 
Whenever  the  surface  of  the  ulcers,  in  these  positions,  is  covered  with  a 
whitish  exudation,  whatever  may  be  their  duration  or  size,  from  the 
small  superficial  aphthous  ulceration  to  the  obstinate  and  destructive 
cancrum  oris,  the  solution  of  sulphate  of  zinc  will,  according  to  my 
observation,  effect  a  cure.  I  do  not  include  in  this  category  the  gan- 
grsena  oris,  which  I  believe  to  be  a  different  affection,  and  which  is  more 
effectively  treated  by  more  active  escharotics.  as  nitrate  of  silver  or  sul- 
phate of  copper,  nor  syphilitic  ulcers,  in  which  corrosive  chloride  of 
mercury  is  more  effectual.  The  solution  should  have  the  strength  of 
fifteen  or  twenty  grains  to  the  fluidounce  of  water,  and  should  be  applied 
daily  or  twice  a  day,  by  means  of  a  brush  or  hair-pencil,  exclusively  to 
the  diseased  surface,  and  continued  until  the  whitish  exudation,  before 
alluded  to,  gives  way  to  a  red  surface,  after  which  it  should  be  omitted. 
As  soon  as  this  change  takes  place,  the  ulcer  speedily  heals. 

A  much  weaker  solution,  say  of  two  or  three  grains  to  the  fluidounce, 
may  sometimes  be  used  in  obstinate  cases  of  the  infantile  thrush  or 
mug  net  of  the  French,  with  great  benefit. 

The  same  remedy  is  applicable  to  all  ulcers,  wherever  seated,  which, 
in  consequence  of  a  loose,  flabby,  debilitated  state  of  the  old  tissue,  or  of 
the  new  granulations,  refuse  to  take  on  the  healing  process;  and  espe- 
cially when  the  ulcers  are  attended  with  a  copious  purulent  discharge. 
The  strength  of  the  solution  mu*t,  in  these  cases,  vary  so  much  that  no 
precise  rule  can  be  given.  It  may  contain  from  two  to  twenty  Drains  to 
the  fluidounce. 

Dr.  F.  L.  Keyes,  of  Jerseyville,  W.  Canada,  strongly  recommends  a 
solution  containing  three  grains  of  the  sulphate  to  a  fluidounce  of 
water,  as  a  dressing  for  burns  and  scalds,  of  all  kinds,  except  those  pro- 
duced by  gunpowder,  and  containing  grains  of  the  powder  in  the  wound. 
(Pharm.  Journ.  and  Trans.,  Dec.  1865,  p.  338.) 

Certain  cutaneous  eruptions  yield  to  the  local  use  of  this  solution.  I 
have  found  it  specially  beneficial  in  that  brownish  superficial  discolora- 
tion, which  sometimes  spreads  over  large  portions  of  the  surface,  to  the 
great  anxiety  of  the  patient,  and  which  is  now,  under  the  name  of  pity- 
riasis  versicolor,  recognized  as  a  parasitic  affection.  Made  in  the  pro- 


CHAP.  I.]  MINERAL    TONICS. — ACETATE   OF   ZINC.  417 

portion  of  from  two  to  five  grains  to  the  fluidounce,  and  thoroughly  ap- 
plied morning  and  evening,  the  solution  has,  I  believe,  invariably  within 
my  recollection,  effected  cures. 

Sometimes  a  mixture  of  acetate  of  lead  and  sulphate  of  zinc  in  solution, 
has  been  employed  as  a  collyrium,  and  an  an  injection  in  gonorrhoea, 
preferably  to  the  sulphate  alone  In  this  case,  a  double  decomposition 
takes  place,  with  the  production  of  sulphate  of  lead,  which  is  precip- 
itated, and  of  acetate  of  zinc,  which  remains  dissolved.  If  the  liquid, 
therefore,  be  employed  clear,  it  is  the  latter  salt  which  is  the  real  agent ; 
if  it  be  agitated,  the  insoluble  sulphate  of  lead  is  applied  at  the  same 
time.  It  is  possible  that  this  salt  may  add  something  to  the  curative 
effect  by  affording  a  sort  of  protective  covering  to  the  mucous  surface. 
When  it  is  the  effect  of  the  acetate  of  zinc  alone  that  is  wanted,  recourse 
should  be  had  preferably  to  a  solution  of  the  pure  salt.  The  proportion 
of  the  two  salts  employed  is  usually  three  grains  of  the  acetate  of  lead 
to  two  of  sulphate  of  zinc,  in  a  fluidounce  of  water. 

II.  ACETATE  OF  ZINC.  —  ZlNCI  AcETAS.    U.S.,Br. 

This  is  prepared  by  exposing  metallic  zinc  to  the  action  of  a  solution 
of  acetate  of  lead.  The  zinc  takes  the  place  of  the  lead  in  the  solution, 
while  the  latter  metal  is  deposited  in  the  pure  state.  The  liquid  being 
now  evaporated,  and  allowed  to  stand,  yields  acetate  of  zinc  in  crys- 
tals. The  salt  consists  of  one  equivalent  of  acetic  acid,  one  of  oxide 
of  zinc,  and  seven  of  water.  It  is  in  soft,  white,  shining,  micaceous  crys- 
tals, which  effloresce  in  a  dry  air,  are  inodorous  and  of  an  astringent 
metallic  taste,  and  are  very  soluble  in  water,  and  soluble  also  in  alcohol. 

The  effects  of  this  salt  are  essentially  the  same  as  those  of  the  pre- 
ceding, but  milder,  and  less  astringent.  Though  capable  of  doing  injury 
in  excessive  doses,  it  is  much  less  poisonous  than  the  sulphate.  It  may 
be  given  internally  for  the  same  purposes,  but  is  seldom  used  in  that 
way.  It  is  chiefly  employed  in  the  form  of  solution,  as  a  collyrium  in 
ophthalmia,  or  an  injection  in  gonorrhoea.  The  dose  for  internal  use 
would  be  one  or  two  grains.  The  solution  for  topical  application  may 
contain  from  one  to  three  grains  to  a  fluidounce  of  water. 

III.  YALERIAXATE  OF  ZINC.  —  ZlNCI  VALERIANAS.    U.S., 
Br. 

This  may  be  made  by  double  decomposition  between  valerianate  of 
soda  and  sulphate  of  zinc,  dissolved  separately  in  boiling  water,  and  then 
mixed.  Upon  evaporation,  the  valerianate  of  zinc  is  formed,  being  less 
soluble  than  either  of  the  other  salts,  and  is  separated  in  the  shape  of 
crystals,  which  float  on  the  surface,  and  are  removed  as  they  appear. 
The  salt  is  in  white,  pearly,  scale-like  crystals,  which  have  a  feeble  odour 
of  valerianic  acid,  and  a  styptic,  metallic  taste.  It  is  of  difficult  solubility, 
requiring  160  parts  of  cold  water,  and  60  of  alcohol. 
VOL.  i. — 27 


418  GENERAL    STIMULANTS.  [PART  II. 

Its  effects  on  the  system  tire  essentially  the  same  as  those  of  the  sul- 
phate, though  less  astringent.  It  was  introduced  into  use  under  the  im- 
pression that  valeriauic  acid  might  impart  to  it  greater  antispasmodic 
efficiency  than  belongs  to  the  preparations  of  zinc  generally.  It  has  proved 
useful  in  various  nervous  diseases,  such  as  those  for  which  the  other 
preparations  of  zinc  are  employed;  but  experience  has  not  satisfactorily 
shown  that  it  has  any  superiority  over  them.  The  dose  is  one  or  two 
grains,  several  times  a  day.  It  is  usually  administered  in  the  pilular 
form.* 

IV.  PRECIPITATED  OARBOXATE  OF  ZIX(\— ZlNCI  CAR- 
BON AS  PRJSCIPITATA.  U.S. — ZINCI  CARBONAS.  Br.  —  Carbo- 
nate of  Zinc. 

The  U.  S.  Pharmacopoeia  directs  this  to  be  made  by  double  decompo- 
sition  between  sulphate  of  zinc  and  carbonate  of  soda,  mixed  in  boiling 
hot  solution.  It  has  been  introduced  among  the  officinal  preparations 
as  a  substitute  for  calamine,  or  impure  carbonate  of  zinc,  which,  us 
found  in  the  shops,  is  often  a  wholly  surreptitious  substance,  containing 
no  zinc  whatever,  and  therefore  not  to  be  relied  on.  The  officinal  car- 
bonate of  zinc  is  really  a  subcarbonate  ;  the  oxide  of  zinc  being  in  con- 
siderable excess,  in  consequence  of  the  escape  of  carbonic  acid  during 
the  reaction  of  the  two  salts  used  in  its  preparation. 

Precipitated  carbonate  of  zinc  is  a  soft,  light,  white  powder,  insoluble 
in  water,  and  without  smell  or  taste.  It  is,  however,  soluble  in  most 
acids;  and,  when  applied  locally  to  a  secreting  surface,  may  be  consid- 
ered as  undergoing  solution  in  very  small  proportion  in  the  extravasatcd 
liquid,  through  the  instrumentality  of  an  acid  contained  in  it,  or  some 
other  chemical  reagency. 

Therapeutic  Application.  This  is  exclusively  topical  and  external. 
Probably  in  consequence  of  the  slight  solution,  just  referred  to,  which  it 
may  be  supposed  to  undergo  in  the  moisture  of  the  surface  to  which  it 
is  applied,  it  may  acquire  a  very  moderate  degree  of  the  excitant  and 
astringent  properties  which  characterise  the  soluble  preparations  of  zinc, 
and  thus  produce  a  positive  impression,  such  as  it  could  not  produce  in 
a  perfectly  insoluble  state.  But  it  probably  also  acts,  when  in  the  form 
of  powder,  by  absorbing  the  irritating  secretions  of  the  diseased  surface, 
and  thus  in  some  degree  correcting  their  influence;  and.  whether  in 
powder  or  ointment,  it  has  some  effect  by  the  exclusion  of  atmospheric 

*  In  the  case  of  a  girl  of  fourteen,  troubled  with  an  almost  incessant  barking 
cough,  no  doubt  of  an  hysterical  character,  a  cure  was  effected,  under  the  care  of 
Dr.  Harley,  by  the  use  of  valerianate  of  zinc,  assafetida,  and  camphor,  aided  by  a 
cold  douche,  with  frictions  to  the  spine,  night  and  morning;  but  it  is  impossible  t<> 
say  what  share  the  valerinnatc  had  in  the  cure.  (Med.  T.  and  Gm..  Aug.  186:?,  p. 
116.)— Note  to  the  third  edition. 


CHAP.  I.]  MINERAL   TONICS. — OXIDE   OF   ZINC.  419 

air.  It  is  used  in  excoriations,  whether  from  the  chafing  of  opposed 
surfaces,  as  in  fat  persons  and  particularly  children;  from  acrid  secretions, 
as  of  the  upper  lip  in  coryza,  or  from  superficial  injuries;  also  in  chapped 
hands  and  sore  nipples,  and  sometimes  in  scalds  and  blisters.  It  is 
applied  in  the  form  of  powder  dusted  on  the  part,  or  in  that  of  a  cerate 
(CERATUM  ZINCI  CARBONATIS,  U.  S.),  made  by  incorporating  two  parts 
of  the  powder  with  ten  of  simple  ointment.  This  has  been  substituted 
for  the  old  Turner's  cerate,  which  was  prepared  from  calamine. 

CALAMINE — CALAMINA.  U.S.   1850. 

This,  when  genuine,  is  an  ore  of  zinc  consisting  chiefly  of  the  carbo- 
nate of  that  metal.  It  is  in  hard  masses,  which  are  first  heated,  then 
pulverized,  and  afterwards  submitted  to  the  processes  of  levigation  and 
elutriation,  in  order  to  reduce  them  to  the  state  of  fine  impalpable  pow- 
der, in  which  state  it  constitutes  prepared  calamine. 

Both  the  crude  calamine  and  the  prepared,  though  formerly  recognized 
in  our  own  and  all  the  British  Pharmacopoeias,  have  been  entirely  dis- 
carded, in  consequence  of  uncertainty  as  to  its  genuineness;  substances 
having  been  substituted  for  it,  which  often  do  not  contain  a  particle  of 
zinc. 

Prepared  Calamine  (CALAMINA  PR^EPARATA,  U.  S.  1850)  is  in  the 
form  of  a  powder  of  various  colours,  according  to  the  particular  specimen 
of  ore  from  which  it  may  have  been  obtained,  either  pinkish,  yellowish, 
or  brownish.  It  is  inodorous  and  tasteless,  and  quite  insoluble  in  water. 
Sometimes  it  is  in  small  pulverulent  lumps.  The  sophisticated  article 
often  found  in  the  shops  is  generally  of  a  pink  colour.  Calamine  has 
the  same  properties,  and  is  used  for  the  same  purposes,  and  in  the  same 
manner  as  the  precipitated  carbonate.  There  was  formerly  an  officinal 
cerate  called  Calamine  Cerate  (CERATUM  CALAMINE,  U.  S.  1850),  or 
Turner's  cerate,  which  was  made  by  mixing  prepared  calamine  with 
yellow  wax  and  lard  melted  together.  It  has  Been  superseded  by  the 
aerate  of  carbonate  of  zinc,  mentioned  above. 

V.  OXIDE  OF  ZIXC ZINCI  OxiDUM.  U.  S.,  Br. 

Origin  and  Properties.  The  oxide  of  zinc  is  prepared  either  by  burn- 
ing the  metal,  and  condensing  the  vapours,  or  by  heating  the  carbonate 
of  zinc  strongly,  and  thus  driving  off  the  carbonic  acid.  Procured  by 
the  former  method,  it  has  been  called  floivers  of  zinc.  In  composition 
it  is  a  protoxide,  consisting  of  one  equivalent  of  each  of  its  ingredients. 
It  is  a  white  powder,  without  smell  or  taste,  unalterable  in  the  air,  insol- 
uble in  water,  but  readily  dissolved  by  most  of  the  acids. 

Effects  on  the  System.  Oxide  of  zinc  is  probably  inert  in  its  uncoin- 
bined  state;  but,  as  there  is  very  often  free  acid  in  the  alimentary  canal, 
with  which  it  may  react  so  aa  to  form  soluble  salts,  it  is  capable  of  pro- 
ducing the  characteristic  effects  of  the  preparations  of  zinc  on  the  sys- 


420  GENERAL   STIMULANTS.  [PART  II. 

tern.  The  experiment  of  Orfila,  who  gave  to  a  small  dog  from  three  to 
six  drachms,  without  producing  any  other  observable  effect  than  vomit- 
ing, is  not  to  be  received  as  a  sufficient  proof  of  the  inactivity  of  the 
oxide;  for  there  may  have  been  no  acid  present  in  the  stomach,  or  too 
little  to  generate  any  considerable  proportion  of  soluble  salt.  Given 
largely  to  men,  it  is  said  sometimes  to  have  produced  vomiting  and 
purging;  and  even  giddiness  and  intoxication  have  been  mentioned 
among  its  effects.  As  already  stated,  in  the  general  remarks  on  the  metal, 
it  is  capable  of  acting  injuriously  when  used  freely  and  for  a  long  time. 
Having  recently  been  largely  employed  as  a  substitute  for  white  lead  in 
painting,  in  consequence  of  retaining  its  white  colour  when  exposed  to 
the  action  of  sulphuretted  hydrogen,  it  is  a  very  happy  circumstance 
that,  if  not  absolutely  innoxious,  it  should  have  proved  so  much  less  in- 
jurious than  that  paint.  Its  general  effects  on  the  system,  so  far  as  it 
acts  at  all,  may  be  considered  as  identical  with  those  of  the  preparations 
of  zinc  already  described. 

Therapeutic  Application.  This  medicine  has  been  used  in  all  the  ner- 
vous affections  to  which  the  preparations  of  zinc  are  deemed  applicable; 
namely,  epilepsy,  catalepsy,  chorea,  hysteria,  hooping-cough,  neuralyia, 
and  gastric  spasm;  but  it  is  in  the  treatment  of  epilepsy  that  it  has 
enjoyed  the  highest  reputation.  If  some  accounts  which  have  been 
published  of  its  efficacy  are  to  be  relied  on,  it  is  capable  of  curing  a  very 
considerable  proportion  of  cases;  but  they  who  are  familiar  with  this 
disease,  and  know  how  obstinately,  when  once  established,  it  n 
every  variety  of  treatment,  are  prepared  when  they  read  such  rep 
to  make  many  allowances  for  failure  in  diagnosis,  for  the  deceiving  el: 
of  preconception,  and  for  the  fact,  almost  universally  noticed,  that  the 
paroxysms  of  epilepsy  are  often  suspended,  and  sometimes  kept  long  at 
bay,  by  anything  calculated  to  excite  the  hopes  and  occupy  the  attention 
of  the  sufferers.  NYh'-u  the  disease  is  purely  functional,  it  may  often,  no 
doubt,  be  cured,  if  submitted  to  treatment  at  an  early  stage ;  and  there 
is  as  little  doubt  that  it  has  not  unfrcquently  given  way  under  the  use  of 
oxide  of  zinc;  but  the  number  of  failures,  taking  all  the  cases  into  con- 
sideration, will  probably  greatly  exceed  the  cures  effected  by  this  remedy. 
It  has  the  advantage  over  the  sulphate,  that  it  is  less  disposed  to  irritate 
the  stomach  and  bowels;  and  it  may,  therefore,  be  used  preferably  when 
these  organs  are  peculiarly  delicate. 

Since  the  publication  of  the  first  edition  of  this  work,  the  oxide  of  zinc 
has  acquired  some  reputation  in  the  treatment  of  the  night-sweats  of 
phthisis.  My  own  trials  with  it  have  not  been  so  satisfactory  as  to  in- 
duce me  to  join  in  its  recommendation  from  personal  observation. 

The  dose  is  from  two  to  eight  grains  or  more,  given  three  times  daily. 
It  should  not  be  indefinitely  increased;  as  conditions  of  the  alimentary 
canal,  in  which  it  may  be  innocent  at  one  time,  may  be  so  changed  that 


CHAP.  I.]  MINERAL   TONICS. CHLORIDE    OF    ZINC.  421 

it  shall  prove  highly  irritant  at  another.  I  do  not  think  that  the  dose  of 
twenty  grains  should  be  exceeded;  and,  should  irritant  effects  be  experi- 
enced, the  smaller  doses  mentioned  should  be  diminished,  or  withheld  for 
a  time.  It  may  be  given  in  pill,  or  in  powder  mixed  with  syrup. 

External  Use.  As  in  the  case  of  the  carbonate,  this  preparation  may 
possibly  be  dissolved,  in  minute  quantities,  in  the  liquid  secretion  pro- 
ceeding from  diseased  surfaces,  and  thus  rendered  positively  efficient  in 
its  action  on  such  surfaces.  In  the  form  of  powder  or  ointment,  the 
oxide  has  been  much  used  as  an  absorbent,  desiccant,  and  alterative,  in 
cutaneous  eruptions  characterized  by  copious  liquid  extravasation,  as  in 
eczema  and  impetigo,  in  excoriations  of  all  kinds,  superficial  burns, 
blisters,  chapped  hands,  lips,  and  nipples,  and  profusely  secreting 
ulcers.  In  chronic  ophthalmia,  it  has  been  recommended  in  the  form  of 
a  collyrium,  made  by  diffusing  a  drachm  of  the  powder  equably  in  three 
or  four  fluidounces  of  mucilaginous  liquid ;  and  the  same  method  of  pre- 
paration has  been  recommended  in  cutaneous  affections,  and  for  injec- 
tions in  gonorrhoea  and  leucorrhosa. 

Ointment  of  Oxide  of  Zinc  (UNGUENTUM  ZINCI  OXIDI,  U.  S.)  is  made 
by  mixing  one  part  of  the  oxide  with  six  parts  of  lard.  It  was  intended 
as  a  substitute  for  the  old  iutly  ointment  (unguentum  tutiae)  prepared  in 
the  same  manner  from  tufty,  which  is  an  impure  oxide  of  zinc,  of  uncer- 
tain strength,  formerly  much  used,  but  now  nearly  abandoned. 

VI.  CHLORIDE  OF  ZINC.  — ZlNCI  CnLORIDUM.  U.S.,Br. 

The  mode  of  preparing,  and  the  properties  of  this  compound,  will  be 
considered  under  the  head  of  escharotics,  to  which  it  belongs  by  its  most 
important  application.  It  is  sufficient  here  to  state  that  it  is  a  soft. 
uTi-enish-white,  translucent  substance,  deliquescent  on  exposure,  and  sol- 
uble in  water,  alcohol,  and  ether.  Its  consistence  has  gained  for  it  the 
name  of  butter  of  zinc. 

It  is  locally  irritant  and  caustic,  and,  in  its  effects  upon  the  system, 
corresponds  with  the  soluble  salts  of  zinc  already  mentioned.  In  over- 
doses, it  is  an  irritant  poison,  producing  constriction  of  the  throat, 
nausea,  vomiting,  gastric  and  intestinal  pains,  cramps  in  the  limbs,  and 
great  prostration,  with  paralysis  of  the  extremities,  convulsions,  and 
coma.  Several  cases  of  death  from  it  are  on  record.  The  indications 
of  treatment  are  thoroughly  to  wash  out  the  stomach,  to  administer 
albumen  freely  which  is  coagulated  by  it,  and  afterwards  to  treat  the 
case  with  opiates,  and  such  antiphlogistic  measures  as  may  seem  to  be 
required. 

Introduced  by  Papenguth  into  medicine,  it  has  been  occasionally  used 
by  other  practitioners,  particularly  on  the  continent  of  Europe,  in  scrof- 
ula, epilepsy,  chorea,  and  neuralgia.  It  has  no  advantage,  that  I  can 
appreciate,  over  the  sulphate  or  oxide,  while  it  is  more  likely  to  injure 


422  GENERAL    STIMULANTS.  [PART  II. 

the  stomach  and  bowels.     The  dose  is  from  half  to  three-quarters  of  a 
grain,  to  begin  with. 

Its  local  uses  will  be  more  conveniently  detailed  under  the  escharot- 
ics ;  and,  among  them,  the  disinfectant  property.* 

IV.  BISMUTH. 
BISMUTHUM.  U.  S.,  Br. 

The  only  preparation  of  bismuth  used  in  medicine  was  for  a  long  time 
the  subnitrate ;  but  the  subcarbonate  has  been  of  late  introduced  as  a  sub- 
stitute, and  is  now  recognized  in  the  U.  S.  Pharmacopeia;  and  a  prepa- 
ration containing  the  citrate  of  the  metal  with  ammonia  has  recently 
been  introduced,  with  the  advantage  that  it  may  be  used  in  the  liquid 
form ;  the  others  being  insoluble.  These  three  preparations  will  be 
treated  of  under  the  present  heading. 

I.  SUBNITRATE  OF  BISMUTH.  —  BlSMUTHI  SuBNlTRAS. 
U.S. — BISMUTHUM  ALBUM.  Br. — White  Oxide  of  Bismuth. — 
Magistery  of  Bismuth. 

Origin.  Subnitrate  of  bismuth  is  prepared  by  dissolving  the  metal  in 
nitric  acid,  and  pouring  the  resulting  solution  into  water.  Two  salts  are 
formed ;  one  a  supernitrate,  with  great  excess  of  acid,  which  remains  dis- 
solved, the  other  a  subnitrate,  which  is  thrown  down.  The  latter  is  the 
preparation  in  question. 

Properties.  It  is  a  heavy,  white  powder,  without  smell  or  taste,  very 
slightly  soluble  in  water,  but  readily  dissolved  by  nitric  acid.  It  be- 
comes grayish  on  exposure  to  the  air,  and  blackens  under  the  influence 
of  sulphuretted  hydrogen.  It  has  been  ascertained  by  Prof.  R.  E. 
Rogers,  of  Philadelphia,  that  subnitrate  of  bismuth,  as  found  in  the 
shops,  often  contains  arsenic;  and,  though  this  is  in  small  proportion, 
the  fact  is  sufficient  to  put  the  physician  upon  his  guard  against  pre- 

*  Besides  the  preparations  above  mentioned,  several  others  have  been  employed. 

Iodide  of  Zinc  has  been  recommended  as  peculiarly  useful  in  cases  of  chorea,  con- 
nected with  a  scrofulous  taint.  From  two  to  five  grains  may  be  given  three  times 
a  day;  but,  as  the  salt  is  deliquescent,  it  is  best  kept  and  administered  in  the  form 
of  syrup. 

Lactate  of  Zinc  has  been  recommended  by  M.  Herpin  in  epilepsy,  as  a  substitute 
for  the  oxide,  to  which  it  is  preferable  on  account  of  its  solubility,  more  ready 
entrance  into  the  circulation,  and  greater  uniformity  of  action.  The  dose  is  two 
grains  thrice  daily,  to  be  increased  as  the  stomach  is  found  to  bear  it. 

Phosphate  of  Zinc  has  been  used  in  epilepsy,  by  Dr.  Barnes,  of  London,  under  the 
impression  that  in  this  disease,  which  especially  affects  the  brain,  there  might  be  a 
demand  for  phosphorus  to  supply  the  cerebral  waste.  lie  has  employed  it,  with 


CHAP.  I.]  MINERAL   TONICS. — BISMUTH.  423 

scribing  large  doses  of  the  medicine,  unless  assured  of  its  perfect  freedom 
from  that  poisonous  ingredient.* 

Effects  on'  the  System.  Ordinarily,  when  given  internally,  the  oxide 
produces  little  observable  effect;  and  very  large  quantities  have  been 
exhibited  with  perfect  impunity.  These  facts  might  lead  to  the  sus- 
picion that  former  observers  were  mistaken  in  ascribing  active  irritant 
properties  to  the  medicine.  But  the  apparent  discrepancy  is  explained 
by  reference  to  the  very  feeble  solubility  of  the  salt  in  water,  and  to  its 
ready  solubility  in  some  of  the  acids.  Whether,  therefore,  it  shall  prove 
nearly  inert,  or  powerfully  irritant,  may  depend  on  the  absence  or  pres- 
ence of  an  acid  in  the  primae  vise,  capable  of  dissolving  it.  An  instance 
of  death  is  recorded,  which  resulted  from  swallowing  two  drachms  of  the 
subnitrate  with  a  little  cream  of  tartar.  It  produced  the  ordinary  symp- 
toms of  inflammation  of  the  mucous  membrane  of  the  stomach  and  bow- 
els, as  pain,  vomiting,  purging,  swollen  abdomen,  hiccough,  etc.;  and, 
besides  these,  cramps  and  coldness  in  the  limbs,  intermittent  pulse, 
laborious  breathing,  swelling  of  the  hands  and  face,  suppression  of  urine, 
salivation,  and  delirium.  Some  of  these  symptoms  were  clearly  the 
result  of  the  absorption  of  the  medicine.  The  patient,  who  was  a  man, 
died  on  the  ninth  day.  Dissection  showed  marks  of  inflammation  and 
gangrene  throughout  the  alimentary  canal.  (Chrislison  on  Poisons.)  It 
is  quite  possible  that  the  accompaniment  of  bitartrate  of  potassa  may 
have  had  some  influence  in  the  result,  by  rendering  the  salt  of  bismuth 
more  soluble.  Bismuth  has  not  been  detected  in  the  urine  of  persons 
using  it.  The  effects  of  the  medicine  on  the  system  are  quite  equivocal ; 
but  it  may  probably  be  ranked  with  the  metallic  tonics  of  the  present 
section  more  safely  than  elsewhere. 

Therapeutic  Application.  Subnitrate  of  bismuth  was  introduced  into 
medicine  by  Dr.  Odier,  of  Geneva.  It  has  been  supposed  to  have  a  pe- 
culiar influence  over  painful  affections  of  the  stomach,  either  directly 
blunting  the  sensibility  of  the  nervous  tissue  of  the  organ,  or  operating 
through  the  nervous  centres.  It  has  been  more  especially  recommended 
in  gastralgia,  gastric  spasm,  cardialgia,  and  pyrosis;  and  has  been 
found  also  to  allay  nausea  and  vomiting.  At  a  comparatively  recent 


the  like  object,  in  other  affections  attended  with  exhaustion  of  the  brain.  He  directs 
four  grains,  three  times  a  day,  to  be  given  with  dilute  phosphoric  acid,  which  is  its 
proper  solvent. 

For  further  particulars  in  reference  to  the  iodide  and  lactate  of  zinc,  see  the  U.  8. 
Dispensatory,  and,  in  reference  to  the  phosphate,  the  London  Lancet,  Am.  ed.,  i.  343. 
(Note  to  the  second  edition.) 

*  The  presence  of  arsenic  may  be  detected  by  treating,  by  means  of  Marsh's  ap- 
paratus, a  solution  made  by  boiling  the  subnitrate  with  an  equal  weight  of  potassa 
in  five  times  its  weight  of  water,  filtering,  and  saturating  with  sulphuric  acid. 
(Note  to  the  second  edition.) 


424  GENERAL    STIMULANTS.  [PART  II. 

period,  it  has  been  very  much  employed  in  different  forms  of  diarrhoea, 
with  groat  asserted  advantage.  It  is  not  impossible  that  the  small  por- 
tion dissolved  may  operate  as  an  astringent;  but  it  is  not  in  this  way 
that  the  extraordinary  effects  claimed  for  it  can  be  explained.  Perhaps, 
as  suggested  by  M.  Monneret,  it  may  act  by  deposition  upon  the  inner 
surface  of  the  membrane,  and  the  protection  thus  given  against  the 
irritant  action  of  the  contents  of  the  primae  vise.  Hence,  it  is  recom- 
mended by  that  practitioner  in  very  large  quantities,  not  less  than  two 
or  three  drachms  in  a  day.  It  has  been  special!}'  recommended  as  ex- 
traordinarily efficient  in  the  diarrhoea  of  phthisis,  that  of  enteric  or 
typhoid  fever,  and  the  chronic  diarrhoea  of  children.  I  can  say  little 
of  the  remedy  from  my  own  experience.  Having  almost  constantly 
failed  with  it  in  the  gastric  affections  in  which  it  was  originally  recom- 
mended, I  have  long  ceased  to  employ  it.  The  dose,  as  formerly  given, 
was  too  small.  From  five  to  twenty  grains  may  probably  be  adminis- 
tered with  safety,  under  any  ordinary  circumstances,  to  the  adult.  Cream 
is  said  to  be  an  excellent  excipient.  The  caution  should  be  strictly  ob- 
served, not  to  accompany  its  use  with  that  of  nitric  acid,  or  indeed  any 
other  acid.  Dr.  Rodolfo  Rodolfi,  of  Brescia,  in  Italy,  has  met  with  much 
success  in  arresting  the  night-sweats,  and  diminishing  the  exhausting 
expectoration  in  phthisis,  from  the  administration,  every  two  hours,  of 
about  two  grains  of  the  subnitrate,  with  the  same  quantity  of  sulphur, 
and  about  seven  grains  of  bicarbonate  of  soda.  In  four  or  five  days,  the 
colliquative  sweats  are  arrested  or  materially  diminished ;  and  in  fifteen 
or  twenty  days,  the  expectoration  is  less  copious  and  easier,  and  tin- 
patient  altogether  improved.  (Journ.  de  Pharm.  et  de  Chim.,  Juin,  1866, 
p.  408.)  Topically,  the  subnitrate  has  been  used,  with  great  asserted 
benefit,  as  an  injection  in  gonorrhoea  and  leucorrhcea,  and  as  an  applica- 
tion to  scrofulous  ulcers.  For  these  purposes,  it  is  either  sprinkled  on 
the  diseased  surface,  or  applied  mixed  with  water,  in  the  proportion  of 
one  part  of  the  powder  to  six  or  seven  of  the  vehicle.  The  subnitrate 
has  also  been  used  advantageously,  by  Dr.  W.  R.  Hamilton,  of  Illinois, 
in  protecting  the  skin  against  pitting  from  the  small-pox  eruption.  H. 
first  lubricated  the  face  and  hands  well  with  olive  oil,  and  then  sprinkled 
the  powder  over  the  surface ;  and  repeated  the  application  twice  daily. 
(Am.  Journ.  of  Med.  Sri.,  Oct.  1865,  p.  563.)  The  subnitrate.  sprinkled 
in  fine  powder  on  the  surface  of  suppurating  wounds  and  putrescent 
ulcers,  not  only  promotes  suppuration,  but  is  asserted  by  Riemslach  to 
act  also  powerfully  as  a  disinfectant,  completely  destroying  the  offensive 
odour.  (Journ.  de  Pharm.  et  de  Chim.,  3e  ser.,  xliii.  '2'2±.) 

II.  SUBCARBONATE   OF   BISMUTH.— BlSMUTHI    SuBCAR- 
BONAS.    U.  S. 

This  is  prepared  by  mixing  solutions  of  nitrate  of  bismuth  and  carbo- 


CHAP.  I.]  MINERAL   TONICS. — CITRATE   OF    BISMUTH.  425 

nate  of  soda,  and  washing-  and  drying  the  resulting  precipitate.  By 
double  decomposition  between  the  two  salts,  nitrate  of  soda  and  carbo- 
nate of  bismuth  are  produced ;  the  former,  which  is  soluble,  being  re- 
tained in  solution,  and  the  latter  thrown  down.  The  process  would  seem 
to  be  very  simple ;  but,  on  the  contrary,  as  given  in  the  U.  S.  Pharma- 
copoeia, it  is  very  complex,  being  rendered  so  by  the  necessity  of  pro- 
viding against  the  presence  in  the  preparation  of  a  portion  of  arsenic, 
which  is  often  contained  in  the  metal  as  found  in  commerce. 

Subcarbonate  of  bismuth  is  in  the  form  of  a  white  or  yellowish-white 
powder,  inodorous  and  tasteless,  of  the  sp.  gr.  of  about  4,  and  insoluble 
in  water.  It  should  not  give  evidence  of  the  presence  of  arsenic,  when 
mixed  with  sulphuric  acid,  and  treated  by  Marsh's  test. 

It  was  introduced  into  the  practice  of  medicine  as  a  substitute  for  the 
subnitrate,  the  virtues  of  which  it  possesses,  with  less  tendency  to  dis- 
turb the  stomach.  It  is  thought  by  M.  Fannou,  of  Brussels,  to  have  the 
advantage  over  the  subnitrate  of  being  more  readily  dissolved  by  the 
gastric  juice  ;  but  this  might  be  a  doubtful  recommendation  when  large 
doses  are  given,  especially  in  an  acid  state  of  the  gastric  liquids,  as  a 
highly  irritant  salt  might  thus  be  substituted  for  a  perfectly  bland  pow- 
der. The  probability  is  that,  as  in  the  case  of  the  nitrate,  its  efficacy  in 
the  complaints  of  the  stomach  and  bowels,  in  which  chiefly  it  is  given, 
depends  on  this  very  insolubility,  which,  with  its  weight,  cause  it  to 
spread  over  the  mucous  surface,  and  give  to  this  a  protective  coating 
against  the  irritant  liquids  of  the  primal  vise.  The  dose  is  from  fifteen 
to  forty  grains,  given  three  times  a  day  before  meals,  and  gradually  in- 
creased if  deemed  advisable.  It  should  not  be  administered  in  connec- 
tion with  acids. 

III.  CITRATE  OF  BISMUTH  AND  AMMONIA.— Syn.  Liquor 
Bismuthi. 

This  preparation  was  made  in  order  to  meet  the  demand  for  a  soluble 
form  of  bismuth,  by  which  its  effects  on  the  system  might  be  obtained 
with  greater  certainty,  and  from  a  smaller  dose.  Originally  made  by  a 
secret  formula,  it  was  analyzed  by  Mr.  Tichborne,  who,  having  ascer- 
tained its  composition,  devised  a  method  of  preparing  it,  which  was  after- 
wards improved  by  Mr.  N.  G.  Bartlett,  of  Chicago.  For  the  mode  of 
preparing  it,  the  reader  is  referred  to  the  U.  S.  Dispensatory  (12th  ed.,  p. 
1U-2S).  It  is  believed  to  consist  of  one  eq.  of  teroxide  of  bismuth,  one 
of  ammonia,  one  of  citric  acid,  and  five  eqs.  of  water.  In  the  solid  state, 
it  is  in  transparent  colourless  scales,  of  a  somewhat  metallic  but  not  dis- 
agreeable taste,  very  soluble  in  water,  and  of  an  acid  reaction.  As  first 
prepared  it  was  in  the  liquid  form,  and  denominated  liquor  bismuthi; 
but  this  is  not  necessary,  as  the  compound  keeps  well,  and  may  be  dis- 
solved when  wanted  for  use.  The  dose  of  the  salt  is  two  grains,  that 
of  a  solution  prepared  by  Mr.  Bartlett,  for  which  a  formula  is  given  in 
the  U.  S.  Dispensatory,  a  fluidrachm. 


426  GENERAL   STIMULANTS.  [PART  II. 

3.  Reconstructive  Mineral  Tonics. 

It  will  be  remembered  that  these  are  tonic  substances  which  enter 
essentially  into  the  constitution  of  the  system.  The  only  medicines 
which  have  been  satisfactorily  proved  to  belong  to  this  subdivision  of  the 
mineral  tonics,  are  the  preparations  of  iron. 


IRON. 

FERRUM.  U.S. 
IRON  WIRE.  Br. 

It  has  long  been  known  that  iron  is  a  normal  constituent  of  the  blood  ; 
and  comparatively  recent  researches  have  shown  that  it  exists  exclu- 
sively in  the  colouring  matter  of  the  red  corpuscles,  of  which  it  forms  an 
essential  constituent,  and,  as  is  generally  believed,  in  definite  propor- 
tion.* Without  it,  the  red  corpuscles  could  not  exist,  nor  life  be  sup- 
ported. In  what  state  of  combination  it  is  contained  in  the  colouring 
matter,  has  not  been  ascertained.  It  is  certainly  held  by  a  powerful 
affinity  ;  for  it  is  altogether  insensible  to  the  tests  by  which  iron  can  be 
detected  in  all  other  combinations.  The  probability  is,  that  it  is  united, 
in  an  elementary  condition,  either  directly  with  the  other  elements  of  the 
colouring  matter,  or  with  some  peculiar  organic  principle,  having  for  it 
an  affinity  beyond  that  of  any  other  body  in  nature,  and  capable  of  being 
overcome,  through  chemical  agency,  only  by  the  destruction  of  that  prin- 
ciple. Hence,  it  may  be  found  either  by  burning  blood,  in  which  case  it 
is  left  in  the  ashes,  or  by  the  instrumentality  of  chlorine,  which  destroys 
the  animal  principle  referred  to.  The  part  which  iron  acts  in  the 
economy  is  wholly  unknown.  The  theory  of  Liebig,  which  supposes  it 
to  be  a  carrier  of  oxygen  from  the  lungs  to  all  parts  of  the  system,  enter- 
ing the  respiratory  organs  as  a  protocarbonate,  there  becoming  sesqui- 
oxidized  with  the  escape  of  the  carbonic  acid,  and  afterwards  carried 
away  with  the  arterial  blood  to  supply  oxygen  to  all  the  functions,  and 
l>e  reconverted  into  the  protocarbonate,  though  very  beautiful,  has  not 
been  authenticated,  and  at  present  must  be  regarded  as  at  best  a  plausible 
conjecture.  That  iron  is  the  real  colouring  matter  of  the  blood,  has 


*  According  lo  M.  Le  Canu,  aboul  1  part  of  it  exists  in  4400  of  blood,  and  7  parts 
in  100  of  hcmatosin.  For  the  blood,  the  proportion  is  necessarily  variable,  as  that 
of  hematosin  itself  is  variable;  for  the  hematosin,  it  is  fixed,  the  combination  being 
definite  (Archive*  de  Phy»iol.,  de  Thfrap.,  et  <f  Uyg.  de  Bouchardat,  Oct.  1854,  pp.  144 
and  147.) 


CHAP.  I.]  MINERAL   TONICS. — IRON.  427 

been  regarded  as  highly  probable ;  nor  did  the  discovery  of  hematosin  as 
a  distinct  principle  serve  in  any  degree  to  invalidate  this  opinion;  but  if 
it  be  true,  as  asserted  by  M.  Sanson,  that  hematosin  can  be  deprived  of 
iron  without  losing  its  colour,  the  opinion  must  be  abandoned.  Never- 
theless, M.  Le  Canu,  on  repeating  the  process  of  M.  Sanson,  did  not 
succeed  in  obtaining  the  same  result;  so  that  it  may  be  considered  as  a 
yet  unsettled  point,  whether  iron  is  or  is  not  the  colouring  principle. 
(Quevenne,  Arch,  de  Physiol.,  Oct.  1854,  p.  147.)  That  it  has  the  prop- 
erty, when  taken  internally,  of  increasing  the  redness  of  the  blood,  is  a 
familiar  fact.  A  reference  to  the  above  physiological  points  seemed  to 
be  a  necessary  introduction  to  the  consideration  of  iron  as  a  therapeutic 
agent. 

I.  EFFECTS  ON  THE  SYSTEM.  Whether  metallic  iron  has  any  direct  in- 
fluence on  the  system  is  not  certainly  known ;  for,  though  very  decided 
effects  follow  its  introduction  into  the  stomach,  it  is  supposed  that  the 
metal  is  oxidized  and  combined  with  an  acid  before  it  operates.  Never- 
theless, it  is  by  no  means  certain  that  the  finely  powdered  metal  may 
not  find,  among  the  constituents  of  the  gastric  juice,  the  organic  prin- 
ciple with  which  it  is  combined  in  hematosin,  and,  uniting  with  this, 
enter  into  the  blood  at  once  in  a  state  suitable  for  the  part  it  has  to  play 
in  the  formation  of  the  red  corpuscles.  This  idea  does  not  by  any  means 
preclude  that  of  its  absorption,  and  existence  in  the  scrum  in  other  forms 
of  combination.  In  fact,  it  serves  to  explain  the  double  action  of  the 
metal;  that  of  a  tonic  in  the  blood,  like  any  other  absorbed  medicine  of 
the  same  class ;  and  that  of  a  reconstructive  agent,  serving  to  increase 
the  red  corpuscles,  by  affording  an  essential  constituent  in  a  due  state  of 
preparation. 

The  operation  of  the  chalybeate^,  or  preparations  of  iron,  must  be  con- 
sidered in  reference,  first,  to  their  local  effects  upon  the  tissue  with  which 
they  arc  primarily  brought  into  contact;  and  secondly,  to  their  effects 
upon  more  or  less  distant  parts,  or  on  the  system  generally. 

1.  In  regard  to  their  local  operation,  when  in  any  degree  soluble,  or 
capable  of  being  rendered  so  by  the  reagencies  to  which  they  are  exposed, 
they  act  as  excitants  and  astringents  ;  the  degree  in  which  they  produce 
such  cil'ccts  being  very  different  in  the  different  preparations,  and  in  some 
measure  proportionate  to  their  solubility.  If  used  in  small  doses,  they 
produce  on  the  stomach  only  that  degree  of  excitation  which  is  called 
tonic,  increasing  the  appetite,  and  invigorating  digestion ;  while  their 
astringent  operation  is  evinced  by  a  tendency  to  constipation,  and  the 
smaller,  dryer,  and  harder  stools,  which  are  apt  to  follow.  If  carried 
too  far,  they  cause  irritation  of  the  stomach  and  bowels,  with  a  sense  of 
heat,  weight,  or  uneasiness  in  the  epigastrium,  sometimes  nausea  and 
vomiting,  and  not  unfrequently  griping  pains  and  diarrhoea.  Some  of 
the  soluble  salts,  as  the  sulphate,  sesqui nitrate,  and  chloride,  are  capable 


428  GENERAL    STIMULANTS.  [PART  II. 

of  producing  even  dangerous  if  not  fatal  inflammation,  and  thus  acting 
as  irritant  poisons.  The  local  effects  of  the  chalybeates,  applied  exter- 
nally, either  to  the  mucous  surfaces  or  the  skin,  are  of  the  same  nature; 
but,  in  the  latter  instance,  the  cuticle  serves  as  a  protection,  and  the  irri- 
tant influence  is  much  less  felt. 

A  phenomenon  resulting  from  the  use  of  iron,  though  not  a  part  of  its 
physiological  operation,  is  the  black  colour  of  the  stools  which  almost 
invariably  attends  it,  This  is  caused  probably  in  part  by  the  combina- 
tion of  the  sesquioxide  with  the  tannic  acid  often  contained  in  the  food, 
as  in  tea  and  coffee  for  example,  and  in  part  by  the  formation  of  the  sul- 
phuret  of  iron  through  reaction  with  suphuretted  hydrogen  in  the  bow- 
els, or  one  of  the  soluble  sulphurets.  A  knowledge  of  this  fact  is 
important ;  as  otherwise  wrong  inferences  might  be  drawn  from  the 
colour  of  the  stools,  and  lead  to  improper  practice.  Instances  of  this 
I  have  myself  witnessed.  Not  unfrequently  also  the  preparations  blacken 
the  tongue,  in  consequence  probably  of  the  simultaneous  use  of  astrin- 
gent substances ;  and  care  must  be  taken  not  to  confound  this  appear- 
ance with  the  blackness  of  tongue  resulting  from  disease. 

2.  The  effects  upon  the  system,  or  on  parts  more  or  less  remote  from 
the  surface  of  application,  are  next  to  be  considered.  These  depend 
upon  the  absorption  of  the  iron,  and  are  usually  not  exhibited  until  a 
considerable  time  after  its  introduction  into  the  stomach.  That  iron  is 
absorbed  has  been  proved  by  numerous  experiments.  Tiedemann  and 
Gmelin  found  it  in  the  serum  of  the  blood  of  the  mesentoric  and  portal 
veins  of  a  horse,  to  which  they  had  six  hours  previously  given  a  solu- 
tion of  the  sulphate.  M.  Quevenne  has  shown  that,  if  iron  passes  with 
the  urine  at  all  in  the  normal  state,  it  is  in  extremely  small  proportion ; 
and  that,  after  the  use  of  the  ferruginous  preparations  for  a  short,  time, 
the  quantity,  though  still  very  small,  is  appreciably  increased ;  proving 
that,  while  the  kidneys  are  not  the  avenue  \>y  which  the  metal  is  mainly 
eliminated  from  the  system,  it  must  have  been  absorbed  in  order  to  pro- 
duce the  slight  increase  observed.  (Archives  de  Physiol.,  Oct.  1854,  p. 
104.)  It  is  said  also  to  have  been  found  in  the  milk,  perspiration,  and 
bile.  In  what  state  it  enters  the  blood  is  uncertain;  but  it  is  highly 
probable  that,  in  part  at  least,  it  does  so,  as  before  stated,  in  union  with 
an  organic  principle,  and  that,  in  this  condition,  it  contributes  directly  to 
the  construction  of  the  red  corpuscles.  Another  portion  may  circulate 
in  the  serum  in  other  soluble  forms,  and  simply  act  as  a  tonic  and  per- 
haps astringent  upon  the  tissues. 

After  iron  has  been  taken  in  the  ordinary  medicinal  doses  for  a  few 
days,  often  in  less  than  a  week,  its  effects  on  the  system  imiy  be  scon  in 
an  increased  redness  of  the  complexion,  the  lips,  and  the  tongue,  a  fuller 
and  stronger  pulse,  and  a  general  exaltation  of  the  organic  functions. 
These  results  proceed  from  a  greater  richness  of  the  blood,  in  which  the 


CHAP.  I.]  MINERAL    TONICS. IRON.  429 

proportion  of  the  red  corpuscles  is  increased.  If  the  use  of  the  medi- 
cine be  continued,  a  plethoric  condition  may  lie  induced,  indicated  by 
fulness  or  dull  pains  in  the  head,  sluggishness  of  mind,  a  full  strong 
pulse,  increased  heat,  and  a  heightened  colour  of  the  surface.  It  is  said 
that  pustules  of  acne  are  apt  to  appear  on  the  face,  breast,  and  back. 
This  is  a  morbid  condition,  predisposing  to  active  congestion,  hemor- 
rhage, and  probably  inflammation.  Hence  the  danger  of  an  excessive 
and  long-continued  use  of  the  natural  chalybeate  waters,  against  which 
they  who  frequent  watering  places  should  be  placed  upon  their  guard. 
These  effects  are  scarcely  sufficient  to  rank  iron  among  medicines  poison- 
ous to  the  constitution.  They  are  but  an  exaltation  of  the  healthy  pow- 
ers and  functions,  such  as  may  result  from  an  abuse  of  food  and  other 
agents  essential  to  life.  The  only  mode  in  which  any  preparation  of 
iron  can  become  poisonous,  is,  as  before  mentioned,  by  irritating  and  in- 
flaming the  stomach  and  bowels. 

II.  THERAPEUTIC  APPLICATION.  Iron  has  been  immemorially  em- 
ployed in  medicine.  It  has  two  modes  of  therapeutic  action  ;  one,  by  a 
gentle  excitement  of  the  functions,  and  a  somewhat  constricting  effect  on 
the  tissues,  evinced  in  the  surfaces  to  which  it  is  directly  applied,  whether 
external  or  internal,  and  in  distant  organs  or  the  system  generally, 
through  which  it  circulates  in  the  serum  of  the  blood ;  and  the  other,  as 
a  reconstructive  agent,  by  affording  the  material  and  the  influence  neces- 
sary for  the  production  of  new  blood-corpuscles,  to  supply  the  place  of 
those  which  may  have  been  lost.  In  the  first  method,  it  operates  as 
ordinary  tonics  possessing  some  astringent  power ;  in  the  second,  its  in- 
fluence is  quite  peculiar  and  characteristic,  unless,  as  some  assert,  it  may 
be  imitated  by  manganese.  Some  therapeutists  believe  that  this  recon- 
structive operation  is  essentially  and  purely  tonic ;  that  is,  that  the  iron 
taken  as  a  medicine  acts  simply  by  a  gentle  exaltation  of  all  the  blood- 
making  functions,  enabling  them  to  form  the  red  corpuscles  more  abund- 
antly, not  by  furnishing  the  material,  but  by  increasing  their  power  of 
assimilating  nutriment.  Others,  again,  think  that  it  acts  simply  by  fur- 
nishing an  essential  consiituent  of  the  corpuscles,  and  that  in  fact  it  is 
nothing  more  than  an  article  of  food.  It  is  probable  that  the  truth  em- 
braces both  these  opinions;  and  that  the  chalybeates,  in  augmenting 
the  red  corpuscles,  really  .stimulate  the  functions,  while  they  render  the 
material  more  accessible,  and  furnish  it  in  a  state  more  readily  acted 
on,  than  as  it  exists  in  the  ordinary  diet.  In  referring  to  the  several 
diseases  in  which  iron  is  used,  I  shall  endeavour  to  keep  in  view  the  two 
methods  of  operating  here  described,  though  they  are  often  conjoined  in 
the  same  disease. 

1.  As  a  mere  tonic,  iron  is  much  and  very  advantageously  used  in 
debility  of  the  digestive  organs.  Connected  with  laxatives  and  aroma- 
tics,  it  is  among  the  most  useful  remedies  in  dyspepsia,  and  its  asso- 


430  GENERAL    STIMULANTS.  [PART  II. 

dated  and  dependent  affections.  When  no  effect  on  the  system  at 
large  is  required,  and  the  indication  is  simply  to  stimulate  the  mucous 
membrane  of  the  primse  vise,  one  of  the  soluble  preparations  should  be 
preferably  selected.  Unless  the  medicine  is  given  too  largely,  the  tend- 
ency is  to  produce  constipation;  and  hence  the  propriety  of  administer- 
ing laxatives  at  the  same  time.  Should  irritation  of  stomach  or  bowels 
be  induced,  the  inference  is  that  too  much  has  been  given,  and  the  dose 
should  be  diminished  within  the  irritating  point.  Not  unfrequently,  in 
these  cases,  the  chalybeate  is  associated  with  one  of  the  simple  bitters, 
as  well  as  with  a  laxative  and  aromatic;  and  these  may  be  combined,  in 
the  form  of  pill,  powder,  infusion,  or  tincture,  to  suit  the  particular 
necessities  of  the  case. 

The  astringency  of  the  preparations  of  iron  renders  them,  in  connec- 
tion with  their  tonic  property,  advantageous  also  in  chronic  diarrhoea 
attended  with  relaxation  of  the  mucous  tissue.  The  saline  preparations 
are  preferred  for  this  purpose,  especially  the  sulphate,  and  the  solution 
of  the  nitrate,  the  latter  of  which  was  introduced  into  use  chiefly  for  its 
supposed  efficacy  in  this  complaint.  Great  care  should  be  taken  not  to 
give  them  in  irritating  doses;  and  they  may  often  be  usefully  associated 
with  an  opiate. 

Passive  hemorrhage  from  the  stomach  or  bowels  is  sometimes,  benefi- 
cially treated  with  the  chalybeates.  To  the  active  hemorrhages  from  these 
parts  they  are  inapplicable,  in  consequence  of  their  excitant  property. 
Even  in  the  passive  kinds,  they  should  not  be  trusted  to  exclusively  in 
threatening  cases ;  their  astringency  being  too  feeble ;  and  at  best  they 
are  usually  prescribed  rather  to  meet  some  coexisting  indication,  than 
simply  as  haemostatics.  This  remark,  however,  though  correct  as  a  gen- 
eral rule,  is  not  applicable  to  the  officinal  solution  of  subsitlphate  of 
iron,  which  is  powerfully  astringent,  with  comparatively  little*  of  the  irri- 
tant property. 

Through  the  circulation  they  are  supposed  to  operate  beneficially  as 
tonics  and  astringents  in  passive  hemorrhages,  and  various  excessive 
secretions,  as  in  haemoptysis,  menorrhagia,  hsematuria,  bronchorrhosa, 
laucorrhosa,  spermatorrhoea,  etc. ;  but,  though  they  are  often  useful  in 
these  affections,  it  is  probably  more  by  their  influence  upon  the  blood 
than  their  direct  action  on  the  tissues.  They  should  never  be  exhibited 
when  the  complaint  is  associated  with  a  plethoric  condition  of  the  circu- 
lation, and  a  sound  state  of  the  blood. 

General  debility,  independently  of  any  special  deficiency  of  blood, 
affords  an  indication  for  the  use  of  iron  as  a  tonic.  But  discrimination 
in  necessary.  To  the  cure  of  acute  debility,  such  as  occurs  in  lo\v  fevers, 
the  chalybeates  are  quite  inadequate;  operating  both  too  slowly  and  too 
gently  for  the  wants  of  the  system.  The  preparations  of  Peruvian  bark 
and  serpentaria  among  the  tonics,  are  much  more  effectual  here.  But  in 


CHAP.  I.]  MINERAL   TONICS. — IRON.  431 

the  chronic  weakness  resulting  from  deficient  food,  enfeebled  digestion, 
the  depressing  emotions,  previous  disease,  etc.,  they  act  beneficially  by 
gently  stimulating  the  organic  functions  through  the  circulation;  and 
when  with  the  debility  is  connected  a  special  relaxation  of  the  tissues,  as 
in  scrofula,  and  various  nameless  cachectic  conditions  of  the  system, 
their  astringency  gives  them  additional  efficacy.  But  the  conditions  of 
debility  in  which  they  are  indicated,  in  reference  to  their  tonic  and 
astringent  properties,  are  almost  always  associated  with  a  defective  or 
depraved  state  of  the  blood,  in  which  their  reconstructive  power  is 
wanted;  so  that  it  will  be  most  convenient  to  consider  the  several  affec- 
tions under  that  head. 

2.  As  a  reconstructive  agent,  iron  is  used  whenever  the  red  corpus- 
cles are  relatively  deficient ;  and  such  is  the  case  in  all  instances  of  im- 
poverished  blood.     This  condition  of  the  blood  has  received  the  not 
altogether  appropriate  name  of  anaemia.     In  women  it  is  often  called 
chlorosis.     Some  authors  make  a  distinction  between  these  affections. 
I  have  been  able  to  discover  none  that  is  essential.     In  the  female, 
chlorosis  sometimes  comes  on  without  any  appreciable  cause,  possibly 
from  some  derangement  of  the  assimilative  functions  essentially  con- 
nected with  the  peculiarities  of  the  sex;  but  it  is  also  frequently  pro- 
duced in  them,  as  well  as  in  males,  from  obvious  causes ;  and  there  is 
no  difference  that  I  have  been  able  to  appreciate  in  the  results.     The 
symptoms  are  the  same,  the  mode  of  treatment  is  the  same;  and  the 
obscurity  of  the  cause,  in  certain  instances,  is  not  a  sufficient  ground  for 
assuming  a  distinct  character   in  the   affection.     The  varieties  under 
which  amemia   appears  are  almost  infinite.     Sometimes  it  is  a  pure, 
original,  idiopathic  affection ;  but  much  more  frequently  it  is  associated 
with  other  diseases,  as  their  effect,  their  cause,  or  a  coincident  effect  of  the 
same  cause.     In  whatever  shape  it  may  appear;  so  far  as  the  anaamia 
itself  is  concerned,  iron  is  indicated.     It  may  not  always  succeed;  but 
it  should  always  be  tried  when  it  is  desirable  to  correct  the  anaemia. 
Not  impossibly,  this  condition  of  the  blood  may  sometimes  be  intended 
as  a  safeguard  against  other  affections,  perhaps  of  a  hernorrhagic,  per- 
haps of  an  inflammatory  character;  and  to  correct  it  may  involve  the 
patient  in  the  risk  of  mischief  greater  than  the  evils  of  anemia  itself. 
In  such  ca^t  s.  caution  should  be  observed,  in  the  use  of  the  chalybeates, 
not  to  carry  them  too  far;  but  to  endeavour  as  nearly  as  possible  to  pre- 
serve a  due  balance,  so  that  the  aims  of  nature  may  be  effected,  without 
incurring  danger  in  the  opposite  direction. 

Simple  anaemia  from  the  loss  of  blood,  excessive  secretion,  defective 
supply  of  food,  or  inefficient  assimilation,  is  a  very  common  affection, 
and  in  general  easily  recognizable  by  the  paleness  of  the  face,  lips,  and 
tongue.  For  its  characteristic  symptoms,  the  reader  is  referred  to  works 
on  the  practice  of  medicine.  It  may  be  mentioned  here,  as  having  a 


432  GENERAL    STIMULANTS.  [PART  II. 

special  therapeutic  bearing,  that,  instead  of  the  depressed  state  of  all  the 
functions,  which  might,  ti  priori,  have  been  anticipated,  there  is,  on 
the  contrary,  as  a  general  rule,  much  and  very  prominent  disturbance  of 
ct-rtain  functions,  even  more  so  than  in  the  opposite  condition  of  the 
blood.  A  frequent  pulse,  palpitation  of  the  heart,  panting  respiration, 
and  varied  nervous  agitation,  are  often  striking  phenomena;  and  it  is  of 
the  utmost  importance  not  to  mistake  these,  as  they  were  formerly  often 
mistaken,  for  evidences  of  an  over-excitement  requiring  depletory  treat- 
ment. There  are  too,  very  generally,  especially  in  females,  bellow- 
murmurs  in  the  heart  and  large  blood-vessels,  to  be  heard  by  pressing 
the  ear  or  the  stethoscope  upon  them,  which  might  lead  an  incautious 
observer  to  suspect  the  existence  of  organic  cardiac  disease.  Sometimes, 
when  the  disease  is  not  yet  fully  developed,  the  characteristic  paleness 
of  the  cheeks  may  be  wanting,  and  there  may  even  be  in  the  female 
something  of  the  rose  yet  remaining.  In  this  condition,  those  apparent 
anomalies  above  referred  to,  the  palpitations,  the  panting*,  the  hysterical 
disorders,  and  especially  the  cardiac  and  vascular  murmurs,  become  diag- 
nostic symptoms,  by  which  the  nature  of  the  case  may  often  be  deter- 
mined. In  all  these  cases  of  anaemia,  iron  is  the  great  remedy;  and, 
were  it  of  no  other  use  as  a  medicine,  it  would,  from  the  possession  of 
its  extraordinary  power  over  this  complaint,  be  of  inestimable  value. 
Not  only  is  the  anaemia  with  its  immediate  symptoms  corrected;  but 
evils  of  great  magnitude,  which  are  apt  to  flow  from  a  perseverance  of 
the  affection,  such  as  dropsy,  sterility,  organic  heart  affection,  and  ulti- 
mate death  from  the  unresisted  attacks  of  other  diseases,  are  prevented. 
A  -ufficient  dose  of  the  chalybeate,  repeated  three  times  a  day,  and  con- 
tinued for  six  or  eight  weeks,  will  very  generally  cure  the  complaint 
entirely.  In  the  course  of  a  week  or  two  the  colour  will  begin  to  return 
to  the  lips  and  cheeks,  the  pulse  to  acquire  more  stability,  the  appetite 
and  digestive  function  to  improve;  the  amelioration  of  the  symptoms 
will  advance  regularly;  and,  at  the  end  of  the  time  specified,  a  wan, 
wasted,  and  desponding  girl,  apparently  in  the  last  stage  of  debility,  and 
quite  incapacitated  for  the  performance  of  any  active  duty,  will  have 
been  converted  into  a  cheerful,  rosy,  plump,  and  vigorous  young  woman, 
full  of  energy  and  hope,  and  prepared  to  enter  zealously  upon  the  duties 
of  her  station.  This  change  is  effected  merely  by  restoring  the  healthy 
proportion  of  red  corpuscles  to  the  blood.  The  remedy  should  be  omit- 
ted when  the  cure  is  completed,  for  fear  of  inducing  plethora.  The  only 
caution  necessary  is  that  an  observant  eye  should  be  upon  the  individual 
for  some  months;  and,  upon  the  least  sign  of  a  return  of  the  symptoms, 
the  chalybeates  should  be  again  recurred  to. 

There  is  a  peculiar  form  of  anaemia,  different  in  its  origin  from  the 
preceding,  in  which  iron  is  scarcely  less  effectual.  I  allude  to  the  con- 
dition of  system  often  left  behind  by  miasmatic  fevers,  characterized 


CHAP.  I.]  MINERAL    TONICS. — IRON.  433 

by  a  sallow  paleness  of  the  surface,  general  languor  and  weakness, 
mental  depression,  feeble  digestion,  and  often  more  or  less  dropsical 
eil'usion.  sometimes  only  anasarcous,  but  sometimes  also  in  one  or  more 
of  the  serous  cavities  at  the  same  time.  There  may  or  may  not  be 
attendant  disease  of  the  viscera.  I  believe  this  condition  to  be  a  pure 
anaemia,  resulting  from  the  destruction  of  the  red  corpuscles  of  the  blood 
by  the  miasmatic  poison ;  the  yellowness  bdng  attributable  to  a  changed 
condition  of  the  liberated  hematosin.  The  same  condition  often  follows 
yellow  fever,  probably  from  the  same  cause.  It  is  delightful  to  see  how 
rapidly  this  condition,  serious  if  not  relieved,  will  yield  to  the  conjoined 
use  of  iron  and  quiuia.  Slight  cases  will  often  get  well  in  a  week  or 
two,  the  worst  generally  within  two  months.  When  there  is  consider- 
able dropsy,  however,  bitartrate  of  potassa,  to  the  amount  of  an  ounce, 
taken  through  the  day,  should  be  associated  with  the  other  medicines. 

In  a  large  number  of  diseases,  iron  is  given  with  a  view  mainly  to  the 
correction  of  the  anaemia  with  which  they  are  associated.  The  following 
list  embraces  most  of  them.  When,  in  any  one  of  them,  there  is  an  ad- 
ditional indication  for  the  use  of  the  medicine,  the  fact  is  mentioned. 

Scrofulous  affections  are  often  attended  with  a  poverty  of  the  blood 
which  serve-  1<»  sustain  the  diathesis,  and  aggravate  the  complaint,  But 
there  is  often  also  a  relaxation  of  the  tissues  in  these  affections,  which 
calls  for  a  joint  tonic  and  astringent  action  in  the  remedy.  Iron  answers 
both  indications;  and  is  very  often,  therefore,  given  in  the  different  forms 
of  scrofula.  It  has;  however,  no  specific  influence  over  the  disease,  and 
is  used  only  as  an  adjuvant  to  the  alterative  remedies,  such  as  iodine  and 
cod-liver  oil.  The  iodide  of  iron  is  generally  preferred,  on  the  presumption 
that  the  effects  of  the  iodine  may  be  obtained  along  with  those  of  the 
chalybeate. 

Phthisis  may  be  ranked  among  the  scrofulous  diseases,  and  might  be 
supposed  to  call  for  the  remedy  equally  with  the  other  forms.  But  there 
is  a  consideration  connected  with  this  affection,  which  renders  caution  in 
the  use  of  the  chalybeates  necessary.  The  anaemia  in  phthisis  is  a  pn> 
vision  of  nature  for  bringing  the  blood  into  a  due  relation  with  the  capa- 
city of  the  lungs.  If,  with  the  progressive  destruction  of  these  organs, 
the  blood  should  remain  undiminisbed,  the  quantity  passing  through  the 
lungs  would  be  more  than  could  be  duly  oxidized,  or  indeed  carried 
through  the  remaining  pulmonary  vessels.  Congestion  of  the  lungs, 
with  hemorrhage,  and  other  evils  from  a  want  of  due  aeration  of  that 
fluid,  would  take  place.  The  use  of  iron,  if  successful  in  its  object,  might 
counteract  this  purpose^f  nature,  by  inducing  a  relative  plethora.  Never- 
theless, the  anaemia  is"  often  carried  far  beyond  the  point  essential  for  its 
useful  purpose ;  and,  in  such  cases,  the  chalybeates  would  be  serviceable 
by  lending  the  support  of  good  blood  to  the  exhausted  functions,  and 
even  by  obviating,  in  co-operation  with  other  measures,  in  some  degree, 
VOL.  i.— 28 


434  GENERAL    STIMULANTS.  [PART  II. 

the  disposition  to  tuberculous  deposition.     But  they  should  be  omitted. 
-••on  11.-  the  blood  may  be  deemed  to  have  become  as  much  enriched 
as  the  condition  of  the  lungs  will  permit,  without  risk  of  mischief. 

Various  nervous  affections  offer  indications  for  the  use  of  chalybeate- 
Disorders  of  the  nervous  system  are  often  nothing  more  than  results  of 
the  irritation  of  the  nervous  centres,  su-tained  by  the  constant  call  made 
upon  them  by  the  functions  when  suffering  from  the  want  of  blood. 
Placed  as  points  of  communication  between  all  the  functions,  and  the 
various  agencies  intended  for  the  supply  of  these  functions  with  tin- 
means  of  support,  they  are  constantly  receiving  impressions,  and  sending 
forth  influence;  and,  the  degree  of  their  excitement  being  in  proportion  to 
the  amount  of  impression  received,  they  are  consequently  most  excited 
when  the  wants  of  the  functions  are  the  greatest.  Hence,  in  an  anemic 
condition  of  the  blood,  when  all  the  functions  are  suffering  under  the  de- 
ficiency of  this  essential  pabulum,  the  nervous  centres  are  necessarily 
over-excited,  and  exhibit  their  irritation  by  various  violences  throughout 
the  system.  By  correcting  the  condition  of  the  blood,  the  functions  are 
quieted,  the  nervous  centres  are  relieved,  and  the  existing  obvious  dis- 
ease, so  far  as  it  depended  on  their  irritation  from  this  cause,  ceases 
Hence  the  use  of  iron  in  these  complaints.  But  it  operates  also  on  the 
tonic  principle  of  giving  strength  to  the  nervous  centres,  and  enabling 
them,  in  a  certain  degree,  to  resist  the  irritative  impressions  made  upon 
them ;  though,  in  this  mode  of  action,  it  is  inferior  to  the  preceding  sec- 
tion of  mineral  tonics,  including  the  preparations  of  silver,  copper,  and 
zinc,  which  have  the  advantage  over  the  chalybeates  of  a  special  influ- 
ence upon  these  centres,  not  pos.-es-cd  by  the  latter  remedies,  or,  at  all 
.•vent.-,  in  a  less  degree.  The  chalyb^ates.  therefore,  while  they  are 
much  more  energetic  and  more  relied  upon  in  the  nervous  diseases,  when 
dependent  on  or  aggravated  by  aiuemia,  than  the  other  metallic  remedio 
mentioned,  are  inferior  to  them  under  other  circumstances.  The  rational 
practitioner,  guided  by  this  principle,  will  know  when  to  rely  mainly  on 
the  chalybeates  in  these  complaints,  when  to  use  them  a-  adjuvants  of 
the  other  metallic  tonics,  and  when  to  abstain  from  them  as  usele.-s  or 
pM.-siMy  injurious;  for,  of  course,  they  could  do  only  harm  in  irritation 
of  the  nervous  centres  dependent  on  or  aggravated  by  plethora. 

Hysteria  is  one  of  the  affections  in  which  chalybeates  are  often  used 
advantageously  on  the  principles  above  stated. 

Neuralgia  is  also  frequently  benefited  by  them;  and,  in  many  in- 
stances of  this  complaint,  they  are  among  the  most  effectual  remedies. 
In  the  treatment  of  neuralgia  of  the  face,  or  tic9>uloureux,  they  enjo\ 
a  very  high  reputation;  but,  no  matter  what  may  !*•  the  seat  of  the  com- 
plaint, provided  it  can  be  traced  to  anaemia  as  the  sole  or  a  co-operative 
cause,  they  will  prove  equally  beneficial.  In  gastralgia.  they  sometime.- 
very  favourably.  They  are  often  associated  with  the  narcotic  ex- 


CHAP.  I.]  MINERAL    TONICS. — IRON.  435 

tracts,  as  of  belladonna,  stramonium,  and  coninm;  and  there  is  probably 
on  the  whole,  no  more  effectual  combination  in  the  treatment  of 
neuralgia. 

Chorea,  associated  with  anemia,  will  often  yield  to  the  chalybeates 
when  other  remedies  fail ;  though,  as  a  general  rule,  they  are  inferior  in 
this  affection  to  some  other  metallic  tonics. 

In  epilepsy,  they  may  be  tried  under  similar  circumstances ;  but  little 
reliance  can  be  placed  upon  them  for  the  cure  ;  as  this  fearful  malady  has 
roots  much  deeper  than  an  impoverished  condition  of  the  blood. 

In  spasmodic  asthma,  hooping-cough,  and  amaurosis,  they  have  been 
recommended,  and  may  be  used  to  meet  their  special  indication  when 
presented. 

Carcinomatous  diseases  are  often  usefully  treated  with  iron,  which,  if 
it  does  not  correct  the  tendency  to  the  malignant  growth,  at  least  serves, 
in  some  measure,  to  support  the  system  under  its  exhausting  influence, 
and  probably  contributes  at  once  to  render  the  patient  more  comfortable, 
and  to  lengthen  life. 

Mr.  Henry  Behrend,  of  Liverpool,  has  employed  iron  in  primary 
syphilis,  and,  upon  comparing  the  results  with  Ihose  following  the  use 
of  mercury,  gives  to  the  chalybeate  treatment  a  decided  preference;  as 
it  appears  to  be  equally  effectual,  leaves  the  system  in  a  healthier  condi- 
tion, and  is  not  followed  by  the  occurrence  of  secondary  symptoms.  He 
employs  the  tartrate  of  iron  and  potassa.  (London  Lancet,  Am.  ed., 
March,  1857,  p.  219.)  The  reader  will  please  to  understand  that  this 
statement,  in  regard  to  the  relative  efficiency  of  the  chalybeates  and  mer- 
curials in  syphilis,  is  made  solely  on  the  authority  of  Mr.  Behrend. 

In  the  special  diseases  of  various  organs,  attended  with  ana?mia,  iron 
is  a  most  valuable  adjuvant. 

In  chronic  hepatitis,  or  the  shattered  state  of  system  left  behind  by 
it.  the  chalybeates  are  very  useful.  Invalids  from  tropical  climates  often 
find  their  health  greatly  promoted,  or  quite  restored  by  a  residence  at 
chalybeate  springs,  and  by  the  use  of  the  waters,  especially  when,  as  in 
the  case  of  the  Cheltenham  waters  in  England,  the  iron  is  associated 
with  saline  laxatives.  I  am  disposed  to  think  that  the  chalybeate,  in 
these  cases,  does  good  also  by  a  direct  tonic  action  on  the  liver.  A 
similar  combination  of  iron  and  saline  laxatives,  with  the  various  pleas- 
ures of  a  watering  place,  is  among  the  most  effectual  means  of  cure  in 
certain  cases  of  jaundice,  which,  having  yielded  in  a  great  degree  to 
other  measures,  continue  afterwards  to  resist  for  a  long  time  the  best 
directed  efforts  of  the  physician. 

In  enlarged  spleen,  attended  with  anaemia,  and  especially  when  origin- 
ating under  minsmatic  influence,  the  preparations  of  iron  arc  highly 
useful;  and,  in  conjunction  with  quinia  and  purgatives,  offer  the  best 
means  of  curing  that  often  very  obstinate  affection.  Iron  is  thought  to 


436  GENERAL    STIMULANTS.  [PART  II. 

act  specially  on  the  spleen  as  an  astringent,  and,  as  before  stated,  is  said 
to  reduce  the  bulk  of  that  organ  in  animals  which  are  kept  under  its  use 
for  some  time. 

In  organic  diseases  of  the,  heart,  the  attendant  anosmia  serves  often 
to  aggravate  the  affection,  by  sustaining  an  excessive  action  of  the  organ. 
The  functions,  defectively  supplied  with  blood,  call  on  the  nervous  cen- 
tres, and  they,  in  obedience  to  the  call,  stimulate  the  heart,  in  order  to 
supply,  by  the  rapidity  with  which  the  blood  is  sent,  the  deficiency  in  its 
quality.  The  flaccidity  of  the  heart,  too,  in  anemia,  renders  it  more 
expansible  by  the  forces  to  which  it  is  subjected.  Hypertrophy  is  aggra- 
vated by  the  former  influence,  and  dilatation  by  the  latter.  Without 
being  able  to  cure  either  of  these  conditions,  the  preparations  of  iron, 
by  improving  the  state  of  the  blood,  may  tend  to  moderate  or  control 
the  increase  of  both ;  and,  in  the  case  of  dilatation,  may  possibly,  by 
their  tonic  and  astringent  action  on  the  tissue,  even  favour  a  contraction 
of  the  organ. 

B  right's  disease,  of  the  kidneys  is  almost  characteristically  attended 
with  anaemia,  which  contributes  to  the  accompanying  dropsy,  and.  when 
the  affection  consists  in  fatty  degeneration  of  the  organ,  fatally  promotes 
the  evil  by  lowering  the  vital  forces  which  best  resist  that  destructive 
process.  Iron  is  here  indispensable,  and  acts  powerfully,  in  aid  of  cream 
of  tartar  and  digitalis,  in  the  relief,  and  sometimes  in  the  cure  of  the 
complaint. 

Diseases  of  the  genital  organs,  with  anaemia,  are  occasionally  bene- 
iited  by  the  chalybeates.  Independently  of  their  influence  on  the  blood, 
they  may  act  as  tonics  on  the  organs,  and  by  some  are  supposed  to  exer- 
cise over  them  a  special  influence,  peculiarly  over  the  uterus.  They 
have  not  unfrnquently  relieved  sterility  in  women  ;  and  the  story  is  told 
that  they  first  came  into  vogue  by  curing  the  son  of  an  ancient  monarch 
of  impotence.  Their  supposed  powers  in  spermatorrhoea,  leucorrhoea, 
and  the  passive  forms  of  menorrhflgia  have  already  been  noticed.  Jn 
amenorrhoea,  they  are  among  the  remedies  most  relied  on.  Combined 
with  aloes,  they  probably  restore  the  suppressed,  or  increase  the  deficient 
menses,  in  a  greater  number  of  cases  than  any  other  medicine,  or  asso- 
ciation of  medicines.  Some  suppose  them  to  act  as  a  direct  emmena- 
gogue ;  others,  merely  by  improving  the  blood.  It  is  probable  that  they 
.have  no  specific  emmenagogue  power,  and  that  their  main  influence  is 
•owing  to  the  change  they  produce  in  the  blood;  but,  nevertheless,  they 
,probably  tend,  by  their  tonic  power,  to  which  the  uterus  seems  pecu- 
liarly susceptible,  to  put  that  organ  in  a  healthy^ondition  when  relaxed 
or  debilitated,  and  thus  enable  it  to  perform  its  functions  duly.  In  this 
way,  they  may  be  readily  conceived  to  be;  ommeiuigogue  in  OIK;  instance, 
-and  to  relieve  excessive  menstruation  or  uterine  hemorrhage  in  another. 

It  remains  only  to  consider  the  chalybeates  in  their  relation  to  diseases 


CHAP.  I.]  MINERAL   TONICS. — IRON.  437 

consisting  in  a  depraved  condition  of  the  blood,  as  distinct  from  a  mere 
deficiency  of  one  of  its  normal  ingredients.  Such  a  condition  exists  in 
many  low  febrile  diseases,  and  is  supposed  by  not  a  few  to  be  the  main 
pathological  lesion  in  those  affections.  The  corpuscles  are  not  essentially 
deficient  in  quantity  here,  but  they,  as  well  as  the  fibrin,  are  supposed 
to  be  diseased,  poisoned  probably  by  the  absorbed  cause  of  the  fever. 
Now,  it  is  not  mi  improbable  supposition  that  iron,  so  useful  in  the  con- 
struction of  the  red  corpuscles,  may  also  possess  some  efficacy  in  their 
repair.  Hence,  it  has  recently  been  introduced  into  use  as  a  remedy  in 
some  of  these  afl'ections.  Attention  was  some  years  since  prominently 
called  to  this  application  of  iron  by  Dr.  Bell,  of  Edinburgh,  who  spoke 
in  the  highest  terms  of  the  efficacy  of  the  tincture  of  the  chloride  in  ery- 
sipelas. His  practice  has  been  imitated  by  many  others,  not  only  in 
this  complaint,  but  in  some  of  analogous  character,  particularly  scar- 
latina and  diphtheria. 

But  it  is  probably  in  the  passive  hemorrhages,  that  the  chalybeates 
prove  most  useful  upon  the  principle  of  action  now  under  consideration. 
Though  operating  in  these  diseases  also  by  their  astringency,  they  owe 
the  great  eflicacy  which  they  sometimes  evince  much  more  to  their  in- 
fluence on  the  blood.  In  the  class  of  hemorrhages  here  referred  to,  the 
red  corpuscles,  though  not  wanting  in  amount,  are  apparently  diseased, 
and  unable  to  supply  that  stimulus  to  the  capillaries  which  is  essential 
to  the  support  of  their  healthy  vital  contractility,  while  the  plasticity  of 
the  fibrin  is  so  much  diminished  that  it  coagulates  imperfectly.  Hence 
the  vessels  allow  the  escape  of  blood ;  and  the  means  of  spontaneous 
cure  possessed  in  other  kinds  of  hemorrhage,  through  the  ready  coagu- 
lability of  the  fibrin,  are  deficient  or  wanting  there.  The  chalybeates 
have  a  tendency  to  correct  this  condition,  by  improving  the  character  of 
the  corpuscles,  and  probably  also,  indirectly,  that  of  the  fibrin;  as  there 
is  every  reason  to  suppose  that  this  principle  proceeds  in  part  from  the 
corpuscles,  and  must  therefore  partake  of  their  qualities.  Iron  may  be 
given  in  any  hemorrhage  of  this  kind;  but  it  has  probably  proved,  upon 
the  whole,  most  efficacious  in  menorrhagia. 

III.  CHOICE  OF  PREPARATIONS  OF  IRON.  For  many  of  the  facts  upon 
which  the  following  conclusions  rest,  I  have  pleasure  in  acknowledging 
my  indebtedness  to  a  memoir  by  M.  Quevenne,  published  in  Bouchardat's 
Archives  for  October,  1854,  in  which  are  presented  the  results  of  a  vast 
number  of  experiments,  made  by  the  author,  upon  the  mode  in  which 
iron  enters  the  system.  These  experiments  were  performed  chiefly  on 
dogs,  in  the  stomachs  of  which  an  artificial  opening  had  been  made, 
allowing  of  the  examination  of  their  contents,  and  of  the  changes  going 
on  in  them  from  time  to  time. 

Almost  all  the  ferruginous  compounds,  soluble  in  the  gastric  liquors, 
are  capable  of  contributing  to  the  formation  of  the  red  corpuscles,  and  of 


438  GENERAL    STIMULANTS.  [PART  II. 

producing  the  general  effects  of  iron  upon  the  system.  Two  striking  ex- 
ceptions are  offered  in  the  ferrocyanide  and  ferridcyanide  of  potassium 
(yellow  and  red  ferroprussiate  of  potassa),  both  of  which  are  soluble, 
but  neither  is  capable  of  exercising  the  characteristic  influence  of  iron 
on  the  system.  They  are  absorbed  with  great  facility  into  the  blood, 
but  they  pass  out  unchanged  with  the  urine ;  at  least  the  only  change 
produced  is  the  conversion  of  the  red  salt  into  the  yellow  before  elimi- 
nation. 

Solubility  in  the  gastric  liquids  is  essential  to  the  activity  of  a  chalyb- 
eate ;  and  the  degree  of  its  solubility  may  be  considered  as  an  approx- 
imate measure  of  its  absorbability,  and  therefore  of  its  power.  But  the 
solubility  or  insolubility  of  the  chalybeates  in  water,  is  no  criterion  of 
their  relation  to  the  gastric  liquids  in  this  ivspivt.  On  the  contrary, 
some  of  the  preparations  most  insoluble  in  water  are  most  readily  dis- 
solved in  the  stomach,  as,  for  example,  powdered  iron,  and  the  protocar- 
bonate.  Indeed,  the  soluble  salts  of  iron  almost  always  undergo  precip- 
itation in  the  stomach,  before  final  solution  in  the  gastric  liquids.  The 
precipitate  is  probably  formed  by  reaction  with  the  organic  principles 
either  of  the  food  or  of  the  mucus;  and,  in  the  absence  of  acid  in  the 
stomach,  would  remain  undissolved.  Acids  do  not  ordinarily  exist  in  the 
stomach  while  fasting;  but,  on  the  introduction  of  food,  and  probably 
of  substances  excitant  to  the  stomach,  though  not  nutritive,  they  are 
secreted  with  the  gastric  juice,  to  the  efficiency  of  which  they  seem  to  be 
essential.  The  chalybeate,  if  introduced  into  the  empty  stomach,  may 
possibly  excite  it  to  the  production  of  these  acids;  if  introduced  with  the 
food,  must  encounter  them  in  the  liquid  by  which  this  is  dissolved. 
Though  precipitated,  therefore,  it  is  always  subsequently  in  a  greater  or 
less  degree  dissolved  in  the  liquor  of  the  stomach.  Quevenne  ascertained 
that,  if  the  gastric  liquid  thus  holding  iron  in  solution,  be  treated  by  an 
alkali,  a  portion  at  least  of  the  chalybeate  is  thrown  down  ;  and  this  pre- 
cipitate was  always  found,  on  decomposition,  to  yield  nitrogenous  pro- 
ducts, proving  that  it  contained  an  organic  principle.  This  was  probably 
albumen.  Mitscherlich  inferred,  from  his  experiments,  that  in  the 
stomach  albumen  unites  with  the  salts  of  iron  to  form  compounds,  of 
which  those  containing  the  protoxide  are  soluble  in  water,  those  con- 
taining the  peroxide  are  insoluble;  but  both  are  dissolved  by  the  gastric 
acids.  It  is  probably,  then,  in  this  state  of  combination  with  albumen, 
that  the  chalybeates,  taken  into  the  stomach,  finally  enter  the  circulation. 
Of  the  changes  which  the  absorbed  iron  undergoes  in  the  blood,  in  order 
that  it  may  be  fitted  to  form  a  part  of  the  red  corpuscles,  we  know 
nothing ;  and  conjecture  is  futile. 

The  above  considerations  are  calculated  to  aid  us  in  the  choice  of  cha- 
lybeates. In  reference  to  their  effects  on  the  system,  their  mere  solu- 
bility in  water  is  of  no  advantage.  In  fact,  it  is  sometimes  otherwise; 


CHAP.  I.]  MINERAL   TONICS. — IRON.  439 

for  until  they  are  precipitated,  they  may  act  as  irritants  to  the  stomach, 
and  thus  interfere  with  absorption,  and  with  their  own  further  exhibi- 
tion. Besides,  Quevenne  has  shown  that,  as  a  general  rule,  they  yield 
a  less  proportion  of  metallic  iron  than  insoluble  preparations  to  the  gas- 
tric liquors.  Of  these  latter,  however,  the  sesquioxide  of  iron,  as  repre- 
sented by  the  preparation  oflicinally  denominated  subcarbonate,  is  an 
exception;  as  it  gives  a  less  proportion  of  the  metal  to  that  liquor  than 
any  other  chalybeate  in  use.  Upon  the  whole,  then,  when  tin-  object  is 
to  affect  the  system  through  the  absorption  of  iron,  as  soon  and  with  as 
little  inconvenience  as  possible,  it  is  advisable  to  select  one  of  the  insol- 
uble preparations,  as  the  powder  of  iron,  or,  if  a  soluble  one  is  chosen, 
to  employ  the  mildest  and  least  irritating,  as  the  tartrate  of  iron  and 
potasta.  Should  a  compound  insoluble  preparation  be  chosen,  one  of 
the  proto-compounds  should  be  preferred  to  those  in  which  the  iron  is  of 
higher  equivalent  value;  as  the  protocarbonate,  for  example,  to  the  ses- 
quioxide. If  the  object  be  solely  to  act  on  the  mucous  membrane  of  the 
prima>  via-,  as  upon  the  stomach  in  dyspepsia,  or  on  the  bowels  in  diar- 
rhoea, then  recourse  should  be  had  preferably  to  one  of  the  more  active 
of  the  soluble  salts,  as  the  sulphate,  or  the  chloride. 

The  best  period  for  exhibiting  the  chalybeate  is  also  a  point  for  con- 
sideration. When  the  aim  is  to  introduce  the  iron  into  the  circulation, 
the  preparation  should  be  given  at  the  commencement  of  a  meal;  as  it 
is  then  better  borne  by  the  stomach,  and  is  placed  under  circumstances 
most  favourable  for  solution  by  the  gastric  acids.  Quevenne  ascertained 
that  a  dog  could  bear  twice  as  much,  given  with  food,  as  upon  an  empty 
stomach.  A  dose  which  would  vomit  or  purge  under  the  latter  circum- 
stances, caused  no  inconvenience  under  the  former.  But,  when  the  op- 
eration of  the  chalybeate  is  to  be  confined  to  the  mucous  membrane,  it 
should  be  given  on  an  empty  stomach ;  as  it  will  thus  operate  with 
greater  promptitude  and  certainty,  while,  as  the  quantity  of  metal  that 
may  enter  the  circulation  is  now  a  matter  of  indifference,  the  dose  can  be 
regulated  according  to  the  effects  without  inconvenience. 

Another  fact  ascertained  by  Quevenne  is,  that  the  quantity  of  a  cha- 
lybeate absorbed  is  increased  somewhat  with  the  increase  in  the  quan- 
tity given,  but  by  no  means  proportionally;  so  that,  in  estimating  the 
relative  value  of  two  preparations  for  affecting  the  system,  one  yielding 
iron  largely  to  the  blood,  the  other  sparingly,  we  cannot  supply  the  defi- 
ciency of  the  latter,  so  as  to  bring  the  two  upon  an  equality,  by  increas- 
ing its  quantity. 

The  great  multiplication  of  the  chalybeate  preparations  is  unfortunate, 
as  it  tends  to  embarrass  the  student  and  young  practitioner,  without 
affording  him  any  equivalent  advantage;  for  all  the  good  that  can  be 
obtained  from  the  whole  catalogue,  whether  in  regard  to  diversity  of 
effect,  or  facility  of  administration,  can  be  equally  obtained  from  one- 


440  GENERAL    STIMULANTS.  [PART  II. 

third,  or  at  most  one-half  of  the  number.  I  have  seldom  found  occasion 
to  prescribe,  for  internal  use,  any  others  than  the  powder  (reduced  iron, 
U.  S.),  the  prolocarbonate  (pills  of  carbonate  of  iron,  U.  S.),  and  the 
xubcarbonate,  among  the  insoluble  preparations;  and  the  sulphate,  the 
tartrate  of  iron  and  potassa,  the  citrates,  the  tincture  of  the  chloride, 
and  the  solution  of  the  iodide,  among  those  which  are  soluble.  I  be- 
lieve that  all  the  remedial  effects  which  iron  is  capable  of  producing  can 
be  obtained  from  these  chalybeates,  which  afford  also  opportunity  for 
every  desirable  diversity  in  the  form  of  exhibition,  whether  in  powder, 
pill,  mixture,  or  solution  in  water  or  alcohol. 

The  preparations  may  be  arranged  under  the  heads  of  1.  those  in  the 
metallic  state,  2.  the  oxides,  3.  the  salts  consisting  of  an  oxide  and  acid, 
and  4.  the  haloid  salts. 

1.   Preparations  of  Iron  in  the  Metallic  /State. 

I.  REDUCED  IRON. — FERRUM  REDACTUM.  U.8.,Br. — Pow- 
der of  Iron.  —  FERRI  PULVIS.  U.  S.  1850. —  Quevenne  s  Iron. 

This  is  prepared  by  passing  hydrogen  over  sesquioxide  of  iron  heated 
to  redness.  The  hydrogen  abstracts  oxygen  from  the  sesquioxide,  and 
escapes  as  watery  vapour,  leaving  the  iron  in  a  metallic  state.  This  is 
powdered,  and  kept  in  well-stopped  bottles. 

Properties.  It  is  a  dark  iron-gray  powder,  without  smell  or  taste.  A 
little  of  it,  struck  with  a  smooth  hammer  upon  an  anvil,  forms  a  scale 
having  the  metallic  lustre.  Thrown  into  a  dilute  acid,  it  produces  effer- 
vescence, with  the  escape  of  hydrogen.  It  rapidly  oxidi/es  <m  exposure 
to  the  air,  from  which  it  should  be  as  much  as  possible  r.\<  hided.  If 
quite  black,  and  but  feebly  effervescing  with  dilute  acids,  it  may  be 
looked  on  as  not  having  been  fully  reduced,  and  consequently  imperfect. 

Effects  on  the  System.  Powdered  iron  produces  all  the  characteristic 
effects  of  the  metal  on  the  system,  but  has  little  action  on  the  stomach 
locally.  Nevertheless,  in  very  large  doses,  it  sometimes  disturbs  the 
bowels,  and  has  been  known  to  cause  vomiting.  When  there  is  any  acid 
in  the  stomach,  it  is  rapidly  dissolved,  being  probably  iirst  oxidized  at 
the  expense  of  the  water,  and  then  combining  with  the  acid.  From  the 
experiments  of  Quevenne,  it  appears  to  yield  a  larger  proportion  of  iron 
to  the  gastric  liquor  than  any  other  preparation  of  the  metal,  given  in 
the  same  quantity. 

Therapeutic  Application.  This  particular  form  of  powdered  iron  was 
first  introduced  to  the  notice  of  the  profession  by  MM.  Quevenne  and 
Miquelard,  of  Paris,  and  has  now  come  into  general  use.  Its  want  of 
taste,  the  smallness  of  its  dose,  and  the  mildness  of  its  action  are  valu- 
able qualities;  but  the  facility  of  its  solution  in  tin;  gastric  liquids,  and 
of  its  absorption,  constitutes  its  great  recommendation.  It  may  be  em- 


CHAP.  I.]  MINERAL   TONICS. — IRON    FILINGS.  441 

ployed  with  advantage  in  all  cases,  in  which  the  object  is  to  introduce 
iron  into  the  system  through  the  circulation.  Perhaps  no  chalybeate  is 
superior  to  it  in  this  respect.  It  has  been  specially  employed  in  anemia, 
and  acts  with  great  efficiency  in  this  affection,  in  all  cases  which  arc 
amenable  to  the  influence  of  iron.  An  objection  has  been  urged  against 
all  the  fotfnis  of  metallic  iron,  that  they  occasion  unpleasant  flatulence, 
by  the  hydrogen  liberated  in  the  stomach.  But,  in  reference  to  this  par- 
ticular preparation  at  least,  the  objection  is  rather  theoretical  than  prac- 
tical ;  the  dose  being  too  small  to  produce  any  great  effect  of  the  kind. 
Three  grains  of  it  could  evolve  only  about  one-tenth  of  a  grain  of  hydro- 
gen. It  is  not  adapted  to  those  cases,  in  which  the  indication  is  to  act 
exclusively  or  specially  on  the  mucous  membrane  of  the  stomach  and 
bowels  by  direct  contact. 

Administration.  The  dose  is  from  three  to  five  grains  twice  or  three 
times  a  day,  which  may  be  increased  if  necessary.  From  fifteen  to 
thirty  grains  of  the  powder  prove  irritant,  disturbing  the  bowels,  and 
more  or  less  incommoding  the  stomach,  though  very  rarely  vomiting. 
It  may  be  given  mixed  with  syrup,  or  in  pill. 

II.  IROX  FILINGS.— FERRI  RAMENTA.  U.  S.  1850.— FERRI 

LlMATURA.  til. 

These  were  formerly  much  more  used  than  at  present;  and  were  not 
dismissed  from  our  Pharmacopoeia  until  the  late  revision.  As  kept  in 
the  shops,  they  are  too  often  the  mere  refuse  of  the  workshops,  and  are 
consequently  impure,  not  unfrequently  containing  particles  of  copper  and 
other  metals.  Obtained  from  this  source,  they  should  be  pounded  and 
sifted;  and  may  then  be,  in  some  degree,  further  purified  by  drawing 
them  through  a  sieve  with  a  magnet,  which  attracts  the  iron,  leaving 
the  isolated  particles  of  other  metals,  and  at  the  same  time  the  coarser 
particles  of  the  iron  itself.  This  method,  however,  answers  but  imper- 
fectly; and  the  only  method  of  securing  them,  fit  for  medical  use,  is  to 
prepare  them  directly  by  filing,  from  a  piece  of  pure  soft  iron.  The 
present  French  Codex  (A.D.  1866)  directs  them  to  be  prepared  from  iron 
by  means  of  a  file  of  steel,  and  then  beaten  so  as  to  obtain  a  coarse 
powder,  with  the  grains  always  uniform.  They  should  be  kept  quite 
dry,  in  well-stopped  bottles,  to  prevent  oxidation,  and  should  have  a 
bright  and  clean  appearance. 

I  have  no  doubt  that  iron  filings,  or  steel-dust  as  they  were  often  called 
in  old  times,  are  an  efficient  chalybeate.  The  flatulence  they  may  occa- 
sion is  but  a  trifling  inconvenience,  while  their  mildness,  and  facility  of 
entrance  into  the  system  through  the  action  of  the  gastric  acids,  are 
positive  recommendations.  The  great  objection  to  them  is  their  fre- 
quent impurity.  They  have,  however,  at  present,  been  entirely  super- 


442  GENERAL    STIMULANTS.  [PART  II. 

seded  by  the  reduced  powder  of  iron,  which  has  all  their  advantages,  in 
a  still  higher  degree,  without  their  disadvanta 

The  dose  of  iron  filings  is  from  five  to  fifteen  grains.  They  may  be 
taken  in  powder  with  syrup,  or  in  the  form  of  pill. 

Porphyrized  iron  is  a  preparation  directed  by  the  French  Codex. 
and  is  made  by  rubbing  pure  iron  filings  into  the  state  of  impalpable 
powder,  by  means  of  porphyry.  Its  colour  is  black,  probably  owing  to 
a  partial  oxidation.  The  dose  is  the  same  as  that  of  the  preceding  pre- 
paration, or  somewhat  less. 

2.  Preparations  of  Iron  in  the  State  of  Oxide. 

I.  BLACK  OXIDE  OF  IRON.  —  FERRI  OxiDUM  NlGRUM.- 
Martial  Ethiops. 

Under  this  name,  several  preparations  have  been  introduced  into  use. 
all  of  analogous  composition,  and  probably  identical  medical  propertk  -s. 
but  differing  somewhat  in  the  proportion  of  their  ingredients.  They  con- 
sist of  the  two  oxides  of  iron,  the  protoxide  and  sesquioxide,  in  different 
proportions,  with  or  without  water.  The  oxides  are  combined  chemi- 
cally, the  sesquioxide  acting  the  part  of  acid,  and  the  protoxide  that  of 
base;  and  it  is  in  consequence  of  this  combination  that  they  undergo  no 
change  on  exposure.  If  they  were  mixtures  of  the  two  oxides,  the  pro- 
toxide would  gradually  absorb  oxygen  until  converted  into  the  sesqui- 
oxide. Three  of  them  merit  particular  notice;  1.  the  scales  of  iron,  2.  the 
hydrated  oxide  of  the  late  Edinburgh  Pharmacopoeia,  and  3.  the  mag- 
netic oxide  of  the  late  Dublin  and  present  British  Pharmacopoeias. 

1.  SCALES  OP  IRON.  — SQUAMA  FERRI. 

This  is  the  true  old  Jkirtial  Ethiops,  It  consists  of  the  scales  which 
fall  from  heated  iron  when  hammered  on  the  anvil.  These  are  first 
powdered  coarsely,  then  purified  by  the  magnet,  and  finally  brought  to 
the  state  of  an  impalpable  powder  by  levigation  and  elutriation.  They 
are  of  variable  composition;  the  sesquioxide  seeming  to  unite  with  dif- 
ferent equivalent  quantities  of  the  protoxide,  forming  different  definite 
compounds,  which  are  then  mixed  in  uncertain  proportions. 

2.  HYDRATED  BLACK  OXIDE  OF  IRON.—  OXIDUM    FERRI 
NIGRUM  HYDRATUM.  —  FERRI  OXIDUM  NIQRUM.  Ed. 

This,  though  directed  in  the  late  Edinburgh  Pharmacopoeia,  has  been 
discarded  in  the  British.  It  is  prepared  by  precipitating,  by  means  of 
ammonia,  mixed  solutions  of  the  sulphates  of  the  protoxide  and  sesqui- 
oxide of  iron.  The  two  bases  are  thrown  down,  combined  with  water. 
According  to  Wohler,  who  originally  proposed  this  preparation,  it  con- 
sists of  two  equivalents  of  protoxide,  one  of  sesquioxide,  and  two  of 
water. 


CHAP.  I.]         MINERAL    TONICS. — SESQUIOXIDE   OF   IRON.  443 

3.  MAGNETIC  OXIDE  OF  IRON.  —  FERRI  OXIDUM  MAQNETI- 
CUM.  Br. 

The  magnetic  oxide  is  prepared  by  decomposing,  by  means  of  soda, 
a  solution  of  persulphate  and  protosulphate  of  iron,  the  former  having 
been  obtained  by  boiling  a  little  nitric  acid  with  sulphate  of  protoxide 
of  iron  so  as  to  sesquioxidizc  the  protoxide.  A  compound  is  precipi- 
tated, consisting  of  sesquioxide  and  protoxide  of  iron;  and  the  formula 
was  so  calculated  as  to  give  an  equivalent  of  each  of  these  oxides  in  the 
resulting  compound,  which  corresponds  in  composition  with  the  native 
magnetic  black  oxide. 

Properties.  In  all  these  forms,  the  black  oxide  is  a  blackish  or  gray- 
ish-black powder,  inodorous  and  tasteless,  w^th  decided  magnetic  prop- 
perties,  and  insoluble  in  water.  The  stronger  acids  dissolve  it  without 
effervescence,  showing  that  it  contains  no  metallic  iron.  It  is  unchangea- 
ble in  the  air. 

Medical  Uaes.  The  black  oxide  has  all  the  effects  of  the  chalybeates 
upon  the  system,  and  is  very  mild  in  its  operation.  It  is  more  readily 
dissolved  in  the  stomach  than  the  sesquioxide,  but  not  so  readily  as  the 
reduced  iron  above  described.  It  may  be  used  whenever  it  is  desirable 
to  bring  the  system  generally  under  the  influence  of  iron.  The  dose  is 
from  five 'to  twenty  grains. 

II.  SESQUIOXIDE  OF  IRON.  —  FERRI  SESQUIOXIDUM. 

The  proper  chemical  sesquioxide  of  iron  consists  of  two  equivalents  of 
the  metal,  and  three  of  oxygen.  It  constitutes  the  sole  or  chief  ingre- 
dient of  several  officinal  preparations,  of  which  the  hydrated  sesquioxide, 
the  dry  sesquioxide,  the  rust  of  iron,  and  the  subcarbonate  of  iron  of 
the  U.  S.  Pharmacopoeia  require  special  notice.  The  first  three  will  be 
considered  here  ;  the  last,  from  its  comparative  importance,  will  be  treated 
of  distinctly,  in  an  article  immediately  succeeding  the  present. 

1.  HYDRATED  SESQUIOXIDE  OP  IRON.  —  FERRI  OXIDUM 
HYDRATITM.  U.  S.  —  FERRI  PEROXIDUM  HYDRATUM.  Br. 

This  is  prepared  by  dissolving  sulphate  of  iron  in  water,  adding  sul- 
phuric acid,  and  boiling;  then  adding  nitric  acid  in  small  portions  suc- 
cessively, boiling  after  each  addition,  until  a  dark  colour  is  no  longer 
produced  ;  and,  finally,  precipitating  with  ammonia  in  excess,  and  wash- 
ing the  precipitate  with  water.  The  object  of  the  first  part  of  the  pro- 
cess is  to  convert  the  protoxide  of  the  sulphate  completely  into  sesqui- 
oxide, which  is  done  at  the  expense  of  the  oxygen  of  the  nitric  acid. 
The  addition  of  sulphuric  acid  is  necessary  to  saturate  the  sesquioxide 
formed,  which  requires  more  acid  than  the  protoxide  in  the  proportion 
of  its  excess  of  oxygen.  The  precipitated  sesquioxide,  after  having 
been  washed,  is  introduced  into  a  bottle,  and  kept  in  a  moist  state  under 
water. 


444  GENERAL    STIMULANTS.  [PART  II. 

This  preparation  consists  of  one  eq.  of  the  sesquioxide,  and  two  of 
water  of  combination,  which  it  retains  when  carefully  dried. 

Properties.  Hydrated  sesquioxide  of  iron,  as  officially  prepared,  is  a 
moist,  reddish-brown  mass  or  pulp,  inodorous,  of  a  slightly  styptic  taste, 
nearly  insoluble  in  water,  but  readily  dissolved  by  most  acids.  Dried 
carefully,  it  is  still  dissolved  by  acids,  though  less  rapidly.  J\v  standing 
long,  even  under  water,  it  acquires  a  new  molecular  condition,  which, 
though  it  does  not  render  it  absolutely  insoluble,  very  much  impairs  its 
solubility.  Heated  to  redness,  so  as  to  be  deprived  of  all  its  water,  it  is 
dissolved  very  slowly  by  the  dilute  acids. 

Medical  Effects  and  Uses. — As  this  preparation,  in  the  moist  state, 
or  when  carefully  dried,  is  dissolved  with  considerable  facility  by  acids, 
it  would  no  doubt  act  efficiently  as  a  chalybeate ;  but  it  is  not  used  for 
this  purpose.  It  was  introduced  into  the  Pharmacopoeias  as  an  antidote 
for  arsenious  acid ;  and  there  can  be  little  doubt  that  it  possesses  great 
efficiency  in  this  respect;  often  saving  life,  and  perhaps  always,  if  prop- 
erly employed,  unless  the  injury  already  done  is  fatal.  It  acts  by 
converting  the  poisonous  arsenious  acid  into  an  insoluble  and  inert  sub- 
arseniate  of  the  sesquioxide  of  iron.  It  is  true  that  it  will  not  produce 
this  effect  on  the  undissolved  arsenious  acid ;  but  it  is  not  in  this  condi- 
tion that  the  poison  acts ;  and  if,  as  it  dissolves,  there  is  enough  of  the 
antidote  present  to  neutralize  the  dissolved  portion,  it  prevents  evil  effects, 
until  the  whole  of  the  arsenic  can  be  evacuated  from  the  stomach,  and 
subsequently  from  the  bowels.  To  prove  successful,  however,  it  is  neces- 
sary that  the  antidote  should  be  employed  in  great  excess ;  not  less  than 
twelve  times  as  much  as  the  arsenious  acid  taken  being  required ;  and 
some  advise  thirty  times  as  much,  or  even  more.  As  the  chalybeate 
produces  no  injury,  except  perhaps  a  slight  irritation,  infinitely  less  dele- 
terious than  the  effects  of  the  poison,  it  should  be  given  very  freely  ;  and 
attention  to  precise  quantity  is  unnecessary.  It  becomes  much  less  effi- 
cacious when  dried,  or  long  kept  even  in  the  moist  state ;  and  should, 
therefore,  if  possible,  be  obtained  freshly  precipitated  when  wanted  for 
use.  Hence  the  propriety  of  keeping  a  portion  of  the  solution  of  the 
sesquisulphate  (tersulphate  of  the  sesquioxide,  Fea03,  3SO3),  as  pre- 
pared in  the  process,  and  precipitating  the  oxide  by  ammonia  at  the  time 
it  may  be  wanted. 

2.  ANHYDROUS  SESQUIOXIDE  OF  IRON.  —  FKKUI  PEROXI- 
DUM.  Br.  —  Colcothar. 

This  may  be  prepared  by  drying  the  hydrated  sesquioxide  above  no- 
ticed, and  afterwards  exposing  it  for  a  short  time  to  an  obscure  red  heat; 
or  by  calcining  the  sulphate  of  iron.  In  the  former  case,  the  water  of 
the  hydrate  is  simply  driven  off,  leaving  the  dry  srsqiiioxide  ;  in  the 
latter,  the  protoxide  of  the  sulphate  is  sesquioxidized  at  the  expense  of 
the  sulphuric  acid,  which  is  partly  converted  into  sulphurous  acid,  and 


CHAP.  I.]       MINERAL   TOXICS. — SUBCARBONATE    OF   IRON.  445 

partly  escapes  in  the  anhydrous  state.  It  is  a  reddish-brown  powder, 
inodorous  and  tasteless,  insoluble  in  water,  and  dissolved  very  slowly 
and  with  difficulty  by  the  dilute  acids. 

Medical  Uses.' — Taken  internally,  this  oxide  is  almost  inert,  as  regards 
any  effect  on  the  system,  in  consequence  of  its  very  difficult  solubility  in 
the  acids.  The  British  Pharmacopoeia  employs  it  in  the  preparation  of 
the  plaster  of  iron  or  strengthening  plaster. 

3.  RUST  OF  IRON.  —  RUBIGO  FERRT. 

This  is  made  by  exposing  iron,  in  the  shape  of  wire  or  filings,  to  the 
action  of  air  and  water.  The  metal  becomes  in  time  covered  with  a 
powder,  which  is  rubbed  off  by  trituration  under  water,  and,  being  sus- 
pended in  the  liquid,  is  poured  off  with  it,  and  subsides.  It  may  be 
afterwards  brought  to  an  impalpable  state  by  levigation  and  elutriation. 
It  is  chemically  a  sesquioxide  of  iron,  containing,  according  to  Berze- 
lius,  14.7  per  cent,  of  water.  Sometimes,  at  least,  it  contains  also  a 
minute  proportion  of  the  carbonate  of  the  protoxide  of  iron,  to  which  it 
probably  mainly  owes  any  efficiency  which  it  may  possess  as  a  chalyb- 
eate. The  probability  is  that,  in  the  process  of  rusting,  when  the  iron 
becomes  protoxidized.  a  portion  of  the  protoxide  combines  with  the  car- 
bonic acid  of  the  air  or  water,  and,  though  it  very  soon  parts  with  most 
of  this  on  becoming  further  oxidized,  retains  a  small  proportion  for  a 
long  time,  perhaps  indefinitely. 

Rust  of  iron  is  in  the  form  of  a  light  yellowish-brown  powder,  or  of 
small,  pulverulent,  conical  lumps,  into  which  it  has  been  formed  when 
drying.  It  is  inodorous,  nearly  or  quite  tasteless,  insoluble  in  water,  and 
slowly  dissolved  by  the  dilute  acids. 

Medical  ("so-.  It  was  formerly  very  much  employed  to  obtain  the 
effects  of  the  chalybeates  on  the  constitution ;  but,  as  it  was  very  slow 
in  its  operation,  in  consequence  of  its  difficult  solubility  »  the  weak 
acids,  and  uncertain,  either  from  the  variable  quantity  of  acid  present  in 
the  stomach,  or  its  own  variable  proportion  of  carbonate  of  the  protoxide, 
it  has  been  to  a  considerable  degree  abandoned.  The  following  prepa- 
ration is  more  elegant,  and  has  almost  universally  superseded  it.  The 
dose  is  from  five  to  thirty  grains. 

III.  SUBCARBONATE  OF  IRON.  —  FERRI  SuBCARBONAS. 
U.  S.  —  Ferri  Carbonas  Prsecipitatus,  U.  S.  1830.  —  Precipi- 
tated Carbonate  of  Iron. —  Crocus  Martis. 

This  was  introduced  into  practice  as  a  substitute  for  the  old  rust  of 
iron.  Its  claim  to  the  title  of  subcarbonate  cannot  be  sustained  on 
chemical  grounds.  Only  one  compound  of  carbonic  acid  and  iron  is 
known,  and  this  consists  of  equivalent  proportions  of  the  acid  and  pro- 
toxide. There  is,  therefore,  no  known  subcarbonate.  The  preparation 


446  GENERAL    STIMULANTS.  [PART  II. 

under  consideration  consists  mainly  of  hydrated  sesquioxidc  of  iron,  with 
which  is  associated  a  variable  proportion,  always,  however,  small,  of 
carbonate  of  the  protoxide.  In  the  U.  S.  Pharmacopoeia  it  was  denom- 
inated subcarbonate,  partly  because  it  had  previously  held  the  name  of 
precipitated  carbonate,  which,  when  its  true  nature  came  to  be  known, 
was  considered  quite  inappropriate,  and  partly  under  the  impression  that 
its  virtues  were,  in  great  measure,  ascribed  to  the  small  proportion  of 
carbonate  contained  in  it,  which  could  not,  therefore,  it  was  thought,  be 
appropriately  excluded  from  a  share  of  the  title.  The  term  subcarbonate 
may,  in  this  sense,  be  considered  as  simply  signifying  that  it  contains 
carbonic  acid,  but  not  in  quantity  equivalent  to  the  basic  matter. 

This  preparation  is  made  by  precipitating  a  solution  of  sulphate  of 
iron  with  carbonate  of  soda,  and  afterwards  washing  and  drying  the  pre- 
cipitate. By  reaction  between  the  two  salts,  carbonate  of  protoxide  of 
iron  is  formed,  which,  though  of  a  bluish-white  colour  when  deposited, 
rapidly  changes  on  exposure  to  the  air,  and,  before  the  close  of  the 
washing  and  drying,  is  converted  mainly  into  sesquioxide  of  a  reddish- 
brown  colour.  The  protoxide  of  iron  has  so  strong  an  aflinity  for  oxy- 
gen that,  whether  separate  or  combined  with  an  acid,  it  quickly  becomes 
sesquioxidized  on  exposure;  and,  if  previously  combined  with  carbonic 
acid,  gives  so  much  of  it  off  as  was  united  with  the  portion  converted 
into  sesquioxide.  In  the  present  preparation,  however,  a  small  propor- 
tion of  the  carbonate  precipitated  remains  unchanged.  The  manufac- 
turer sometimes  calcines  it  to  improve  its  colour,  thus  driving  off  the 
water,  and  probably  converting  the  small  residue  of  carbonate  into 
quioxide,  very  much  to  the  detriment  of  the  preparation.  It  is  said  that 
the  beautiful  bright  reddish-brown  powder,  often  found  in  the  shops,  ha- 
always  undergone  this  treatment,  and  should,  therefore,  be  rejected.  Un- 
less the  ponder  effervesce  somewhat  when  dissolved  in  muriatic  acid,  its 
fitness  for  medicinal  use  may  be  doubted. 

Properties.  The  subcarbonate  of  iron  is  a  dull  reddish-brown,  or  some- 
what chocolate-coloured  powder,  inodorous,  of  a  slightly  styptic  and  fer- 
ruginous taste,  insoluble  in  water,  and  soluble  with  difficulty  in  the  acids. 
except  the  muriatic,  which  dissolves  it  with  some  effervescence,  owing 
to  the  escape  of  carbonic  acid. 

Effects  on  the  System.  It  has  little  local  action  on  the  stomach,  and 
may  be  taken  to  an  almost  unlimited  amount,  with  no  other  effect  than 
to  occasion  feelings  of  epigastric  weight  and  oppression,  and  sometimes 
probably  slight  nausea  and  vomiting.  It  may,  too,  when  taken  exces- 
sively, accumulate  in  the  bowels,  and  produce  some  mechanical  incon- 
venience. By  far  the  larger  portion  passes  out  of  the  bowels  with  the 
stools,  which  it  blackens.  Of  a  considerable  number  of  chalybeate  pre- 
parations examined  by  Quevenne,  this  gave  to  the  gastric  liquor  the 
least  proportion  of  iron.  As  it  can  impart  to  the  circulation  only  so 


CHAP.  I.]        MINERAL   TONICS. — SUBCARBONATE   OF   IRON.  447 

much  of  the  metal  as  it  yields  to  that  liquor,  it  must  be  inferred  to  be 
among  the  feeblest  in  its  effects  on  the  system.  Nevertheless,  experience 
has  shown  that  it  is  capable  of  producing  all  the  general  effects  of  the 
ehalybeatos;  and,  though  it  must  be  given  in  larger  doses  than  most 
other  preparations,  it  is  yet  well  borne  by  the  stomach,  so  that  the  dis- 
advantage of  its  relative  feebleness  is  in  some  degree  counterbalanced. 
These  large  doses  are  rendered  necessary  by  the  small  proportion  it  con- 
Tains  of  the  carbonate,  which, probably,  is  the  ingredient  through  which, 
mainly,  it  is  capable  of  affecting  the  system. 

Therapeutic  Application.  Little  good  can  be  expected  from  the  sub- 
carbonate,  as  a  simple  tonic,  in  reference  to  its  direct  action  on  the  stom- 
ach and  bowels;  and  it  is  seldom  given  for  such  a  purpose.  But,  with  re- 
gard to  its  effects  on  the  system,  before  the  discovery  of  the  protective 
power  of  sugar  over  carbonate  of  iron,  and  the  consequent  adoption  of 
that  salt,  and  while  yet  the  extraordinary  chalybeate  virtues  of  the  pow- 
der of  iron  reduced  by  hydrogen  were  unknown,  this  was  among  the 
most  popular  of  the  ferruginous  preparations,  partly  from  its  ascertained 
efficiency,  and  partly  from  its  innocence,  even  in  very  large  doses;  and 
it  is  still  employed  to  a  considerable  extent  for  special  purposes.  It  is 
unnecessary  to  repeat  an  account  of  the  diseases  to  which  the  chalyb- 
eates  in  general,  and  consequently  this  particular  preparation,  are  appli- 
cable. For  this  the  reader  is  referred  to  the  general  remarks  upon  the 
subject  of  iron.  It  will  be  sufficient  here  to  call  attention  to  the  special 
purposes  just  alluded  to. 

The  therapeutic  application  for  which  the  subcarbonate  is  most  highly 
esteemed  is  to  the  cure  of  neuralgia.  About  forty  years  since,  Mr.  B. 
Hutchinson,  in  a  pamphlet  on  the  subject,  called  the  notice  of  the  profes- 
sion to  several  cases  of  tic  douloureux,  which  had  been  successfully 
treated  by  this  remedy.  The  practice  was  quickly  imitated  by  others, 
with  results  so  frequently  favourable,  that  the  confidence  of  the  profes- 
sion in  its  efficiency  became  established.  I  have  frequently  employed  it 
myself  in  this  painful  and  often  very  obstinate  affection,  and  do  not  think 
that  I  have  obtained  so  much  advantage  from  any  remedy,  as  from  a 
joint  use  of  the  subcarbonate  of  iron  and  the  narcotic  extracts,  especially 
that  of  belladonna.  Many  cases  certainly  will  resist  the  influence  of 
this  remedy,  and  others  may  succeed  where  this  has  failed;  for  there  are 
few  affections  having  a  greater  diversity  of  origin,  or  requiring  greater 
diversity  of  treatment  than  neuralgia;  but  it  may,  I  think,  rank  among 
the  most  efficacious.  Its  usefulness  in  this  disease  suggested  its  employ- 
ment in  other  obstinate  nervous  affections;  and  it  has  been  given  in  a 
considerable  number  of  cases  of  traumatic  tftanus  with  asserted  success. 
It  has  also  been  employed  advantageously  in  chorea,  and  in  the  second 
stage  of  hooping-cough,  when  its  nervous  character  has  begun  to  pre- 
dominate. As  a  r  ledy  in  these  nervous  affections,  particularly  neural- 


448  GENERAL   STIMULANTS.  [PART  II. 

gia  and  tetanus,  the  doses  employed  are  much  larger  than  those  ordinarily 
administert'd  merely  for  the  improvement  of  the  blood.  From  half  a 
drachm  to  three  drachms  are  given  three  times  a  day;  and,  in  one 
of  tetanus,  it  was  carried  to  half  an  ounce  every  two  or  three  hours. 
Care  should  be  taken,  when  these  large  doses  are  given,  that  the  bowels 
should  be  duly  evacuated ;  and  I  have  generally  combined  the  chalyb- 
eate with  a  little  ginger,  to  obviate  its  disagreeable  effects  on  the  stomach. 

How  the  medicine  operates  in  the  nervous  diseases,  whether  merely 
as  a  chalybeate,  by  improving  the  blood,  and  exercising  a  tonic  influence 
directly  on  the  nervous  centres,  or  by  some  additional  and  peculiar  influ- 
ence, it  is  difficult  to  determine.  If  upon  the  former  principle  alone, 
the  same  effects  ought  to  be  produced  by  other  chalybeate.*,  still  more 
efficient  than  it  in  obviating  anaemia.  I  cannot  help  suspecting  that  the 
operation  of  its  mere  mass  on  the  interior  surface  of  the  stomach  and 
bowels  may  have  something  to  do  with  the  result,  probably  through 
the  sympathies  connecting  the  alimentary  canal  with  the  brain  and 
spinal  marrow.  In  a  case  of  very  severe  neuralgia  of  the  bowels,  which 
occurs  to  my  recollection,  the  curative  effect  was  so  speedy  that  it  could 
scarcely  be  ascribed  to  the  absorption  of  the  iron.  It  seemed  to  me 
highly  probable  that  the  powder,  retained  by  its  weight  in  contact  with 
the  surface  on  which  it  was  spread,  acted  as  a  protective  to  the  mucous 
membrane,  and  thus  prevented  the  neuralgic  paroxysms,  which  might 
have  depended  on  an  irritant  action  of  the  intestinal  contents  on  the 
excessively  sensitive  surface. 

Another  purpose  for  which  this  preparation  may  be  employed  is  to 
act  as  an  antidote  to  arsenious  acid.  Though  not  equal  to  the  freshly 
precipitated  hydrated  gesquioxide,  it  has  considerable  efficacy,  and 
should  be  resorted  to  when  the  other  cannot  be  obtained.  But  if  pre- 
viously exposed  to  a  red  heat,  it  becomes  inapplicable  to  this  purpose,  in 
consequence  of  the  same  molecular  change  which  renders  it  insoluble  in 
dilute  acids.  It  may  be  given  ad  libitum. 

The  dose  for  the  ordinary  purposes  of  the  chalybeate?  is  from  five  to 
thirty  grains,  three  times  a  day.  It  may  be  administered  in  the  form  of 
an  electuary  mixed  with  syrup  or  molasses,  and  may  often  be  usefully 
associated,  to  meet  special  indications,  with  aromatic,  tonic,  and  laxative 
powders,  as  ginger,  columbo,  and  rhubarb. 

The  Iron  Plaster  (EMPLASTRUM  FERRI,  U.  S.)  is  made  from  this  pre- 
paration, by  incorporating  it  with  lead  plaster  and  Burgundy  pitch,  pre- 
viously melted  together.  Under  the  impression  that  this  plaster  serves 
to  strengthen  debilitated  parts,  it  has  commonly  been  called  strengthen- 
ing plaster,  and  employed  in  weakness  of  the  loins  and  joints.  But 
there  is  no  reason  whatever  to  suppose  that  the  chalybeate  can  pene- 
trate the  cuticle  so  as  to  reach  the  part  affected ;  and  the  notion  of  the 
strengthening  influence  of  the  iron  is  probably  quite  illusory.  Neverthe- 


CHAP.  I.]   MINERAL  TONICS. — PILLS  OF  CARBONATE  OF  IRON.  449 

less,  the  plaster  may  prove  useful  in  some  cases  of  chronic  rheumatism, 
or  other  inflammatory  affection  of  these  parts,  through  the  revulsion 
effected  by  the  gentle  irritatini^.it  sustains  upon  the  surface;  and  the 
muscles  or  joints,  being  thus  relieved  of  the  disease  which  interferes 
with  their  functions,  seem  to  be  strengthened. 

3.  Preparations  of  Iron  in  the  Saline  State. 

I.  PILLS  OF  CARBONATE  OF  IRON.  —  PlLUL^E  FERR1 
CARBONATIS.  U.S.  —  FERRI  CARBONAS  SACCHARATA.  Br.—^ 
PILULA  FERRI  CARBON ATIS.  Br.  —  Vallets  Ferruginous  Pills. 

The  protoxide  of  iron  has  so  powerful  an  affinity  for  oxygen,  that  it 
cannot  remain  an  instant  in  contact  with  air,  or  water  containing  air, 
without  undergoing  a  partial  change  into  sesquioxide;  and  a  brief  expo- 
sure is  sufficient  to  render  that  change  almost  complete.  The  same  prop- 
erty is  evinced  when  it  is  combined  with  acids,  and  especially  with  car- 
bonic acid.  Hence,  as  soon  as  the  carbonate  of  the  protoxide  is  precipitated 
from  a  solution  of  the  mixed  salts  out  of  which  it  is  formed,  it  begins  to 
absorb  oxygen,  and  give  out  carbonic  acid,  until,  as  explained  in  the 
foregoing  article,  it  is  almost  wholly  converted  into  sesquioxide. 

Now  it  is  believed  that  the  protoxide  and  its  compounds  find  a  readier 
entrance  into  the  system  than  the  sesquioxide  and  its  compounds ;  and 
the  fact  is  beyond  all  doubt  in  relation  to  the  carbonate,  which  expe- 
rience has  shown  to  be  much  more  efficient,  in  bringing  the  system 
under  the  influence  of  iron,  than  the  sesquioxide  resulting  from  its 
exposure. 

The  difficulty,  however,  was  to  preserve  the  carbonate  unchanged  till 
it  could  be  administered.  It  had  been  discovered  that  sugar  had  the 
singular  property  of  impeding,  if  not  preventing  the  oxidation  of  iron; 
and  the  idea  suggested  itself  to  a  German  physician  of  the  name  of 
Becker,  that  this  property  might  be  taken  advantage  of  for  medicinal 
purposes.  The  idea  was  carried  into  effect  by  Klauer,  a  German  chem- 
ist, who  prepared  a  carbonate  of  iron  so  protected  by  sugar  that  it  re- 
sisted the  tendency  to  sesquioxidation.  M.  Vallet,  of  Paris,  improved 
the  process ;  and  hence,  the  preparation  adopted  by  the  U.  S.  Pharma- 
copoeia, and  most  used  in  this  country,  goes  commonly  by  the  name  of 
ValleVs  ferruginous  pills. 

Preparation.  According  to  the  U.  S.  process,  sulphate  of  iron  and 
carbonate  of  soda  are  dissolved  in  separate  portions  of  sweetened  water; 
the  solutions  are  mixed  in  a  bottle  which  they  just  fill,  and  which  is  well 
stopped  to  exclude  the  air;  the  precipitate  of  carbonate  of  iron  thus 
formed  is  separated,  and  washed  with  sweetened  water;  and,  lastly, 
having  been  allowed  to  drain,  the  mass  is  instantly  mixed  with  honey 
VOL.  L— 29 


450  GENERAL    STIMULANTS.  [PART  II. 

and  sugar,  and  evaporated  to  a  consistence  fit.  for  the  formation  of 
pills. 

The  British  Pharmacopoeia  simply  mixes  the  two  salts  dissolved  in 
water,  and,  after  washing  the  precipitated  carbonate,  mixes  it  with  sugar, 
and  dries  at  a  heat  not  exceeding  212°.  The  preparation  thus  obtained 
is  denominated  Ferri  Carbonas  Saccharata  (Saccharated  Carbonate  of 
Iron),  and  is  converted  into  pill  by  rubbing  with  confection  of  red  roses. 

As  the  slightest  exposure  of  the  carbonate  is  attended  with  change,  it 
is  desirable  that  the  protecting  influence  of  the  saccharine  matter  should 
]>e  present  in  every  step  of  the  process;  and  that,  until  it  is  completed, 
there  shall  be  no  avoidable  exposure  to  the  air.  These  conditions  are 
fulfilled  in  the  U.  S.  process,  adopted  from  Vallet;  and  the  resulting 
preparation,  therefore,  is  the  unchanged  carbonate  of  the  protoxide 
simply  incorporated  with  sugar. 

In  the  British  formula,  oxidation  is  going  on  from  the  commencement 
of  the  process  to  the  moment  when  the  sugar  is  finally  added ;  and  con- 
sequently a  considerable  proportion  of  the  carbonate  is  changed  into 
sesquioxide.  It  is  obvious,  therefore,  that,  of  the  two  preparations,  that 
of  the  U.  S.  Pharmacopoeia  is  to  be  preferred. 

Properties.  The  U.  S.  preparation  is  a  soft  mass,  of  such  a  consistence 
as  to  be  readily  made  into  pills.  It  is  black,  of  a  sweet  and  strongly 
ferruginous  taste,  and  readily  and  wholly  soluble  in  muriatic  acid,  with 
brisk  effervescence.  The  British  preparation  is  a  grayish-green  powder, 
having  a  similar  taste,  and  in  like  manner  soluble  in  muriatic  acid. 
The  former  consists  exclusively  of  carbonate  of  protoxide  of  iron  with 
somewhat  more  than  half  its  weight  of  sugar ;  the  latter  has  the  same 
ingredients  with  an  uncertain  proportion  of  sesquioxide  of  iron. 

Medical  Uses.  This  preparation  is  little  used  for  obtaining  the  direct 
effects  of  the  chalybeates  upon  the  primse  vise,  for  which  it  is  not  adapted. 
But,  in  reference  to  its  effects  on  the  system,  it  is  one  of  the  best  cha- 
lybeates, probably  upon  the  whole  inferior  to  none;  being  at  th<-  same 
time  perfectly  mild  in  its  action  on  the  stomach,  which  it  very  seldom 
offends,  and  readily  and  wholly  soluble  in  the  gastric  liquids,  and  there- 
fore absorbable  into  the  circulation.  Abundant  experience  has  proved 
both  its  gentleness  and  efficiency.  I  have  been  in  the  constant  habit  of 
using  it,  and  have  always  calculated,  with  the  utmost  certainty,  upon  the 
desired  effects  from  it,  so  far  as  these  might  depend  on  the  impregnation 
of  the  system.  In  the  Pennsylvania  Hospital  there  is  a  constant  succession 
of  patients,  especially  in  the  autumn,  in  the  most  pitiable  state  of  anemic 
debility,  often  complicated  with  oedema  of  the  limbs,  to  whom  a  dose  of 
this  medicine  three  times  a  day,  with  a  little  quinia  and  nutritious  diet, 
in  the  course  of  from  two  to  four  weeks,  and  sometimes  even  a  shorter 
period,  restores  healthy  colour  and  strength.  Indeed,  whatever  can  be 
accomplished  by  any  one  of  the  chalybeates  towards  improving  the  blood 


CHAP.  I.]  MINERAL   TONICS. — COMPOUND    PILLS   OF   IRON.  451 

may  be  expected  from  this.  There  are  others  preferable  for  some  special 
purpose,  or  on  particular  occasions  from  their  solubility,  or  in  reference 
to  a  direct  action  on  the  mucous  membrane  of  the  primes  vise,  but  none, 
I  believe,  as  a  reconstructive  agent,  to  build  up  a  debilitated  system  by 
the  restoration  of  red  corpuscles  to  the  blood. 

The  dose  of  the  pilular  mass  is  from  throe  to  ten  grains  three  times  a 
(i;iv.  Five  grains  may  be  given  in  a  pill  without  inconvenience.  More 
than  fifteen  grains  would  be  liable  to  produce  irritation  of  the  stomach 
or  bowels.  Of  course,  if  continued  so  as  to  produce  plethora,  the  med- 
icine may  occasion  headache  and  other  unpleasant  symptoms. 

There  are  two  officinal  preparations  which  may  be  most  conveniently 
noticed  here,  because  the  aim  in  them,  so  far  as  their  chalybeate  ingre- 
dient is  concerned,  is  to  produce  the  carbonate  of  iron,  though,  from 
the  deficiency  of  sugar,  this  undergoes  a  somewhat  rapid  change  into 
sesquioxide.  The  preparations  referred  to  are  the  Mistura  Ferri  Com- 
poxita,  and  the  Pilulse  Ferri  Composites  of  the  U.  S.  Pharmacopoeia. 

1.  COMPOUND  MIXTURE  OP  IRON.  — MISTURA  FERRI  COM- 
POSITA.  U.  S.,  Br. 

This  is  prepared  from  sulphate  of  iron,  carbonate  of  potassa,  and 
myrrh,  with  spirit  of  lavender  and  a  little  sugar  to  flavour  it,  and  rose- 
water  as  the  vehicle.  When  freshly  prepared,  it  is  greenish,  and  may 
lie  kept  so  if  perfectly  excluded  from  the  air;  but  the  least  exposure 
changes  its  colour,  in  consequence  of  the  sesquioxidation  of  the  protoxide 
of  iron  of  the  carbonate,  which  results  from  the  mutual  reaction  of  the 
two  saline  ingredients.  A  large  addition  of  sugar  would  have  a  tendency 
to  prevent  this  change.  It  is  an  imitation  of  the  antihectic  myrrh  mix- 
ture of  Dr.  Griffith,  which  at  one  time  had  considerable  celebrity.  It 
combines  the  effects  of  myrrh  with  those  of  the  chalybeates,  and  may 
therefore  be  given  in  anemic  states  of  the  system,  with  amenorrhcea,  and 
chronic  catarrh ;  but  should  never  be  administered  in  inflammatory  con- 
ditions of  the  gastric  mucous  membrane.  I  have  seldom  found  much 
benefit  from  it  in  phthisis,  in  which  it  was  formerly  employed.  The  dose 
is  one  or  two  fluidounces  two  or  three  times  a  day. 

2.  COMPOUND  PILLS  OP  IRON.  — PILULE  FERRT  COMPOSITE 
U.S. 

These  pills  are  made  with  sulphate  of  iron,  carbonate  of  soda,  myrrh, 
and  syrup  sufficient  to  form  a  pilular  mass.  Carbonate  of  iron  results 
from  the  double  decomposition  of  the  two  salts,  but  by  time  and  exposure 
i.->  converted  into  the  sesquioxide.  The  pills  are  no  doubt  useful  as  a 
tonic  and  emmenagogue;  but,  since  the  introduction  into  use  of  the 
pills  of  carbonate  of  iron,  have  no  sufficient  end  to  answer.  Their  in- 
tended effects  would  be  better  obtained  by  combining  the  latter  prepa- 
ration with  myrrh,  in  such  proportions  as  might  seem  best  adapted  to 


452  GENERAL    STIMULANTS.  [PART  II. 

the  particular  occasion.    The  dose  is  from  two  to  six  pills,  equivalent  to 
about  six  and  eighteen  grains  of  the  muss. 

3.  NATURAL  CHALYBEATE  WATERS. 

These  belong  to  the  present  head,  as  they  generally  owe  their  virtues 
to  the  carbonate  of  iron  they  hold  in  solution.  Carbonate  of  iron  is  in- 
soluble in  water,  but  is  dissolved  by  water  impregnated  with  carbonic 
acid  gas.  Water  which  has  been  exposed  to  the  air  always  contains  a 
small  proportion  of  carbonic  acid,  sufficient  to  enable  it  to  dissolve  a 
portion  of  the  carbonate.  Hence  ordinary  spring  or  river  water,  remain- 
ing long  in  contact  with  ores  of  carbonate  of  iron,  would  be  more  or  less 
impregnated;  but  when  waters  highly  carbonated  are  similarly  exposed, 
they  become  of  course  much  more  strongly  chalybeate.  All  chalybeate 
waters,  when  exposed  freely  to  the  atmosphere,  gradually  part  with  their 
iron ;  the  protoxide  of  the  carbonate  being  converted  into  the  sesqui- 
oxide,  which,  being  insoluble,  and  incapable  of  uniting  with  carbonic 
acid,  is  deposited.  Hence  the  yellowish-brown  deposit  in  springs  of  this 
kind,  and  the  track  of  a  similar  colour,  which  marks  the  course  of  a 
chalybeate  streamlet  The  pure  chalybeate  waters  act  upon  the  system 
in  the  same  manner  as  the  officinal  carbonate,  and  probably,  from  the 
dissolved  state  of  the  salt,  with  still  greater  facility.  They  are  admirably 
adapted  to  produce  all  those  beneficial  changes  in  the  system  for  which 
the  chalybeates  are  generally  given ;  especially  when  drank  at  their 
native  sources  in  mineral  springs,  where  they  are  often  aided  by  the  in- 
vigorating influence  of  pure  air,  exercise,  and  agreeable  association. 
They  may,  however,  be  abused ;  and  it  is  necessary  to  be  cautious  in 
their  use  in  health,  and  not  to  continue  them  too  long  in  debility,  lest 
plethora  should  be  induced,  with  its  risk  of  hemorrhage  and  inflamma- 
tion, or  fever.  The  natural  chalybeate  waters  appear  to  be  occasion- 
ally diuretic,  and  are  thought  to  have  proved  useful  in  chronic  nephritic 
diseases. 

Artificial  chalybeate  water  may  be  made  by  dissolving  a  mixture  of 
sulphate  of  iron  and  bicarbonate  of  soda  in  carbonic  acid  water.  Ten 
grains  of  each  of  these  salts,  powdered  and  intimately  mixed,  and  then 
dissolved  in  a  tumbler  of  the  water,  will  afford  a  lively  drink,  containing 
four  grains  of  carbonate  of  iron,  with  a  little  sulphate  of  soda,  and  an 
excess  of  the  bicarbonate.  The  whole  quantity  may  be  taken  at  once, 
morning  and  evening. 

II.  SULPHATE  OF  IRON- — FERRI  SuLPf&s.  U.S.,Br. — 
Green  Vitriol. 

Preparation.  For  medical  purposes,  this  salt  should  be  prepared  by 
heating  together  dilute  sulphuric  acid  and  iron  wire.  The  iron  is  oxidized 
at  the  expense  of  the  water,  hydrogen  escaping  with  effervescence;  while 
the  acid  unites  with  the  oxide  to  form  the  sulphate  of  the  protoxide, 


CHAP.  I.]  MINERAL   TONICS. — SULPHATE    OF    IRON.  453 

which  remains  in  solution.  In  order  that  there  may  be  no  admixture 
of  the  sesquioxide,  which  it  is  desirable  to  avoid,  the  iron  should  be  in 
excess,  and,  after  the  resulting  solution  has  been  poured  off,  a  very  little 
sulphuric  acid  should  be  added ;  care  being  taken,  in  the  subsequent 
filtration,  evaporation,  and  crystallization,  to  exclude  atmospheric  air  as 
much  as  possible.  This  is  the  process  of  Bonsdorff,  which  has  been 
adopted  in  the  U.  S.  Pharmacopoeia,  and  affords  a  pure  sulphate  of  the 
protoxide. 

Composition.  Crystallized  sulphate  of  iron  consists  of  one  equivalent 
of  sulphuric  acid,  one  of  protoxide  of  iron,  and  seven  of  water. 

Properties.  Obtained  in  the  manner  above  described,  the  crystals  are 
of  a  fine  bluish-green  colour.  If  quite  green,  they  contain  a  considerable 
proportion  of  sesquioxide.  They  are  inodorous,  of  a  strongly  astringent, 
inky  or  ferruginous  taste,  very  soluble  in  water,  and  insoluble  in  alcohol. 
A  moderate  heat  drives  off  their  water  of  crystallization,  and  reduces 
them  to  the  state  of  a  whitish  powder.  By  an  intense  heat  they  are  de- 
composed, sulphurous  and  sulphuric  acids  being  given  off,  and  the  red 
srsquioxide  remaining'.  Prepared  by  the  method  of  Bonsdorff,  they  un- 
dergo little  change  upon  exposure,  on  account  of  a  minute  quantity  of  un- 
combined  sulphuric  acid  contained  in  them ;  but,  as  ordinarily  found  in  the 
shops,  they  effloresce  in  the  air,  and  at  the  same  time  absorb  oxygen,  with 
the  production  of  a  red  subsulphate  of  the  sesquioxide.  In  consequence  of 
this  change,  they  first  become  quite  green,  and  afterwards  more  or  less 
covered  with  a  whitish  or  reddish-brown  powder;  the  latter  colour  pre- 
dominating after  long  exposure.  Their  solution,  which  reddens  litmus, 
is  at  first  bluish-green,  but  afterwards  becomes  successively  green,  green- 
ish-brown, and  reddish,  through  the  absorption  of  oxygen,  and  the  grad- 
ual conversion  of  the  protoxide  into  sesquioxide ;  the  latter  being  partly 
deposited  in  the  state  of  an  insoluble  subsulphate  of  the  sesquioxide,  and 
partly  remaining  in  solution  as  the  neutral  sulphate  of  the  same  oxide. 
When  the  liquid  has  assumed  a  clear  red  colour,  this  change  may  be 
considered  as  complete,  and  no  protoxide  is  left.  The  solution,  however, 
may  be  kept  in  the  original  state,  by  means  of  iron  wire,  which  appro- 
priates the  oxygen  as  fast  as  absorbed ;  and  sugar  has  the  same  effect 
by  its  peculiar  influence  in  preventing  the  oxidation  of  iron.  The  sul- 
phate of  iron  of  the  shops  almost  invariably  contains  more  or  less  of  the 
sesquioxide. 

Incompalibles.  This  salt  is  decomposed  by  the  alkalies,  the  alkaline 
carbonates,  soaps,  lime-water,  the  soluble  salts  of  lime,  lead,  and  baryta, 
the  borate  and  phosphate  of  soda,  nitrate  of  silver,  the  soluble  sulphurets, 
and  ferrocyanide  of  potassium.  When  a  perfectly  pure  sulphate  of  the 
protoxide,  it  is  not  affected  by  tannic  acid,  or  the  vegetable  astringents; 
but,  as  kept  in  the  shops,  it  always  yields  a  black  or  bluish-black  pre- 
cipitate with  these  reagents,  in  consequence  of  the  sesquioxide  of  iron 


454  GENERAL    STIMULANTS.  [PART  II. 

contained  in  it.  But,  though  it  gives  precipitates  with  the  above  sub- 
stances, it  does  not  follow  that  they  are  all  medicinally  incompatible. 
On  the  contrary,  it  is  often  given  in  connection  with  an  alkaline  car- 
bonate, with  a  view  to  the  production  of  the  carbonate  of  the  protoxide, 
which  is  a  milder  salt,  and  may  be  more  advantageously  employed  when 
the  object  is  to  affect  the  general  system.  The  officinal  compound  mix- 
ture of  iron,  and  compound  pills  of  iron,  are  prepared  on  this  principle. 
(See  page  451.) 

Effects  on  the  System.  Sulphate  of  iron  is  locally  excitant  and  ac- 
tively astringent.  On  the  stomach,  in  moderate  doses,  it  operates  often 
very  kindly  as  a  tonic,  and  in  the  bowels  is  apt  to  produce  constipation 
by  its  astringency.  In  larger  quantities  it  becomes  irritant,  causing 
heat  and  uneasiness  in  the  stomach,  and,  in  excessive  doses,  nausea, 
vomiting,  and  diarrhoea,  with  griping  pains.  In  great  excess,  it  may 
even  prove  poisonous  by  inflaming  the  stomach  and  bowels.  Orfilu 
found  two  drachms  to  kill  a  dog;  and  Dr.  Christison  states  that  he  has 
met  with  a  case,  in  which  half  an  ounce  seemed  to  have  proved  fatal  in 
a  child.  (Christison's  Dispensatory.)  It  is  no  doubt  capable  of  bringing 
the  system  under  the  influence  of  iron;  but  it  is  probably  never  absorbed 
as  a  sulphate ;  undergoing  decomposition  in  the  stomach,  and  forming 
new  compounds  before  it  is  dissolved  by  the  gastric  juice.  In  the  mean 
time,  it  exercises  its  excitant  influence  upon  the  mucous  membrane  of 
the  stomach ;  and,  if  given  freely,  with  a  view  to  the  impregnation  of 
the  system,  it  endangers  unpleasant  symptoms  of  gastric  and  intestinal 
irritation. 

Therapeutic  Application.  From  the  above  considerations,  it  may  In- 
inferred  that  sulphate  of  iron  is  useful  as  a  tonic  in  dyspepsia,  and  as  a 
joint  tonic  and  astringent  in  relaxed  states  of  the  bowels  attended  with 
diarrhoea.  In  the  defective  appetite  and  feeble  digestion  of  convalescence, 
especially  when  accompanied  with  an  atonic  diarrhoea,  it  is  particularly 
indicated ;  and  it  may  be  used  with  hopes  of  benefit  in  passive  hemor- 
rhages from  the  stomach  or  bowels.  It  has  often,  moreover,  been  em- 
ployed, with  a  view  to  its  operation  through  the  circulation,  in  anemic 
affections,  ainenorrhoea,  passive  hemorrhages  generally,  colliquative 
sweats,  diabetes,  excessive  secretion  from  the  mucous  membrane  of  the 
urinary  passages,  leucorrhoea,  and  chronic  catarrh  with  exhausting  ex- 
pectoration ;  but,  for  reasons  stated  in  the  preceding  paragraph,  it  is  not 
so  well  adapted  for  the  chalybeate  impregnation  of  the  system  as  some 
of  the  milder  preparations,  and  has  been  nearly  superseded  by  them.  It 
has  also  been  used  in  intermittent  fevers,  and  for  the  destruction  of  the 
tape- worm ;  but  is  of  little  real  service  in  either  of  these  affections. 

Administration.  It  may  be  given  in  pill  or  solution.  If  in  the  former 
method,  it  should  first  be  deprived  of  its  water  of  crystallization ;  as,  if 
made  from  the  crystals,  the  pills  would  be  apt  to  crumble  from  the  efflo- 


CHAP.  I.]  MINERAL  TONICS. — SOLUTION  OF  SUBSULPHATE  OF  IRON.  455 

rescence  of  the  salt  In  this  state,  it  is  officinally  directed  under  the 
name  of  Dried  Sulphate  of  Iron  (FERRI  SULPHAS  EXSICCATA,  U.S., 
Br.).  In  solution,  the  salt  may  be  given  dissolved  in  sweetened  water, 
in  order  to  protect  it  from  oxidation,  or  in  carbonic  acid  water,  which  aids 
its  tonic  effect  in  dyspepsia.  The  dose  of  the  crystallized  sulphate  is 
from  one  to  five  grains,  of  the  dried  from  half  a  grain  to  three  grains.* 

The  British  Pharmacopoeia  has  a  preparation  denominated  Granu- 
lated Sulphate  of  Iron  (FERRI  SULPHAS  GRANULATA,  Br.),  which  dif- 
fers from  the  crystallized  simply  in  having  been  made  to  assume  the 
form  of  a  coarse  powder  by  agitation  during  crystallization.  It  is  said 
to  have  the  advantage  of  oxidizing  less  readily  by  exposure.  The  dose 
is  the  same. 

External  Use.  Sulphate  of  iron  has  been  considerably  used  as  a  top- 
ical remedy.  In  the  aggregate  solid  state,  in  powder,  or  in  strong  solu- 
tion, it  has  been  used  to  check  the  oozing  of  blood  from  hemorrhagic  or 
wounded  surfaces;  in  weaker  solution,  as  a  collyrium  in  ophthalmia,  and 
an  injection  in  gleet,  leucorrhcea,  and  prolapsus  ani ;  and,  in  the  same  form, 
as  a  wash  in  indolent  or  flabby  ulcers,  and  cutaneous  eruptions,  espe- 
cially in  the  lichenous  or  herpetic  ring-worm  of  the  face.  The  strength 
of  the  solution  may  vary,  according  to  the  purposes  for  which  it  is  used, 
from  one  to  twenty  grains  to  the  fluidounce  of  water;  the  feeblest  pro- 
portion being  used  in  ophthalmia,  the  strongest  to  arrest  hemorrhage,  or 
with  a  view  to  a  powerful  alterative  influence  on  limited  surfaces,  as 
those  of  diseased  ulcers,  and  patches  of  chronic  cutaneous  eruptions. 
Velpeau  has  found  ft  the  most  efficacious  local  remedy  that  he  has  used 
in  erysipelas,  stating  that  it  never  fails  to  cut  short  the  inflammation  in 
one  or  two  days.  He  uses  a  lotion  consisting  of  about  half  an  ounce  of 
the  salt  dissolved  in  a  pint  of  water,  which  is  aplied  b}-  compresses,  fre- 
quently wetted  so  as  to  keep  the  skin  constantly  moist.  (Lond.  Med. 
Times  and  Gaz.,  March,  1855,  p.  239.) 

Sulphate  of  iron  is  one  of  the  salts  which  has  been  applied  to  the  in- 
terior of  the  larynx  and  the  bronchial  tubes,  in  the  form  of  spray,  by 
means  of  the  atomizer.  (See  page  16.)  It  may  be  used  in  ulceration  and 
chronic  inflammation ;  and  the  solution  may  be  employed  of  a  strength 
varying  from  one  to  ten  grains  to  the  fluidounce  of  water. 

1.  SOLUTION  OP  SUBSULPHATE  OP  IRON.  — LIQUOR  FERRI 
SUBSULPHATIS.  U.  S.  —  Astringent  Solution  of  Sulphate  of  Iron.  — 
MonseVs  Solution. 

This  preparation  of  iron  was  brought  into  notice,  a  few  years  since,  as 

*  In  a  communication  to  the  London  Medical  Times  and  Gazette  (xiii.  64),  it  is  stated 
by  the  writer  that  he  had  found  the  use  of  rhubarb,  conjointly  with  the  sulphate  of 
iron,  to  prevent  the  blackening  of  the  stools  occasioned  by  the  latter  medicine,  as 
by  other  chalybeates,  when  used  alone,  or  in  other  form  of  combination.  (Note  to 
the  second  edition. ) 


456  GENERAL    STIMULANTS.  [PART  II. 

a  powerful  styptic,  by  M.  Monsel,  surgeon  to  the  military  hospital  at 
Bordeaux;  and  was  introduced  into  the  U.  S.  Pharmacopoeia  at  the  late 
revision.  It  is  prepared  by  boiling  powdered  sulphate  of  iron  in  a 
mixture  of  dilute  sulphuric  and  nitric  acids  until  red  vapours  cease  to 
escape,  and  the  liquid  becomes  of  a  deep  ruby  colour.  The  object  of 
the  nitric  acid  is  to  sesquioxidize  the  protoxide  of  the  sulphate,  and  of 
the  sulphuric  acid  to  meet  the  demand  of  the  sesquioxide  produced  for  a 
greater  amount  of  acid  to  saturate  it;  but,  as  the  quantity  of  sulphuric 
acid  is  not  sufficient  to  neutralize  the  whole  of  the  sesquioxide  produced, 
the  result  is  necessarily  a  subsalt  of  the  sesquioxide ;  and  this,  there- 
fore, is  correctly  designated  in  the  Pharmacopoeia  as  subsulphate. 

The  solution  is  inodorous,  of  a  deep  reddish-brown  colour,  and  of  an 
extremely  styptic  taste,  without  causticity.  Its  sp.gr.  is  1.552.  When 
evaporated  to  dryness,  it  yields  a  reddish  salt,  which  is  soluble  in  water 
and  alcohol  without  decomposition.  It  is  thought  to  contain  2  eqs.  of 
srsijuioxide  of  iron  and  5  eqs  of  sulphuric  acid  (2  Fe2O3,  5  S03),  and  is 
probably  a  double  salt,  consisting  of  one  eq.  of  tersulphate  of  sesquiox- 
ide of  iron  (Fe203,  3  SO3)  and  one  of  bisulphate  of  the  sesquioxide 
(Fe203,  2  S08). 

The  property  to  which  it  owes  its  therapeutic  value  is  that  of  pro- 
ducing a  speedy  and  firm  coagulation  of  the  blood,  whereby  it  is  enabled 
to  arrest  hemorrhage  more  quickly  and  effectually  than  most  other  styp- 
tics; while  it  is  less  irritant  than  the  other  medicinal  sulphates.  It  is 
used  to  suppress  bleeding  from  wounds,  also  spontaneous  hemorrhage 
from  the  mouth,  nostrils,  and  fauces,  and  from  the  uterus,  whether  active 
or  passive.  It  is  said  to  have  proved  peculiarly  efficacious  in  chancre. 

The  solution  has  also  been  used  internally,  and,  in  consequence  of  its 
exceeding  astringericy,  with  little  relative  irritating  power,  would  seem 
to  be  peculiarly  applicable  to  hemorrhage  from  the  stomach  and  rectum  ; 
being  swallowed  in  the  former  case,  and  administered  by  enema  in  the 
latter.  It  may  be  given  in  the  dose  of  from  three  to  ten  drops. 

2.  SOLUTION  OF  TERSULPHATE  OP  laON.  —  LIQUOR 
FERRI  TERSULPHAtis.  U.  S.  —  Solution  of  Persulphate  of  Iron.  Er. 
Appendix. 

This  solution  was  introduced  into  the  Pharmacopoeias  chiefly  as  a 
step  in  the  preparation  of  various  important  clmlybeates,  and  is  there- 
fore less  immedfately  interesting  to  the  practitioner  of  medicine  than  to 
the  pharmaceutist.  Containing  the  sesquioxide  of  iron,  and  yielding  it  in 
a  state  peculiarly  suitable  for  combination  with  acids,  it  is  used  very  con- 
veniently in  the  formation  of  other  salts  having  the  sesquioxide  for  their 
base.  It  is  sufficient  to  say  of  it,  that  it  is  prepared  by  boiling  sulphate 
of  iron  with  a  mixture  of  dilute  sulphuric  and  nitric  acids,  in  such  pro- 
portions that  the  protoxide  of  iron  shall  be  completely  sesquioxidi/nl, 
and  the  resulting  sesquioxide  neutralized  by  the  sulphuric  acid;  that 


CHAP.  I.]  MINERAL  TONICS. SOLUTION  OF  NITRATE  OF  IRON.  457 

the  solution  thus  obtained  is  a  clear  reddish-brown  liquid,  inodorous, 
sourish  and  extremely  astringent  to  the  taste,  and,  according  to  the  U. 
S.  Pharmacopoeia,  is  of  the  sp.  gr.  1.320;  and  that  it  is  readily  precipi- 
tated by  solution  of  ammonia,  yielding  a  hydrated  sesquioxide  of  iron, 
which  is  highly  interesting  to  the  physician,  as  the  only  reliable  anti- 
dote to  arsenic.  As  the  antidotal  efficacy  of  this  hydrated  sesquioxide 
of  iron  is  proportionate  to  its  freshness,  it  is  important  that  a  portion  of 
the  solution  should  always  be  kept  on  hand,  ready  for  the  preparation 
of  the  antidote  at  the  moment  it  may  be  wanted. 

3.  SULPHATE  OF  IRON  AND  AMMONIA.  —  FERRI  ET  AMMO- 
NIA SULPHAS.  U.S.  —  Ammonio-ferric  Alum. 

This  is  a  new  officinal  of  the  TJ.  S.  Pharmacopoeia,  introduced  as  a 
substitute  for  ammonia  alum,  which  it  resembles  in  composition ;  the 
sesquioxide  of  iron  being  substituted  for  alumina.  Hence  it  has  been 
called  ammonia-ferric  alum.  It  is  prepared  by  dissolving  a  due  pro- 
portion of  sulphate  of  ammonia  in  boiling-hot  solution  of  tersulphate  of 
iron,  with  insufficient  water  to  hold,  when  the  solution  cools,  the  salt 
formed  by  their  combination.  It  consists  of  1  eq.  of  tersulphate  of  ses- 
quioxide of  iron,  1  of  sulphate  of  ammonia,  and  probably  24  eqs.  of  water 
(Fes03,  3  SC^+NH^SC^-f  24  110). 

\\  may  be  given  in  the  same  complaints  in  which  alum  is  employed, 
and  has  been  especially  recommended  internally  in  leucorrhoea,  diar- 
rhoea, chronic  dysentery,  and  other  complaints  requiring  the  joint  use  of 
astringent,  tonic,  and  chalybeate  remedies.  The  dose  is  from  three  tp 
fifteen  grains  twice  or  three  times  daily. 

III.  SOLUTION  OF  NITRATE  OF  IRON.  — LlQUOR  FERRI 
NITRATIS.  U.S.  —  LIQUOR  FERRI  PERNITRATIS.  Br. 

Preparation.  This  preparation,  first  made  known  as  a  remedy  by  Mr. 
William  Kerr,  of  Scotland,  in  1832,  has  been  adopted  as  officinal  in  the 
U.  S.  and  Br.  Pharmacopoeias.  As  made  by  the  process  of  Mr.  Kerr, 
and  according  to  former  officinal  directions,  by  simply  dissolving  iron 
wire  in  nitric  acid,  with  the  addition  of  water  to  give  it  a  certain  strength, 
it  was  a  solution  of  the  mixed  nitrates  of  the  protoxide  and  sesquioxide 
of  iron,  and  consequently,  on  exposure  to  the  air,  was  apt  to  become 
turbid  by  the  further  oxidation  of  the  protoxide,  and  the  deposition  of  a 
subnitrate  of  the  sesquioxide.  Mr.  Kerr  obviated  this  effect  by  adding  to 
the  solution  a  little  muriatic  acid,  which  dissolves  the  sesquioxide  as  fast 
as  formed.  By  the  present  formula  of  the  U.  S.  Pharmacopoeia,  which  was 
framed  according  to  suggestions  of  Prof.  Procter,  it  is  believed  that  the 
difficulty  at  first  experienced  has  been  obviated,  and  a  solution  obtained 
of  the  nitrate  of  the  sesquioxide  of  iron  without  any  protoxide  what- 
ever. (See  U.  S.  Dispensatory,  12th  ed.,  p.  1199.) 

Properties.  The  solution,  as  made  by  the  former  process,  is  of  a  dark 


458  GENERAL   STIMULANTS.  [PART  II. 

colour,  and  apt  to  become  turbid  ;  by  the  improved  method,  is  of  a  pale- 
amber  colour  and  permanent.  The  taste  is  ferruginous,  acid,  and  very 
astringent,  but  not  corrosive.  All  substances  are  incompatible  with  it 
which  form  insoluble  compounds  with  sesquioxide  of  iron,  and  soluble 
compounds  with  nitric  acid;  consequently,  ferrocyanide  of  potassium, 
phosphate  of  soda,  and  the  alkaline  sulphurets ;  and  with  all  the  vege- 
table astringents  it  affords  copious  black  precipitates.  The  alkalies  and 
alkaline  earths  precipitate  the  base. 

Medical  Use.  This  preparation  operates  like  the  soluble  salts  of  iron 
in  general ;  that  is,  locally  as  an  astringent,  and  either  a  moderate  exci- 
tant or  irritant,  according  to  the  dose,  or  the  strength  of  the  solution 
employed ;  and  upon  the  system  at  large,  as  a  tonic  and  reconstructive 
agent;  though,  in  these  latter  respects,  much  inferior  to  the  protosalts  of 
iron,  or  the  metal  itself  in  impalpable  powder.  It  would  no  doubt  prove 
useful  in  debilitated  states  of  the  stomach  and  bowels,  in  the  absence  of 
inflammation ;  and  will  occasionally  cure  diarrhoeas  connected  with  this 
condition  of  the  alimentary  canal.  It  was  as  a  remedy  in  diarrhoea  that 
it  was  introduced  into  practice;  and  much  testimony  has  been  adduced 
in  its  favour.  From  the  trials  I  have  made  with  it,  I  do  not  consider  it 
superior  to  the  other  soluble  chalybeates  for  this  purpose,  especially  the 
sulphate,  when  care  is  taken  not  to  administer  that  remedy  in  an  over- 
dose. From  the  experiments  of  Quevenne,  it  may  be  inferred  that  it 
must  be  decomposed  and  undergo  precipitation  in  the  stomach,  like  the 
other  soluble  salts  of  iron,  and  consequently  does  not  reacli  the  seat  of 
its  operation  in  the  small  intestines,  in  the  state  of  nitrate.  The  very 
blackening  of  the  stools  is  alone  evidence  of  decomposition.  The  dose 
is  from  five  to  thirty  drops,  from  two  to  four  times  a  day,  which  may  IK: 
gradually  increased,  if  necessary,  while  borne  without  inconvenience. 
In  an  over  dose  it  will  irritate  and  inflame,  if  not  corrode  the  stomach 
and  bowels.  It  should  be  borne  in  mind  that  the  British  preparation  is 
about  twice  as  strong  as  that  of  our  Pharmacopoeia ;  and  should  not  be 
given  in  more  than  half  the  dose. 

The  solution  has  been  locally  used  as  an  injection  in  leucorrhoea,  di- 
luted so  as  to  produce  only  a  slight  smarting  sensation ;  but  it  is  prob- 
ably inferior,  in  this  and  other  mucous  discharges,  to  the  sulphate  of 
iron,  as  being  less  astringent. 

IV.  PHOSPHATE  OF  IRON.—FERRI  PHOSPHAS.    V.  S.,  Br. 

Phosphate  of  iron  is  prepared,  according  to  the  directions  of  our  offici- 
nal code,  by  mixing  solutions  of  sulphate  of  iron  and  phosphate  of  soda. 
A  double  decomposition  takes  place,  resulting  in  the  formation  of  sul- 
phate of  soda,  which  remains  in  solution,  and  phosphate  of  iron,  which 
is  precipitated.  This  is  then  washed  and  dried.  If  the  salt  of  iron 
employed  be  a  pure  sulphate  of  the  protoxide,  the  resulting  phosphate 


CHAP.  I.]  MINERAL   TONICS. — PHOSPHATE    OF   IRON.  459 

will  contain  the  iron  in  the  same  condition,  and  will  be  white  when 
thrown  down;  but  this  almost  never  happens;  and  if  it  do,  oxygen  will 
be  quickly  absorbed,  and  the  salt  assume  its  characteristic  colour. 

Composition.  As  employed,  this  salt  always  consists  of  a  mixture  of 
the  phosphates  of  the  protoxide  and  sesquioxide  of  iron,  which  are  in 
variable  proportion.  As  the  phosphoric  acid  is  tribasic,  the  composition 
of  the  protosalt,  which  greatly  predominates,  is  two  equivalents  of  pro- 
toxide of  iron,  one  of  water,  and  one  of  the  acid;  that  of  the  sesquisalt, 
probably  one  equivalent  of  sesquioxide,  and  one  of  acid. 

Properties.  Phosphate  of  iron  is  a  bluish- white  powder,  nearly  taste- 
less, insoluble  in  water,  but  soluble  in  the  acids. 

Medical  Use.  Its  operation  is  that  of  the  insoluble  chalybeates  gen- 
erally; that  is,  it  produces  the  usual  effects  of  the  chalybeates  on  the 
system,  without  much  affecting  the  mucous  surface  of  the  stomach.  It 
was  brought  prominently  before  the  notice  of  the  profession  by  Mr. 
Carmichael,  of  Dublin,  in  his  work  on  cancer,  published  in  1809,  as  a 
remedy  in  that  disease,  in  which  he  employed  it  both  internally,  and  as 
an  application  to  the  ulcerated  surface.  In  a  treatise  on  diabetes,  pub- 
lished in  1825,  Dr.  Venables  speaks  highly  of  its  usefulness  in  that  dis- 
ease ;  and  Dr.  Prout  confirms  his  favourable  estimate,  stating  that  he 
regards  it  as  an  excellent  remedy.  (Stom.  and  Sen.  Dis.,  Lond.  1848, 
p.  50.)  The  late  Dr.  Thos.  T.  Hewson,  of  Philadelphia,  was  in  the 
habit  of  using  it  for  the  general  purposes  of  the  ferruginous  prepa- 
rations; and,  at  his  recommendation,  it  was  introduced  into  the  Pharma- 
copeia of  the  United  States.  It  is  no  doubt  a  good  chalybeate,  capable 
of  doing  what  can  be  accomplished  by  iron  in  the  improvement  of  the 
blood,  and  of  the  general  health,  and  is  thus  far  useful  in  cancer  and 
diabetes ;  but  it  has  no  special  power  over  these  formidable  diseases,  and 
is  altogether  inadequate  to  their  cure.  It  is  probably  in  no  degree  supe- 
rior to  the  pill  of  carbonate  of  iron,  if  equal  to  that  excellent  prepa- 
ration. The  dose  is  from  five  to  ten  grains,  which  may  be  given  in  the 
form  of  powder,  pill,  or  electuary.  Locally,  it  may  be  applied  to  can- 
cerous ulcers,  either  by  being  dusted  over  them,  or  in  the  form  of  a  lotion 
suspended  in  water,  or  mixed  with  water  or  glycerin  to  the  consistence 
of  a  thin  paste,  and  spread  over  the  surface. 

Other  combinations  of  phosphoric  acid  and  oxidized  iron  have  been 
recommended;  but  there  is  probably  no  one  which  surpasses  the  officinal 
phosphate,  either  in  mildness  or  efficiency. 

1.  PYBOPHOSPHATE  OF  IRON.  —  FERRI  PYROPHOSPHAS.  U.S. 

Under  this  name,  a  preparation  of  iron  has  been  introduced  into  the 
present  edition  of  U.  S.  Pharmacopoeia,  consisting  of  sesquiphosphate  of 
sesquioxide  of  iron,  which  is  insoluble  in  water,  and  citrate  of  ammonia, 
by  means  of  which  it  is  rendered  soluble.  It  is  denominated  pyrophos- 
phate  in  the  Pharmacopoeia,  because  the  acid  contained  in  it  is  the  form 


•  GENERAL   STIMULANTS.  [PART  II. 

of  phosphoric  acid,  disposed  to  unite  with  two  eqs.  of  base,  and  called 
pyrophosphoric,  because  produced  by  the  action  of  heat  on  the  tri- 
basic  acid.  (See  U.  S.  Dispensatory.)  The  salt  is  in  scales  of  a  green- 
ish colour,  and  an  acidulous  somewhat  saline  taste,  and  is  wholly  soluble 
in  water.  It  is  a  mild  chalybeate,  not  disagreeable  to  the  taste,  and 
probably  capable  of  being  used  for  the  same  systemic  effects  as  the  other 
ferruginous  preparations,  while  it  has  the  advantage  over  several  of  them 
that,  from  its  solubility,  it  may  be  administered  in  any  desirable  form, 
whether  in  pills,  watery  solution,  or  syrup.  The  dose  is  from  two  to 
five  grains. 

2.  SYRUP  OP  PHOSPHATE  OP  IRON.  —  SYRUPUS  FERRT  PHOS- 
PHATIS.  Br. 

Several  syrups  of  phosphate  of  iron  have  been  proposed.  The  British 
syrup  contains  the  phosphate  of  iron  of  the  Pharmacopoeia,  dissolved  by 
means  of  phosphoric  acid,  and  duly  incorporated  with  sugar. 

Another  syrup  proposed  by  Soubeiran  contains  the  pyrophodphatfe  of 
iron.  A  formula  for  it  is  contained  in  the  U.  S.  Dispensatory  (12th  ed., 
p.  1144).  A  preparation  essentially  like  it  may  be  made  by  dissolving 
the  pyrophosphate  of  iron  of  the  U.  S.  Pharmacopoeia  in  a  little  water, 
and  mixing  the  solution  with  syrup. 

A  compound  syrup  of  phosphate  of  iron,  called  chemical  food,  from 
the  circumstance  that  it  contains  many  of  the  mineral  constituents  of  the 
system,  which  may  be  supposed  to  contribute  in  this  form  to  its  nourish- 
ment and  support,  has  been  much  used  in  general  practice,  without 
having  yet  obtained  officinal  sanction.  A  formula  for  its  preparation  will 
be  found  in  the  U.  S.  Dispensatory  (12th  ed.,  p.  1143).  It  is  very  doubtful 
whether  any  material  advantage  can  be  obtained  from  it  which  may  not 
be  obtained  from  the  simple  syrup,  with  such  additions  as  the  wants  of 
the  system  may  at  any  time  require ;  while  many  of  its  ingredients  must 
generally  be  quite  superfluous,  as  the  system  seldom  needs  the  whole. 

The  dose  of  the  British  syrup  is  one  or  two  fluidrachms,  each  contain- 
ing 3.5  grains  of  phosphate  of  iron.  By  dissolving  half  a  drachm  of  the 
U.  S.  pyrophosphate  in  a  fluidounce  of  syrup,  an  equivalent  preparation 
may  be  made,  of  which  a  fluidrachm  would  be  a  medium  dose. 

V.  TARTRATE  OF  IRON  AND  POTASSA.  —  FfiRRI  ET  Po- 
TASS.E  TARTRAS.  U.  S.  —  FERRUM  TARTARATUM.  Br.  — 
Tartarated  Iron.  Syn.  Ferri  Potassio-tartras.  Ftrrum  Tar- 
f'ln'zatum. 

This  is  among  the  most  valuable  of  the  chalybeates.  It  is  prepared, 
according  to  the  method  of  Soubeiran,  which  has  been  adopted  in  the 
U.  S.  and  Br.  Pharmacopoeias,  by  adding  irradually  to  a  heated  mixture 
of  bitartrate  of  potassa  and  water,  the  recently  precipitated  hydrated 
sesquioxide  of  iron  (see  page  443),  constantly  stirring,  until  the  latter 


CHAP.  I.]     MINERAL  TOXICS. — TARTRATE  OF  IRON  AND  POTASSA.     461 

ceases  to  be  dissolved ;  then  filtering,  evaporating1  to  the  consistence  of 
syrup,  and  drying  in  thin  layers. 

Composition.  It  is  probable  that,  in  the  above  process,  half  of  the  tar- 
taric  acid  leaves  the  bitartrate  of  potassa,  and  combines  with  the  ses- 
quioxide.  According  to  Soubeiran  and  Capitaine,  the  salt  contains 
30.49  per  cent,  of  the  sesquioxide.  It  may  be  supposed  to  consist  of 
one  equivalent  of  tartrate  of  potassa,  and  one  of  basic  tartrate  of  ses- 
quioxide of  iron  (one  eq.  of  acid  and  one  of  base  F203),  chemically  com- 
bined ;  the  latter  ingredient  probably  acting  the  part  of  an  acid  in  the 
compound.  Buf  other  vic\vs  have  been  taken  of  its  chemical  nature; 
and  its  insensibility  to  certain  reagents  which  ordinarily  act  strongly  on 
iron  in  its  soluble  forms,  would  seem  to  show  that  its  metallic  constituent 
is  in  a  peculiar  state  of  combination. 

Properties.  As  above  prepared,  the  salt  is  in  translucent  scales,  of  a 
ruby-red  colour,  and  permanent  in  the  air;  but,  as  formerly  made,  and 
still  frequently  found  in  the  shops,  it  is  in  the  state  of  a  dark-greenish  or 
olive-coloured  powder,  slightly  deliquescent  on  exposure.  The  prepa- 
ration is  inodorous,  of  a  mild,  sweetish,  slightly  chalybeate,  and  not  dis- 
agreeable taste,  freely  and  wholly  soluble  in  water,  slightly  so  in  alcohol, 
and  considerably  in  diluted  alcohol  or  wine.  Its  watery  solution  is  not 
rendered  blue  by  ferrocyanide  of  potassium,  nor  precipitated  by  the 
alkalies  at  ordinary  temperatures,  nor  sensibly  affected  by  the  ordinary 
acids.  Astringent  vegetable  infusions,  however,  affect  it  in  the  same 
manner  as  other  ferruginous  solutions. 

Medical  Use.  In  one  or  another  form,  this  chalybeate  has  long  been 
in  use ;  but  is  not  at  present,  I  think,  employed  as  much  as  it  deserves 
to  be.  With  little  disposition,  notwithstanding  its  solubility,  to  irritate 
the  stomach,  and  almost  destitute  of  astringency,  it  is  yet  capable  of 
readily  imparting  its  iron  to  the  s}rstem,  and  produces  all  those  effects 
upon  the  blood  and  the  tissues  which  characterize  the  ferruginous  pre- 
parations. Without,  therefore,  being  a  very  efficient  remedy  in  dys- 
pepsia, diarrhoea,  or  hemorrhages  from  the  primae  viae,  in  which  it  is 
inferior  to  other  soluble  salts,  it  may  be  employed  with  advantage  when- 
ever the  object  is  to  improve  the  blood,  or  produce  a  tonic  impression 
directly  on  the  system.  With  a  view  to  these  results,  and  without  refer- 
ence to  a  specific  or  peculiar  influence  of  any  kind,  I  should  prefer  it  to 
all  other  soluble  chalybeates.  It  may  require  to  be  exhibited  in  a  larger 
dose  than  they ;  but,  even  in  equivalent  quantities,  in  relation  to  the  iron 
it  gives  to  the  blood,  it  is  less  irritant  to  the  stomach.  Another  advant- 
age is  its  less  tendency  to  constipate.  Its  want  of  unpleasant  taste,  as 
well  as  its  general  mildness,  admirably  adapt  it  to  the  cases  of  young 
children ;  and  it  is  wonderful  how  soon  it  will  restore  a  healthy  colour 
to  their  cheeks,  in  the  lowest  states  of  anaemia,  when  purely  functional. 
The  dose  for  an  adult  is  from  ten  to  thirty  grains,  three  or  four  times  a 


462  GENERAL   STIMULANTS.  [PART  II. 

day,  to  be  given  in  solution.    Three  or  four  grains  of  it  may  be  given  to 
a  child  from  two  to  four  years  old. 

Wine  of  Iron  (ViNUM  FERRT,  Br.\  which  is  a  vinous  solution  of  this 
salt,  has  been  long  in  use  as  a  chalybeate.  The  British  Pharmacopoeia 
prepares  it  by  simply  dissolving  the  tartrate  of  iron  and  potassa  in  sherry 
wine.  Formerly  the  London  College  directed  it  to  be  made  by  digesting 
iron  wire  in  sherry  wine  for  a  month.  The  iron  was  oxidized  at  the  ex- 
pense of  the  air  or  water,  and  then  combined  with  the  excess  of  tartaric 
acid  of  the  bitartrate  of  potassa  always  present  in  wine,  forming  a  salt 
which  was  probably  essentially  the  same,  so  far  at  least  as  medical  effect 
is  concerned,  with  the  one  above  described.  The  present  plan,  there- 
fore, while  yielding  an  equally  efficient  preparation,  is  preferable  in  point 
of  precision  ;  as,  by  the  old  method,  the  strength  of  the  preparation 
depended  on  the  character  of  the  wine.  The  preparation  is  a  weak 
chalybeate,  adapted  to  cases  requiring  the  use  of  iron,  and  in  which  the 
patient  has  been  in  the  habit  of  using  wine  regularly.  It  has  the  ad- 
vantage over  an  aqueous  solution,  of  not  being  liable  to  the  spontaneous 
decomposition  of  the  organic  acid.  The  dose  is  from  half  a  fluidounce 
to  two  fluidounces,  two  or  three  times  a  day. 

VI.  TARTRATE  OF  IRON  AND  AMMONIA.  —  FERRI  ET 
AMMONLE  TARTRAS.  U.S. 

Preparation.  This  is  made,  according  to  the  process  of  Professor 
Procter,  by  dissolving  freshly  prepared  hydrated  sesquioxide  of  iron  in 
a  solution  of  bitartrate  of  ammonia,  then  evaporating  by  means  of  a 
water-bath,  and  drying  in  thin  layers,  as  in  the  instance  of  the  last-men- 
tioned salt.  The  equivalent  in  excess  of  tartaric  acid  in  the  bitartrate 
unites  with  an  equivalent  of  the  sesquioxide  of  iron,  and  a  double  salt  is 
formed,  consisting  probably  of  one  equivalent  of  basic  tartrate  of  the 
sesquioxide  of  iron  acting  as  the  acid,  and  one  of  tartrate  of  ammonia 
acting  as  the  base,  united,  according  to  Prof.  Procter,  with  four  equiva- 
lents of  water.  Or,  if  tartaric  acid  be  considered  as  bibasic,  with  a 
doubled  equivalent,  the  new  salt  may  be  considered  as  composed  of  one 
eq.  of  tartaric  acid  and  one  of  each  of  the  bases,  and  to  be,  what  its 
name  imports,  a  tartrate  of  iron  and  ammonia.  When  incinerated,  the 
salt  leaves  29  per  cent,  of  sesquioxide  of  iron. 

Properties.  It  is  in  brilliant,  dark-brown,  almost  blackish  scales,  or 
small,  irregular,  angular  fragments,  like  those  of  the  East  India  kino ; 
but,  by  transmitted  light,  it  exhibits  a  garnet  redness.  The  taste  is 
sweetish,  moderately  ferruginous,  very  slightly  styptic,  and  not  disagree- 
able. The  salt  is  very  soluble  in  water.  In  its  reagencies  it  resembles 
tartrate  of  iron  and  potassa,  with  which  also  it  is  closely  analogous  in 
composition,  ammonia  taking  the  place  of  potassa. 

Medical  Uses.  In  medical  properties,  as  well  as  in  chemical  nature, 


CHAP.  I.]  MINERAL   TONICS. — CITRATE    OF    IRON.  463 

tin's  salt  bears  a  close  resemblance  to  the  preceding;  and  all  that  has 
been  said  in  relation  to  the  tartrate  of  iron  and  potassa,  of  its  want  of 
unpleasant  taste,  general  mildness,  efficiency  as  a  chalybeate  in  its  oper- 
ation upon  the  system  at  large,  and  inapplicability  to  the  treatment  of 
stomachic  and  intestinal  affections,  belongs  equally  to  this  salt.  It  may 
be  used  in  any  case  in  which  it  is  desirable  to  impregnate  the  system 
with  iron,  and  in  which  a  soluble  preparation  is  wanted.  Another  ad- 
vantage of  both  these  salts  is  that  they  may  be  given  with  the  alkaline 
carbonates,  and  generally  with  other  saline  medicines,  without  undergo- 
ing decomposition.  The  dose  is  from  five  to  thirty  grains,  three  times  a 
day.  The  first  quantity  mentioned  is  sufficient  to  begin  with,  unless  in 
urgent  cases. 

VII.   CITRATE  OF  IRON.  —  FERRI  ClTRAS.   U.S. 

The  U.  S.  Pharmacopoeia  directs  this  salt  to  be  made  by  evaporating 
the  officinal  Solution  of  Citrate  of  Iron  (LIQUOR  FERRI  CITRATIS,  U.  S.) 
to  the  consistence  of -syrup,  and  then  spreading  it  on  plates  of  glass  to 
dry.  The  solution  is  prepared  by  gradually  adding  to  a  heated  solution 
of  citric  acid,  freshly  precipitated  hydrated  sesquioxide  of  iron  (see  page 
443)  until  it  ceases  to  be  dissolved,  and  the  acid  is  saturated.  A  direct 
union  takes  place  between  the  acid  and  oxide,  resulting  in  the  formation 
of  a  salt  consisting  of  one  equivalent  of  citric  acid,  and  one  of  sesquiox- 
ide of  iron. 

Citrate  of  iron  is  an  uncrystallizable  salt,  and,  as  above  prepared,  is  in 
translucent  laminae  of  a  fine  garnet-red  colour,  of  a  mild  ferruginous 
taste,  slowly  soluble  in  cold,  but  readily  in  boiling  water. 

It  is  a  mild  chalybeate,  and  may  be  employed  to  obtain  the  gen- 
eral effects  of  iron  on  the  system,  either  in  pill  or  solution,  in  doses  of 
from  three  to  ten  'grains,  three  times  a  day.»  It  has  been  considerably 
used  in  this  country. 

The  officinal  solution  is  a  convenient  form  for  administration,  and  may 
be  given  in  the  medium  dose  of  ten  minims,  equivalent  to  five  grains  of 
th»>  salt. 

CITRATES  OF  THE  PROTOXIDE  and  of  the  BLA^  or  MAGNETIC  OXIDE 
OF  IRON  have  been  prepared,  but  have  no  special  advantage  to  recom- 
mend them. 

CITRATE  OF  IRON  AND  QUINIA  (Ferri  et  Quiniae  Citras,  U.  S.)  is  the 
name  given  to  a  preparation  made  by  heating  together  recently  precipi- 
tated quinia  and  officinal  solution  of  citrate  of  iron,  until  a  solution  is 
effected,  then  evaporating,  and  drying  upon  glass  plates.  It  is  in  thin, 
garnet-red  scales,  of  a  bitter,  slightly  chalybeate  taste,  and  soluble  in 
water.  It  is  a  double  citrate  of  iron  and  quinia;  but,  as  usually  found 
in  the  shops,  contains  a  large  excess  of  the  salt  of  iron.  It  may  be  used 
us  a  tonic,  and  wou'd  be  especially  adapted  to  that  anemic  condition  of 


464  GENERAL    STIMULANTS.  [PART  II. 

system  which  so  frequently  follows  our  autumnal  fevers;  but  I  can  see 
no  advantage  it  possesses  over  a  mixture  of  the  citrate  of  iron  with  sul- 
phate of  quinia,  while  it  has  this  disadvantage,  that  the  relative  quantity 
of  the  two  salts  cannot  be  adjusted  to  the  particular  indications  of  the 
case.  The  dose  is  about  five  grains. 

VIII.  CITRATE  OF  IRON  AND  AMMONIA.  —  FERRI  ET 
AMMONIA  CITRAS.  U.S.,Br. 

Preparation  and  Composition.  This  salt  is  made  by  mixing  officinal 
solution  of  citrate  of  iron  and  water  of  ammonia,  evaporating  at  a  heat 
of  150°  or  less  to  a  syrupy  consistence,  and  then  drying  on  glass  plates. 
The  chemical  composition  of  the  resulting  compound  is  not  exactly 
determined ;  but  it  probably  consists  of  one  equivalent  of  citric  acid,  one 
of  sesquioxide  of  iron,  and  one  of  ammonia.  Mr.  Redwood  found  the 
salt  of  commerce  to  contain  variable  proportions  of  the  sesquioxide,  from 
31  to  34.5  per  cent.  (Pereira,  Mat.  Med.,  3d  ed.,  p.  793  )  When  the 
officinal  salt  is  incinerated  In  the  air,  it  yields  26.5  per  cent,  of  the  ses- 
quioxide. 

Properties.  This  salt  is  in  very  thin,  shining  scales,  of  a  bright,  almost 
ruby-red  colour,  and  of  a  sweetish  or  acidulous,  slightly  chalybeate,  very 
feebly  styptic,  and  not  disagreeable  taste.  It  is  readily  soluble  in  water, 
but  almost  insoluble  in  alcohol.  Ferridcyanide  of  potassium  does  not 
change  it  blue;  though  with  the  ferrocyanide  it  yields  a  copious  blue 
precipitate,  and  caustic  potassa  and  lime-water  decompose  it,  throwing 
down  the  sesquioxide  with  escape  of  ammonia.  It  is  not  decomposed 
by  the  carbonates  of  the  alkalies.  I  am  told  that  ammonia  escapes  when 
it  is  heated. 

Medical  Uses.  All  that  has  been  said  of  the  medical  applications  of 
tartrate  of  iron  and  potassa,  and  tartrate  of  iron  and  ammonia,  is  equally 
applicable  to  this  salt,  which  is  closely  analogous  to  them  in  composition 
and  properties.  It  is  an  excellent  chalybeate,  and  may  be  given  when- 
ever it  is  desired  to  bring  the  system  under  the  influence  of  iron,  and  a 
soluble  preparation  is  wanted.  It  is  less  calculated  than  some  other 
soluble  salts  of  iron,  tMaieet  the  indications  for  the  tonic  and  astringent 
effects  of  the  chalybeates  on  the  alimentary  mucous  membrane.  The 
dose  is  from  five  to  thirty  grains,  the  former  being  sufficiently  large  for 
a  commencing  dose  in  ordinary  cases. 


Several  other  salts  of  iron  have  been  recommended  at  different  times, 
and  received  more  or  less  attention,  of  which  very  brief  notices  must 
suffice;  as  none  of  them  have  come  into  general  use,  and  probably  none 
are  capable  of  producing  effects  which  cannot,  to  say  the  least,  be  quite 
as  conveniently  and  advantageously  obtained  from  those  already  de- 
scribed. 


CHAP.  I.]  MINERAL   TONICS. — LACTATE   OF   IRON.  465 

1.  ARSENIATE  OF  IRON.  —  FERBI  ARSENIAS.  Br. 

This  is  an  officinal  of  the  British  Pharmacopoeia,  made  by  mixing 
solutions  of  sulphate  of  iron,  and  of  arseniate  and  acetate  of  soda.  A 
white  precipitate  falls,  which  soon  becomes  green  on  exposure  to  the 
air.  It  is  amorphous,  inodorous,  insipid,  and  insoluble  in  water,  but 
is  readily  dissolved  by  muriatic  acid;  and,  when  first  formed,  consists  of 
three  eqs.  of  protoxide  of  iron  and  one  of  arsenic  acid.  On  exposure, 
however,  the  protoxide  absorbs  oxygen,  and  the  preparation,  therefore, 
contains  a  portion,  though  indefinite,  of  the  sesquioxide.  It  has  been  in- 
troduced into  use,  under  the  idea  that  it  might  exercise  upon  the  system 
the  combined  virtues  of  arsenic  and  iron.  It  is  in  fact  useful  in  cuta- 
neous affections,  such  as  yield  to  arsenic ;  but  the  proportion  of  iron  con- 
tained in  it  is  too  small  to  be  of  account ;  and  this  salt  must  be  regarded 
simply  as  arsenical.  In  this  respect,  I  know  no  superiority  which  it 
possesses  over  Fowler's  solution.  The  dose  is  from  the  eighth  to  the  tenth 
of  a  grain,  which  may  be  given  in  the  form  of  pill  three  times  daily. 

2.  ACETATE  OF  IRON".  —  FERRI  ACETAS. 

Acetate  of  protoxide  of  iron  is  in  small,  green  crystals,  which  decom- 
pose rapidly  on  exposure  to  the  air;  acetate  of  sesquioxide  of  iron  is 
uncrystallizable,  and,  in  the  solid  state,  deliquescent ;  it  is  only,  there- 
fore, in  solution  that  either  of  these  salts  can  be  conveniently  kept.  The 
Dublin  Pharmacopeia  directed  a  Tincture  of  Acetate  of  Iron  (TINCTURA 
FERRI  ACETATIS),  which  was  made  by  mixing  alcoholic  solutions  of  the 
sulphate  of  sesquioxide  of  iron  and  acetate  of  potassa.  A  double  decom- 
position took  place,  resulting  in  the  formation  of  sulphate  of  potassa, 
which  was  precipitated,  and  acetate  of  sesquioxide  of  iron,  which  re- 
mained in  solution.  The  liquid  was  then  expressed  and  filtered.  The 
tincture  thus  made  is  transparent,  of  a  deep-red  colour,  and  a  strong, 
ferruginous  taste.  It  is  an  agreeable  and  efficacious  chalybeate,  and  was 
a  favourite  with  Dr.  Percival,  who  is  said  to  have  introduced  it  into  the 
Dublin  Pharmacopoeia.  In  this  country,  it  is  seldom  or  never  used.  The 
dose  is  from  twenty  minims  to  a  fluidrachm. 

3.  CITRATE  OF  IRON  AND  MAGNESIA..  — FERRI  BT  MAGNE- 
SIA ClTRAS, 

This  is  made  by  dissolving  freshly  prepared  hydrated  sesquioxide  of 
iron  in  citric  acid,  saturating  with  carbonate  of  magnesia,  evaporating 
to  the  consistence  of  syrup,  and  drying  in  thin  layers.  It  is  in  trans- 
lucent scales,  of  a  greenish -yellow  colour,  and  an  acidulous,  slightly 
chalybeate  taste,  very  soluble  in  water,  but  insoluble  in  alcohol.  It  has 
the  general  properties  of  the  ferruginous  preparations,  and  may  be  given 
in  the  dose  of  five  grains  or  more,  in  pill  or  solution. 

4.  LACTATE  OF  IRON.  — FERRI  LACTAS.  U.  S. 

Under  the  impression  that  lactic  acid  is  ordinarily  present  in  the  gas- 
ric  juice,  that  it  is  consequently  the  form  of  lactate  which  the  ferruginous 
VOL.  i. — 30 


466  GENERAL    STIMULANTS.  [PART  II. 

preparations  introduced  into  the  stomach  generally  assume,  and  that  in 
this  form  they  enter  the  circulation,  MM.  Gelis  and  Conte  were  induced 
to  recommend  the  use  of  the  lactate  of  iron  in  medicine,  as  more  likely 
than  other  chalybeate^  to  find  its  way  readily  into  the  blood,  and  to  produce 
the  required  effects  on  the  system.  Some  trials  that  were  made  confirmed 
their  views  as  to  the  efficiency  of  the  salt,  and  it  was  for  a  time  con- 
siderably used ;  but  further  experience  has  shown  that  it  is  not  superior 
to  other  salts  of  iron ;  and,  from  the  experiments  of  Quevenne,  it  would 
appear  that  it  is  no  less  liable  than  others  to  undergo  precipitation  in 
the  stomach. 

It  may  be  made  either,  as  directed  in  the  U.  S.  Pharmacopoeia,  by  di- 
gesting iron  filings  in  lactic  acid,  or  by  double  decomposition  between 
lactate  of  lime  and  sulphate  of  iron.  In  the  former  case,  the  iron  is 
protoxidized  at  the  expense  of  the  water,  and  then  combines  with  the 
acid  to  form  a  lactate  of  the  protoxide;  in  the  latter,  the  same  salt  re- 
mains in  solution  after  the  precipitation  of  sulphate  of  lime.  The  lactate 
may  be  obtained  from  the  solution  in  crystals  in  the  ordinary  mode,  or 
in  the  form  of  scales  by  evaporating  to  the  consistence  of  syrup,  and 
then  spreading  thinly  on  glass  or  porcelain  to  dry. 

Lactate  of  protoxide  of  iron  is  in  greenish-white  crystalline  grains  or 
crusts,  of  a  mild  ferruginous  taste,  little  changed  on  exposure  to  the  air, 
slowly  and  sparingly  soluble  in  water,  and  scarcely  soluble  in  alcohol. 
The  watery  solution  becomes  yellowish  on  exposure,  in  consequence  of 
the  partial  sesquioxidation  of  the  protoxide ;  and  the  dry  salt  is  some- 
times met  with  of  the  same  colour,  probably  from  the  same  cause,  or 
from  want  of  care,  in  its  preparation,  to  avoid  this  source  of  impurity. 

In  its  effects  on  the  system,  lactate  of  iron  is  not  unlike  the  sulphate, 
but  is  less  astringent  It  is  capable  of  exciting,  and,  in  over-doses,  of 
irritating  the  stomach,  and  may,  therefore,  be  used  as  a  gastric  stimulant 
in  dyspepsia,  though  less  efficient  than  some  others  in  diarrhoea,  and 
hemorrhage  from  the  mucous  membrane  of  the  prim®  vise.  It  may  also 
be  employed  to  produce  the  effects  of  iron  on  the  system  at  large ;  but 
is  inferior  for  this  purpose  to  powdered  iron,  or  the  pill  of  the  carbonate, 
or  even  to  the  milder  soiuble  salts,  as  the  tartrate  of  iron  and  potassa, 
and  the  tartrate  or  citrate  of  iron  and  ammonia,  because  more  liable  to 
irritate  the  stomach  when  freely  administered,  "and  consequently  inca- 
pable of  imparting  so  much  iron  to  the  circulation  within  a  given  time. 
The  dose  is  one  or  two  grains,  three  times  a  day,  which  may  be  gradually 
increased  so  as  to  amount  to  twelve  grains  daily.  It  may  be  given  in 
powder,  pill,  or  syrup. 

5.  VALERIANATE  OF  IRON.  —  FERRI  VALERIANAS.  Dub. 

This  preparation  was  introduced  into  the  Dublin  Pharmacopoeia,  prob- 
ably under  the  impression,  that  the  valerianic  acid  contained  in  it  might 
superadd  to  the  tonic  action  of  the  iron,  in  chlorotic  cases,  the  peculiar 


CHAP.  I.]  MINERAL   TONICS. — CHLORIDE   OF   IRON.  467 

antispasmodic  influence  of  the  oil  of  valerian.  It  is,  however,  so  easy 
to  mix  a  little  oil  of  valerian  with  one  of  the  preparations  of  iron,  that, 
even  admitting  the  peculiar  additional  virtue  supposed  to  be  acquired, 
it  is  scarcely  a  sufficient  reason  for  increasing  the  already  overburdened 
catalogue  of  the  chalybeates.  Accordingly,  the  preparation  has  been 
omitted  in  the  Br.  Pharmacopoeia.  The  salt  is  made  by  double  decom- 
position between  the  sulphate  of  sesquioxide  of  iron  and  valerianate  of 
soda ;  sulphate  of  soda  being  left  in  solution,  and  valerianate  of  sesqui- 
oxide of  iron  precipitated.  The  latter  is  then  washed,  dried,  and  kept  in 
well-stopped  bottles.  The  salt  is  composed  of  three  equivalents  of  acid 
and  one  of  sesquioxide.  It  is  in  the  form  of  a  loose,  dark-red  powder, 
with  a  slight  odour  and  taste  of  valerianic  acid,  insoluble  in  cold  water, 
soluble  in  alcohol,  and  deprived  of  its  acid  by  boiling  water.  It  is  also 
decomposed  by  the  acids,  which  liberate  valerianic  acid,  recognizable  by 
its  peculiar,  very  offensive  odour.  The  preparation  is  thought  to  be 
specially  adapted  to  anemic  cases  associated  with  hysteria.  One  grain 
is  mentioned  as  the  dose,  to  be  repeated  three  or  four  times  a  day. 

4.  Preparations  of  Iron  in  the  State  of  Haloid  Salts. 

I.  CHLORIDE  OF  IRON.  —  FERRI  CHLORIDUM.  U.S.  —  Sea- 
quichloride  of  Iron.  Ptrchloride  of  Iron. 

This  is  properly  the  sesquichloride  or  perchloride  of  iron.  Though 
long-  and  very  largely  used  in  alcoholic  solution,  and  more  recently,  to  a 
considerable  extent,  dissolved  in  water,  this  chalybeate  has  until  of  late 
never  been  kept  in  the  dry  state,  and  was  for  the  first  time  introduced 
into  the  U.  S.  Pharmacopoeia  at  the  last  revision.  It  is  prepared  by  first 
treating  iron  wire  with  muriatic  acid,  by  which  the  protochloride  is  pro- 
duced in  solution ;  then  bringing  this  to  the  state  of  sesquichloride  by 
adding  nitric  acid,  and  a  further  quantity  of  muriatic  acid,  to  the  heated 
solution ;  and  lastly  evaporating  and  crystallizing  The  simplest  expla- 
nation of  the  process  is  that,  in  the  first  step,  iron  attracts  sufficient 
chlorine  from  the  muriatic  acid  to  convert  it  into  the  protochloride,  while 
the  hydrogen  of  the  acid  escapes  with  effervescence ;  and,  in  the  second, 
the  nitric  acid  gives  up  a  portion  of  its  oxygen  to  the  hydrogen  of  the 
muriatic  acid  in  excess,  thereby  liberating  enough  chlorine  to  bring  the 
protochloride  of  iron  to  the  state  of  the  sesquichloride. 

Thus  procured,  the  chloride  of  iron  is  in  crystalline  fragments,  of  an 
orange-yellow  colour,  inodorous,  of  a  strongly  styptic  and  ferruginous 
taste,  very  soluble  in  water,  deliquescent,  and  soluble  in  alcohol  and  in 
ether.  It  consists  of  two  eqs.  of  iron  and  three  of  chlorine,  and  is  rep- 
resented by  the  formula  FeaCls,  with  a  variable  quantity  of  water  of 
crystallization.  That  it  is  a  sesquichloride  of  iron,  containing  no  proto- 
chloride, is  proved  by  its  affording  a  blue  precipitate  with  the  ferrocy- 


468  GENERAL    STIMULANTS.  [PART  II. 

anide,  but  none  with  the  ferridcyanide  of  potassium.  The  only  objection 
to  it  in  the  solid  state  is  its  liability  to  deliquescence,  which  can  be 
guarded  against  by  keeping  it  in  accurately  closed  bottles.  It  undergoes 
no  change  on  exposure.  There  are  two  officinal  preparations  of  it;  the 
tincture,  which  is  chiefly  employed  internally;  and  the  watery  solution, 
which  is  used  locally.  It  has  been  employed  as  a  local  styptic  in  a 
seini-deliquesced  state,  and  found  to  be  extremely  efficient.  For  this 
purpose,  Mr.  J.  Z.  Lawrence  keeps  it  in  a  bottle  loosely  closed,  and, 
as  it  deliquesces,  applies  the  thick  liquid  portion,  by  means  of  a  spun- 
glass  brush,  to  bleeding  surfaces.  MM.  Jodin  and  Aubrun,  of  Paris, 
have  used  it  internally  in  pseudomembranous  croup,  with  great  asserted 
success,  giving  it  in  quantities  varying  from  ninety  grains  to  half  an 
ounce,  in  divided  doses,  very  frequently  repeated,  in  the  twenty-four 
hours.  (Ann.  de  Therap.,  1861,  p.  201.)  But  these  I  should  consider 
as  very  hazardous  doses,  and  justifiable  only  under  desperate  circum- 
stances. The  solid  sesquichloride  has  proved  an  efficient  remedy  in  that 
obstinate  and  painful  ulceration  about  the  toe-nail,  resulting  from  the 
pressure  of  the  edge  of  the  nail  upon  the  flesh.  The  powder  is  intro- 
duced beneath  the  protruding  flesh,  and  sprinkled  on  its  surface.  The 
pain  quickly  subsides,  and  the  patient  is  able  to  walk  in  a  few  days. 
(Bost.  Med.  and  Surg.  Journ.,  Oct.  22,  1863,  p.  240.) 

1.  TINCTURE  OF  CHLORIDE  OF  IRON.  —  TINCTURA  FERRI  CHLO- 

RIDI.     U.S. TlNCTURA    FERRI    PERCHLORIDI.    Br. FERRI    MURIATIS 

TINCTURA.  Ed.  —  Muriated  Tincture  of  Iron. 

Preparation.  This  was  formerly  prepared  by  dissolving  subcarbo- 
nate  of  iron  (U.  S.)  in  muriatic  acid,  and,  after  filtration,  adding  alco- 
hol to  the  solution.  As  the  subcarbonate  of  iron  of  the  U.  S.  Pharma- 
copoeia consists  mainly  of  sesquioxide  of  iron,  and  this,  by  reaction  with 
muriatic  acid,  is  converted  into  sesquichloride,  there  is  obtained  by  this 
process  a  solution  of  sesquichloride  of  iron  in  alcohol,  with  only  so  much 
water  as  was  contained  in  the  muriatic  acid  used.  But  there  is  usually, 
in  the  subcarbonate  above  referred  to,  a  small,  though  uncertain  propor- 
tion of  carbonate  of  protoxide  of  iron,  producing  with  the  muriatic  acid 
a  corresponding  proportion  of  protochloride,  which  remains  in  the  solu- 
tion. But  protochloride  of  iron,  exposed  to  the  air,  is  converted,  by  tin- 
absorption  of  oxygen,  into  sesquichloride  and  se'squioxide,  the  latter  of 
which,  being  insoluble,  has  a  tendency  to  render  the  preparation  turbid. 
If  there  be  an  excess  of  muriatic  acid  present,  it  will  dissolve  the 
quioxide  as  fast  as  formed,  and  thus  preserve  the  liquor  clear ;  but,  as 
this  was  not  the  case  in  the  old  U.  S.  formula,  the  tincture  was  apt  to  be- 
come turbid  on  standing.  A  precipitate  was  slowly  produced,  which 
formed  crusts  on  the  bottle,  and  in  this  state  was  insoluble  in  an  excess  of 


CHAP.  I.]      MINERAL  TONICS. — TINCTURE  OF  CHLORIDE  OF  IRON.     469 

muriatic  acid,  probably  from  its  peculiar  state  of  aggregation.*  Another 
inconvenience  incident  to  the  preparation  was  that,  in  consequence  of  the 
muriatic  acid  of  the  shops  falling  short  of  the  officinal  sp.  gr.  1.16,  the 
whole  of  the  subcarbonatc  directed  was  not  dissolved,  and  the  resulting 
tincture  was,  therefore,  too  weak.  If  the  strong  acid  could  not  be  ob- 
tained, this  defect  might  be  obviated,  as  suggested  by  Mr.  A.  P.  Sharp, 
of  Baltimore,  by  passing  a  little  muriatic  acid  gas,  from  some  liquid  mu- 
riatic acid  heated  in  a  Florence  flask,  through  a  bent  glass  tube,  into  the 
mixture  of  the  subcarbonate  and  acid,  until  a  perfect  solution  was  ef- 
fected, and  then  proceeding  as  directed  in  the  officinal  process.  (Am. 
Journ.  of  Pharm.,  xxvii.  103.) 

But  most  of  the  disadvantages  above  mentioned  have  been  obviated 
in  the  new  process  adopted  in  the  present  Pharmacopoeia,  in  which  a 
pint  of  aqueous  solution  of  the  sesquichloride  is  first  made  by  the  succes- 
sive action  of  muriatic  and  nitric  acids  on  iron  wire,  as  in  the  process 
for  preparing  the  solid  sesquichloride  ;  and  three  pints  of  alcohol  are  then 
added.  But,  in  order  to  obtain  satisfactory  results  even  with  this 
method,  it  is  necessary  in  the  first  place  to  be  provided  with  materials 
pure  and  of  due  strength,  and  then  faithfully  to  carry  out  all  the  direc- 
tions. (See  U.  S.  Dispensatory.) 

Properties.  The  tincture  of  chloride  of  iron  is  a  deep-brown  liquid, 
which,  in  very  thin  layers,  is  yellowish,  and,  applied  to  white  paper, 
produces  a  yellow  stain.  It  has  a  sour,  very  astringent,  and  strongly 
chalybeate  taste,  and  an  odour  resembling  that  of  muriatic  ether,  a  little 
of  which  is  probably  generated  by  reaction  between  the  muriatic  acid 
and  alcohol.  It  should  have  the  sp.  gr.  0.990;  and  a  fluidounce  of  it 
should  yield  when  diluted,  and  precipitated  with  ammonia,  an  amount 
of  sesquioxide  of  iron  weighing,  after  being  washed,  dried,  and  ignited, 
29  grains.  It  is  sensible  to  the  ordinary  tests  for  iron.  The  following 
substances  produce  precipitates  with  it;  namely,  the  alkalies,  alkaline 
earths  and  their  carbonates,  acetate  and  subacetate  of  lead,  nitrate  of 
silver,  astringent  vegetable  infusions,  and  mucilage  of  gum  arabic. 

Effects  on  the  System.  This  preparation  is  locally  excitant  and  astrin- 
gent, and,  in  excess,  highly  irritant.  Swallowed  in  moderate  doses,  it 
acts  as  a  tonic  and  astringent  upon  the  alimentary  canal,  increasing  the 
appetite,  promoting  digestion,  and  causing  constipation  of  the  bowels. 
More  largely  used,  it  irritates  the  stomach,  and,  in  great  excess,  acts  as 
a  poison  by  inflaming  the  gastric  and  intestinal  mucous  membrane. 
Ohristison,  in  his  treatise  on  poisons,  mentions  a  case  in  which  death 

*  Prof.  Procter  ascertained,  at  my  request,  that  this  precipitate  was  not  an  oxy- 
chloride  of  iron,  for  it  was  dissolved  by  sulphuric  acid  without  the  evolution  of 
muriatic  acid.  It  was,  therefore,  probably  sesquioxide,  rendered,  as  suggested  in 
the  text,  insoluble  in  excess  of  muriatic  acid  by  its  peculiar  molecular  condition. 


470  GENERAL    STIMULANTS.  [PART  II. 

appeared  to  result  from  swallowing  a  fluidounce  and  a  half  of  the  tincture. 
There  were  symptoms  of  inflammation  in  the  stomach  and  bowels  during 
life,  and  the  marks  of  it  after  death.  Upon  the  system  in  general  it  pro- 
duces the  ordinary  effects  of  the  chalybeates,  and  is  thought,  moreover, 
by  some,  to  operate  as  a  diuretic,  and  to  exert  a  peculiar  influence  on 
the  urinary  organs.  Though  I  have  used  the  medicine  considerably,  I 
have  not  noticed  the  latter  effects,  but  I  do  not  wish  to  be  understood 
as  denying  them.  Attention  has  recently  been  called  to  an  extraordinary 
power  of  coagulating  the  blood,  possessed  by  a  strong  watery  solution 
of  the  sesquichloride,  when  injected  into  the  blood-vessels;  and  the 
tincture  would  probably  have  a  similar  effect. 

Therapeutic  Application.  The  tincture  may  be  used  with  advantage 
as  a  tonic  in  dyspepsia,  and  a  joint  tonic  and  astringent  in  diarrhoea  of 
relaxation,  and  in  passive  hemorrhage  from  the  stomach  and  bowels. 
It  may  also  be  used  with  a  view  to  bring  tlie  system  under  the  influence 
of  iron,  and  is  with  many  a  favourite  remedy  for  this  purpose;  but  it  has 
the  disadvantage  of  being  liable  to  irritate  the  stomach,  if  given  somewhat 
too  freely;  and  is  inferior,  I  think,  for  this  purpose,  to  the  powder  and 
carbonate,  and  to  the  milder  soluble  salts,  as  the  double  tartrate,  or  am- 
monio-citrate.  There  are,  however,  special  purposes  which  it  may  be 
better  calculated  to  fulfil  than  those  preparations.  Through  the  chlorine 
in  its  composition,  it  has  been  considered  as  having  alterative  proper 
which  render  it  more  efficient  in  scrofula  than  the  chalybeates  generally ; 
and  it  has,  therefore,  been  associated  with  other  chlorides,  as  those  of 
barium,  calcium,  and  sodium,  in  the  treatment  of  that  affection,  when 
complicated  with  anaemia.  It  is  supposed  also  to  be  men-  <  Hi'M.'ious 
than  most  of  the  chalybeates,  in  checking  hemorrhage  from  the  uterus 
and  urinary  passages.  It  has,  indeed,  enjoyed  considerable  reputation. 
in  consequence  of  the  special  influence  ascribed  to  it  over  the  urinary 
organs.  In  anemic  cases  of  dropsy,  in  which  chalybeates  are  indicated, 
it  might  be  selected  preferably  to  others,  from  its  supposed  possession 
of  diuretic  powers.  It  is  also  well  adapted  to  those  cases  of  ami-mia.  in 
which  there  is  a  coexisting  indication  for  nitromuriatic  acid,  as  in  the 
form  of  cachexia  attended  with  copious  formation  of  oxalate  of  lime  in 
the  urine.  I  have  seen  this  combination  very  speedily  successful  under 
such  circumstances.  Some  surgeons  of  eminence  have  found  it  peculiarly 
efficient  in  spasmodic  stricture  of  the  uretl>ra,  iu  which  it  must  be  used 
more  freely  than  for  other  purposes;  ten  minims  being  given  every  ten 
minutes  until  it  produces  the  desired  effect  or  nauseates.  It  has  also  been 
recommended  in  dysury  from  weakness  of  the  muscular  coats  of  the 
bladder,  in  chronic  mucous  discharges  from  the  same  viscus,  and  from 
the  pelvis  of  the  kidney,  in  leucorrhcea,  gleets,  and  the  advanced  stages 
of  gonorrhosa.  A  very  natural  explanation  of  the  efficacy  of  this  tincture 
in  diseases  of  the  urinary  passages  was  that,  being  eliminated  along 


CHAP.  I.]-   MINERAL  TONICS. — TINCTURE  OF  CHLORIDE  OF  IRON.     471 

with  the  urine,  it  came  in  contact  with  the  interior  surface  of  the  pas- 
sages, and  produced  its  effects  by  an  immediate  action  on  the  seat  of 
the  disease ;  but  Dr.  A.  H.  Hassall,  of  London,  has  satisfactorily  de- 
termined, by  repeated  experiments,  that  neither  the  chloride  itself,  nor 
either  of  its  constituents,  passes  out  with  the  urine ;  and  this  explana- 
tion, therefore,  must  be  abandoned.  (Lancet,  Dec.  1864,  p.  740.)  But 
the  absence  of  the  tincture  from  the  passages  is  no  proof  that  it  may  not 
act  directly  on  the  diseased  tissue ;  for,  if  it  circulates  with  the  blood, 
it  comes  really  more  closely  into  contact  with  the  tissue  than  if  merely 
passing  over  the  outer  surface  of  it;  and,  if  it  has  any  special  relation 
to  these  organs,  it  thus  has  the  opportunity  of  exercising  its  full  influ- 
ence on  them. 

A  new  application  has,  within  a  few  years,  been  made  of  the  tincture 
by  Mr.  C.  Hamilton  Bell,  of  Edinburgh ;  to  the  treatment,  namely,  of 
erysipelas.  He  gives  it  internally,  in  doses  of  from  fifteen  to  twenty- 
five  drops  every  two  hours,  continued  night  and  day,  throughout  the 
complaint,  employing  no  other  treatment,  except  to  operate  freely  on 
the  bowels  in  the  beginning,  and  afterwards  to  keep  them  regularly 
open.  At  the  time  of  his  published  notice,  he  had  used  the  remedy  for 
twenty-five  years,  with  invariable  success.  (Ed.  Month.  Journ.  of  Med. 
Sci.,  A.D.  1851,  p.  498.)  Other  practitioners  have  employed  the  remedy, 
and  reported  favourably  of  its  effects.  I  have  myself  used  it  in  many 
cases,  which  all  terminated  in  health  at  the  usual  period;  though  the 
same  result  might  possibly  have  happened  under  other  modes  of  treat- 
ment; for,  within  my  observation,  this  complaint  has  almost  always 
ended  favourably,  unless  in  individuals  previously  broken  down  by  in- 
temperance or  disease.  Still,  after  so  uniformly  favourable  an  experi- 
ence, running  through  several  years  of  hospital  practice,  I  cannot  but 
think  that  there  is  real  efficacy  in  the  remedy. 

Dr.  H.  L.  Byrd,  of  Savannah,  Geo.,  has  employed  a  similar  treatment, 
with  great  supposed  advantage,  in  scarlet  fever,  and  considers  the  rem- 
edy, from  his  experience  with  it  in  twenty  cases,  as  superior  to  all  others 
in  that  complaint.  He  gave  it  in  doses  varying  according  to  the  age, 
from  half  or  three-quarters  of  a  drop  for  an  infant  six  or  seven  weeks 
old,  to  ten  drops  for  a  child  eight  years  old,  and  at  intervals  varying 
from  four  to  eight  hours.  (Charleston  Med.  Journ.,  ix.  165,  March, 
1854.) 

The  tincture  has  also  been  given,  with  supposed  benefit,  in  pseudo- 
membranous  angina,  or  epidemic  diphtheria,  in  which  the  blood  is 
believed  to  be  depraved  in  a  manner  somewhat  analogous  to  that  which 
characterizes  erysipelas. 

It  ha£  also  been  recommended  as  especially  efficacious  in  purpura 
haBmorrhagica. 

The  dose  of  the  tincture  for  ordinary  purposes  is  from  ten  to  thirty 


472  GENERAL   STIMULANTS.  [PART  II. 

minims,  which  may  be  increased  to  one  or  two  fluidrachms,  two  or  three 
times  a  day. 

Externally  the  medicine  has  boon  employed  as  a  stimulant  and  astrin- 
gent application  to  venereal  warts,  and  cancerous  and  fungous  ulcers; 
and  as  a  styptic  to  bleeding  surfaces. 

2.  SOLUTION  OF  PERCHLORIDE  OF  IRON.  — LIQUOR  FERRI 
PERCHLORIDI.  Br. 

A  strong  solution  of  perchloride  of  iron  having  come  into  extensive 
use  as  a  styptic,  the  British  Pharmacopoeia  adopted  it  as  officinal,  and 
gives  a  process  for  its  preparation.  Unfortunately,  however,  from  certain 
defects  in  the  formula,  the  resulting  preparation  is  not  a  pure  solution  of 
the  sesquichloride  of  iron,  but  contains  also  a  portion  of  the  protochloride 
and  an  excess  of  nitric  acid.  The  preparation  was  not  adopted  in  the 
U.  S.  Pharmacopeia;  because,  directions  having  been  given  for  preparing 
the  solid  sesquichloride,  nothing  more  is  necessary  to  prepare  a  solution 
of  any  desired  strength  than  simply  to  dissolve  this  in  water. 

When  properly  made,  the  solution  has  an  orange  colour,  and  a 
strongly  ferruginous  and  styptic  taste.  It  unites  with  water  and  alco- 
hol in  all  proportions.  The  strength  of  the  British  solution  in  sesqui- 
chloride is  probably  about  four  times  that  of  the  U.  S.  tincture  of  the 
chloride. 

Medical  Properties  and  Uses.  This  preparation  is  used  almost  exclu- 
sively as  a  local  styptic:  a  property  which  it  owes  mainly  to  its  extraor- 
dinary power  of  coagulating  the  blood.  M.  Pravaz,  a  surgeon  of  Lyons, 
in  France,  found  that,  through  the  influence  of  a  few  drops  of  it  thrown 
into  an  artery  or  vein,  all  the  blood  for  an  extent  of  somewhat  more 
than  an  inch,  was  coagulated,  in  the  course  of  a  few  minutes,  into  a  firm 
clot.  It  has  been  employed  especially  in  the  treatment  of  varices  and 
aneurismal  tumours.  In  the  cure  of  varin-s.  it  is  asserted  to  have 
proved  among  the  most  efficient  remedies  known.  For  this  purpose,  a 
solution  has  been  recommended  containing  about  one  part  of  the  salt  to 
two  parts  of  water,  for  aneurisms  about  one  part  to  four.  But  this 
operation  is  not  without  danger;  as  cases  are  on  record  of  death  from  its 
injection  into  naevi  of  the  face  in  infants,  consequent  on  the  direct 
passage  of  the  solution  through  a  vein  of  the  mevus  into  the  heart,  where 
the  blood  was  coagulated.  Caution,  therefore,  is  necessary,  in  perform- 
ing the  operation,  to  introduce  the  solution  very  slowly.  (Med.  T.  and 
Oaz.,  June,  1864,  p.  683.)  It  has  also  been  used  to  check  hemorrhages 
in  surgical  operations,  applied  upon  pledgets  of  lint,  and  for  the  cure  of 
panniform  keratitis,  being  for  this  purpose  dropped  into  the  eye.  (See 
N.  Am.  Medico-chirurg.  JRev.,\.  117.)  It  is  said  to  effect  the  cure  of 
hemorrhoids,  applied  to  them  after  blistering.  Solutions  of  various 
strengths,  to  suit  special  purposes,  may  be  made  by  dissolving  six, 
three,  two,  and  one  and  a  half  drachms  in  a  fluidounce  of  distilled  water. 


CHAP.  I.]  MINERAL  TONICS. — AMMONIATED   IRON.  473 

The  British  solution  may  be  given  internally  in  the  dose  of  from  two  to 
ten  minims.  Applied  locally  to  certain  obstinate  cutaneous  affections, 
as  eczema,  lichen  agrius,  etc.,  it  is  said  in  some  instances  to  have  ef- 
fected speedy  cures. 

Perchloride  of  iron  is  one  of  the  substances  of  which  the  solution  has 
been  used,  in  the  form  of  spray,  by  means  of  the  atomizer.  It  may  be 
employed  in  this  way  in  diphtheric  affections  and  chronic  inflammations 
of  the  air-passages,  and  in  pulmonary  hemorrhage.  The  strength  of  the 
solution,  in  ordinary  chronic  inflammation,  may  be  from  half  a  grain  to 
two  grains  to  the  fluidounce  of  water;  for  diphtheria  and  hemorrhage 
from  two  to  ten  grains. 

II.  AMMONIATED  IRON.  —  FERRUM  AilMONIATUM.  U.  S. 
1850. — Ammonio-chloride  of  Iron. 

When  the  subcarbonate  of  iron  of  the  TJ.  S.  Pharmacopoeia  (sesquiox- 
ide  of  iron)  is  digested  with  muriatic  acid,  a  reaction  takes  place,  by 
which  the  sesquicltloride  of  iron  is  formed  in  solution.  If  now  a  solu- 
tion of  muriate  of  ammonia  be  added,  and  the  mixed  liquids  evaporated 
to  dryness,  we  obtain  the  preparation  under  consideration.  It  is  proba- 
bly nothing  more  than  a  mixture  of  sesquichloride  of  iron  and  muriate 
of  ammonia,  the  former  amounting  only  to  about  15  per  cent. 

Ammoniated  iron  is  in  crystalline  grains  of  a  fine  reddish-orange  col- 
our, and  sharp  saline,  and  chalybeate  taste.  It  is  deliquescent,  and 
soluble  in  water  and  alcohol.  Its  incompatibles  are  the  same  as  those 
of  the  preceding  article. 

Under  the  name  of  flores  martiales  or  martial  flowers,  a  preparation 
closely  analogous  to  this  has  long  been  known,  since  the  times,  indeed, 
of  Basil  Valentine,  which  was  procured  by  subliming  a  mixture  of 
sesquioxide  of  iron  and  muriate  of  ammonia.  The  sesquioxide  was 
probably  converted,  at  the  expense  of  a  part  of  the  muriatic  acid  of 
the  muriate  of  ammonia,  into  sesquichloride  of  iron,  which  then  chemi- 
cally combined  with  the  remainder  of  the  muriate.  The  preparation 
differed  from  that  now  officinal  in  having  a  yellow  colour,  and  a  slight 
peculiar  odour. 

Medical  Uses.  The  great  predominance  of  the  muriate  of  ammonia 
renders  this  a  feeble  chalybeate,  while  it  imparts  aperient,  and,  as  some 
suppose,  alterative  properties,  which  give  it  a  somewhat  peculiar  char- 
acter. It  is  particularly  applicable  to  cases,  which  offer  indications  at 
once  for  the  influence  of  iron  and  of  a  deobstruent  agent.  Such  are  pre- 
sented in  anemic  states  of  the  system,  with  swollen  lymphatic  glands  as 
in  scrofula,  with  enlarged  liver,  or  with  chronically  hepatized  lung. 
At  present,  however,  it  is  little  used;  and  it  is  no  longer  officinal,  hav- 
ing been  abandoned  both  in  the  U.  S.  and  Br.  Pharmacopoeias.  The 
dose  is  ten  or  twelve  grains  to  begin  with,  which  may  be  given  in  pill, 


474  GENERAL   STIMULANTS.  [PART  II. 

solution,  or  electuary.     The  London  College  directed  a  tincture,  which, 
being  a  useless  preparation,  has  been  omitted  in  the  British  code. 

III.  IODIDE  OF  IRON.  —  FERRI  IODIDUM.  Br. 

Preparation.  Iodide  of  iron  is  prepared  by  simply  mixing  the  two 
ingredients  together,  with  the  presence  of  water,  which  dissolves  the 
resulting  compound,  and,  after  filtration,  yields  it  by  evaporation.  The 
iron  is  employed  in  the  state  of  filings,  or  of  wire ;  but  the  latter  is  pref- 
erable, as  it  is  in  general  purer.  The  preparation  consists  of  one  equiva- 
lent of  iron,  one  of  iodine,  and  five  of  water;  but,  if  considerable  heat 
is  employed  in  drying  it,  the  proportion  of  water  is  smaller.  It  should 
be  kept  in  a  well-stopped  bottle. 

Properties.  When  the  solution  of  iodide  of  iron  is  very  carefully  evap- 
orated, with  the  exclusion  of  atmospheric  air,  the  salt  is  obtained  in  the 
form  of  green,  transparent,  tabular  crystals ;  but,  as  ordinarily  prepared, 
it  is  a  greenish-black  substance,  of  an  astringent  chalybeate  taste,  very 
deliquescent,  and  very  soluble  in  water  and  alcohol.  At  a  moderate 
heat  it  melts,  and  on  cooling  solidifies  into  a  dark-gray,  crystalline  ma.-s, 
of  a  metallic  lustre.  At  a  higher  heat,  with  exposure  to  the  air,  it  is 
decomposed ;  the  iodine  escaping,  and  the  iron  absorbing  oxygen,  and 
remaining  behind  as  the  sesquioxide.  Upon  the  slightest  exposure  to 
the  air,  even  at  ordinary  temperatures,  the  iron  attracts  oxygen  and 
passes  into  the  state  of  sesquioxide,  while  the  iodine  becomes  free. 
Analogy  would  lead  to  the  supposition  that,  as  in  the  case  of  the  pro- 
tochloride  of  iron,  the  metal  would  be  divided  between  the  oxygen  ab- 
sorbed, and  the  principle  previously  combined  with  it,  forming  the 
qui-iodide  and  sesquioxide;  but  that  iodine  is  liberated  is  shown  by 
the  fact,  that  the  altered  substance  colours  starch  blue.  This  change 
has  almost  always  happened,  in  some  degree,  with  the  iodide  of  iron  of 
the  shops,  which,  on  that  account,  is  seldom  entirely  soluble  in  water. 

A  solution  of  the  iodide  undergoes  this  change  much  more  rapidly 
than  the  solid  salt,  quickly  depositing  the  sesquioxide,  and  thus  becom- 
ing weakened  as  a  chalybeate.  There  are,  however,  two  means  of  pro- 
tecting the  solution  against  this  change;  one  by  introducing  into  the 
bottle  containing  it  some  iron  filings,  or  a  coil  of  iron  wire,  the  other  by 
incorporating  it  with  a  considerable  proportion  of  sugar.  A  solution 
protected  in  the  latter  method  is  officinal,  and  will  be  described.  In  the 
former  method,  the  free  iron  immediately  takes  all  the  oxygen  which 
that  of  the  iodide  absorbs  from  the  air;  and  the  protiodide,  therefore, 
remains  unchanged  in  the  solution. 

Incompatible 8.  Precipitates  are  produced  in  the  solution  of  iodide  of 
iron  by  the  alkalies  and  their  carbonates,  lime-water,  magnesia,  soaps, 
hydrosulphuric  acid  and  the  soluble  sulphurets,  ferrocyauide  of  potas- 
,  the  soluble  salts  of  lead,  copper,  silver,  and  mercury,  but  not  those 


CHAP.  I.]  MINERAL  TONICS. — IODIDE    OF   IRON.  475 

of  zinc,  by  the  soluble  phosphates,  all  the  astringent  vegetable  infusions, 
and  many  other  organic  substances. 

Effects  on  the  System.  Iodide  of  iron  has  both  the  topical  and  consti- 
tutional effects  of  the  other  soluble  salts  of  the  metal,  increasing  the  ap- 
petite, improving  digestion,  enriching  the  blood,  and  operating  generally 
as  a  tonic;  but  it  is  less  astringent  than  the  sulphate,  and  probably 
less  so  than  the  nitrate  or  chloride;  and,  moreover,  possesses  peculiar 
properties  quite  distinct  from  its  powers  as  a  chalybeate,  and  attribu- 
table to  the  iodine  it  contains.  These  are  evinced  in  its  alterative, 
diuretic,  and  laxative  effects.  Dr.  A.  T.  Thompson  states  that,  shortly 
after  its  administration  in  large  doses,  both  iron  and  iodine  may  be  found 
in  the  urine ;  but  it  is  not  mainly  in  the  form  of  iodide  of  iron  that  it  is  thus 
thrown  off.  The  experiments  of  Quevenne  show  that  but  a  small  por- 
tion of  the  metal  passes  by  the  kidneys,  while  the  iodine  passes  abund- 
antly ;  proving  that  the  two  constituents  are  separated  in  the  system, 
and  most  of  the  iron  retained.  (Arch,  de  Physiol.  de  Bouchardat,  Oct. 
1854,  p.  104.)  We  can  thus  explain  the  two  classes  of  effects  produced, 
one  belonging  to  the  chalybeate  ingredient,  the  other  to  the  iodine.  In 
over-doses,  iodide  of  iron  proves  irritant  to  the  stomach  and  bowels,  caus- 
ing epigastric  uneasiness,  nausea,  vomiting,  purging,  and  griping  pains. 
Very  largely  taken,  it  would  probably  induce  serious  gastro-intestinal 
inflammation;  though  I  have  seen  no  account  of  positively  poisonous 
effects. 

Therapeutic  Application.  This  medicine  was  first  employed  by  Dr. 
Pierquin  so  early  as  in  the  year  1824.  It  is  now  among  the  most  pop- 
ular of  the  chalybeates,  though  employed  chiefly  in  a  special  class  of 
cases.  It  may  be  used  as  a  gastric  tonic  in  dyspepsia,  or  with  a  view 
to  the  general  effects  of  iron  on  the  system,  as  in  simple  chlorosis,  or  in 
the  anemic  condition  attended  with  amenorrhoea,  leucorrhcea,  etc.;  but 
its  best  effects  are  displayed  in  cases  of  scrofulous  disease,  and  other 
forms  of  local  tumefaction  or  induration,  in  which  there  is  at  the  same 
time  an  indication  for  the  improvement  of  the  blood.  It  is  only  in  the 
absence  of  all  febrile  excitement  and  gastric  inflammation,  that  it  should 
be  resorted  to*in  such  cases;  but,  when  properly  accommodated  to  the 
state  of  the  system,  it  is  an  excellent  remedy.  In  swellings  of  the 
lymphatic  glands  external  or  internal,  diseases  of  the  bones,  ligaments, 
and  joints,  and  ulcerative  and  eruptive  affections  of  the  skin,  when  these 
can  be  traced  to  a  scrofulous  taint;  in  chronic  enlargement  of  the  thyroid 
gland,  mamma,  testicle,  ovary,  liver,  and  spleen ;  in  various  subacute  or 
chronic  swellings  and  indurations  without  special  seat,  or  known  pecu- 
liarity of  character;  in  all  these  affections,  it  may  be  considered  as  indi- 
cated when  they  exist  conjointly  with  an  anemic  state  of  the  blood,  and 
a  general  deficiency  of  vital  force.  Without  this  associated  condition, 
and  in  all  cases  in  which  the  excitant  properties  of  the  chalybeate  on  the 


476  GENERAL    STIMULANTS.  [PART  II. 

system  may  be  contraindicated,  some  other  preparation  of  iodine,  espe- 
cially iodide  of  potassium,  should  be  preferred.  Iodide  of  iron  has  also 
been  used  with  advantage  in  secondary  syphilitic  affections,  in  like  man- 
ner connected  with  anemic  debility.  It  is  said,  moreover,  to  have  been 
successfully  employed  in  diabetes.  A  solution  of  it  containing  from  one 
to  two  drachms  in  a  pint  of  water,  has  been  employed  locally  as  an  in- 
jection in  gonorrhoea  and  leucorrhcea,  and  as  a  lotion  in  ulcers. 

Administration.  The  dose  of  iodide  of  iron  is  two  or  three  grains 
three  times  a  day,  which  may  be  increased  to  ten  grains,  if  not  found  to 
disturb  the  stomach.  The  administration  of  it,  in  the  pilular  form,  is 
attended  with  some  difficulty,  in  consequence  of  its  deliquescent  prop- 
erty, and  extreme  proneness  to  chemical  change.  Various  modes  of 
obviating  these  objections  have  been  proposed  Perhaps  the  best  method 
would  be  to  evaporate  to  a  pilular  consistence  the  officinal  solution  of 
the  iodide,  which  is  protected  from  change  by  sugar;  or  the  preparation 
might  be  directly  incorporated  with  sugar  when  made  into  pills ;  or,  as 
suggested  by  Prof.  Procter,  a  little  reduced  iron  might  be  added  to  the 
mass  with  the  same  view.  But,  even  though  protected  against  oxida- 
tion, the  pills  would  still  be  liable  to  deliquescence.  To  obviate  both 
disadvantages,  they  might  be  covered  with  a  coating  of  impervious 
matter,  by  dipping  them  into  a  chloroformic  solution  of  caoutchouc  and 
drying  them.  It  will  be  noticed,  in  the  following  paragraph,  that  these 
suggestions  have  been  carried  into  effect  in  the  recent  revision  of  the 
U.  S.  Pharmacopoeia,  even  to  the  impervious  coating,  though  the  mate- 
rial for  coating  the  pills  is  not  the  one  here  proposed,  and  is  probably 
preferable  to  it. 

Pills  of  Iodide  of  Iron  (PILULE  FERRI  IODIDI,  U.  S.)  are  ordered  by 
our  officinal  code  to  be  made  by  first  forming  the  iodide  in  strong  solution 
by  a  direct  combination  of  the  two  ingredients,  then  incorporating  the 
solution  with  a  little  reduced  iron,  sugar,  and  marshmallow  in  powder, 
and  finally  evaporating  to  a  pilular  consistence,  and  dividing  into  pills. 
Thc.se  are  directed  to  be  coated  with  balsam  of  Tolu,  which  to  a  con- 
siderable extent  preserves  them  from  the  injurious  influence  of  the  air, 
while  the  reduced  iron  and  sugar  still  further  protect  .them  from  the 
oxidation  of  the  iron.  Each  pill  contains  about  a  grain  of  the  iodide  of 
iron  and  one-fifth  of  a  grain  of  reduced  iron.  Two  or  three  of  them 
may  be  taken  two  or  three  times  a  day. 

Syrup  of  Iodide  of  Iron  (SYRUPUS  FERRI  IODIDT,  U.  S.,  Br.).  —  So- 
lution of  Iodide  of  Iron  (LIQUOR  FERRI  IODIDI,  U.  S.  1850).  This  is 
directed  by  the  U.  S.  Pharmacopoeia  to  be  prepared  by  dissolving  iodine 
and  iron  filings  together  in  water,  filtering  the  solution  into  a  certain  pro- 
portion of  syrup,  in  a  bottle,  previously  heated  to  212°,  and  then  adding 
sufficient  syrup  to  produce  the  requisite  measure.  This  preparation 
differs  from  the  solution  of  iodide  of  iron  of  the  U.  S.  Pharmacopoeia 


CHAP.  I.]        MINERAL   TONICS. — FERROCYANIDE    OF   IRON.  477 

in  having  a  larger  proportion  of  sugar,  which  was  needed  for  its  preser- 
vation, and  which  is  now  sufficient  to  authorize  the  preparation  to  be 
placed  among  the  syrups.  It  is  on  the  whole  the  most  convenient  form 
for  the  administration  of  iodide  of  iron. 

The  syrup  is  transparent,  and  of  a  pale-green,  or  yellowish-green 
colour,  and  without  sediment.  By  exposure  to  light,  in  a  closely  stopped 
bottle,  it  becomes  nearly  colourless.  It  is  the  common  form  for  the 
administration  of  iodide  of  iron,  and  is  greatly  preferable  to  the  pill. 
When  it  is  swallowed,  care  should  be  taken  to  wash  out  the  mouth  well, 
in  order  to  avoid  possible  injury  to  the  teeth.  The  dose  of  the  U.  S. 
preparation  is  from  twenty  to  forty  minims,  which  should  be  diluted  with 
water,  but  only  at  the  moment  of  exhibition. 

IV.  FERROCYANIDE  OF  IRON.  —  FERRI  FERROCYANIDUM. 
U.  S. —  Pure  Prussian  Blue. 

Preparation.  As  the  Prussian  blue  of  commerce  is  always  more  or 
less  impure,  this  preparation  should  be  made  specially  for  medical  use. 
The  U.  S.  Pharmacopoeia  directs  that  to  the  officinal  solution  of  tersul- 
phate  of  iron  a  solution  of  ferrocyanide  of  potassium  should  be  added, 
and  that  the  precipitate  produced  should  be  washed  on  a  filter,  and  dried. 
Portions  of  the  iron  of  the  tersulphate,  and  of  the  potassium  of  the  fer- 
rocyanide, change  places,  so  as  to  form  sulphate  of  potassa  and  ferro- 
cyanide of  iron,  of  which  the  former  either  remains  in  the  solution,  or  is 
dissolved  out  in  the  washing,  leaving  the  latter  pure. 

Composition.  Ferrocyanide  of  iron  consists  of  three  equivalents  of 
ferrocyanogen  (which  contains  one  equivalent  of  iron  and  three  of  cya- 
nogen), four  equivalents  of  iron,  and  six  eqs.  of  water ;  the  last  ingre- 
dient being  essential;  as  it  cannot  be  separated  without  decomposing  the 
salt.  The  compound,  however,  as  in  the  case  of  other  haloid  salts,  may 
be  looked  on  as  consisting  of  a  hydracid  and  an  oxide  of  iron,  the  hydro- 
gen of  the  water  going  to  the  ferrocyanogen,  and  the  oxygen  to  the  iron. 
In  this  view,  the  salt  would  be  a  hydroferrocyanate  of  the  sesquioxide 
of  iron,  and  would  consist  of  three  eqs.  of  hydroferrocyanic  acid  (each 
containing  one  eq.  of  ferrocyanogen  and  two  of  hydrogen),  and  two  eqs. 
of  sesquioxide  of  iron.  Commercial  Prussian  blue  always  contains, 
besides  the  above  compound,  a  portion  of  uncombined  alumina  and 
sesquioxide  of  iron. 

Properties.  The  pure  salt  is  in  the  form  of  a  rich  deep-blue  powder, 
inodorous  and  tasteless,  insoluble  in  water  and  alcohol,  and  unaffected 
by  the  dilute  acids.  Strong  sulphuric  acid  dissolves  without  decom- 
posing it,  concentrated  nitric  and  muriatic  acids  decompose  it,  and  the 
alkalies  separate  sesquioxide  of  iron. 

Effects  on  the  System.  From  the  insipidity  of  Prussian  blue,  its  insol- 
ubility even  in  dilute  acids,  and  the  fact  that  it  is  formed  whenever  fer- 


478  GENERAL    STIMULANTS.  [PART  II. 

rocyanide  of  potassium  meets  a  salt  of  iron  in  the  body,  even  in  the 
circulating  liquor  sanguinis,  a  fair  inference  is,  that  it  would  probably 
have  no  other  effect  on  the  system  than  such  as  might  result  mechan- 
ically from  the  presence  of  an  insoluble  powder  in  the  stomach  and 
bowels ;  and  this  view  would  seem  to  be  supported  by  the  experiments 
of  M.  Coullon,  who  found  it  without  action  in  several  different  species  of 
animals.  (Jlerat  et  De  Lens,  ii.  531.) 

Therapeutic  Application.  Notwithstanding,  however,  its  presumed 
inertness,  it  has  been  much  commended  by  some  practitioners.  Dr.  W. 
Zollickoffer,  of  Maryland,  first  called  the  attention  of  the  profession  to  it 
as  a  remedy  in  intermittent  and  remittent  fevers,  in  which  he  was  in- 
duced by  his  observations  to  consider  it  superior  to  Peruvian  bark.  ( Am. 
Med.  Recorder,  July,  1822,  v.  540.)  Dr.  Samuel  Jackson,  late  of  North- 
umberland, employed  it  with  success  in  a  large  number  of  cases,  but 
found  it  to  fail  in  many.  (Am.  Journ.  of  Med.  Sci.,  ii.  33f>,  A.D.  1827.) 
Dr.  Hasse,  a  German  physician,  found  it  effectual  in  an  epidemic  inter- 
mittent which  prevailed  at  Gastrow  in  the  spring  of  1827 ;  but  he  gave 
doses  of  a  grain  of  the  salt  with  a  scruple  of  pepper,  the  latter  of  which 
was  probably  much  the  more  efficacious  of  the  two.  (Hufeland's  Journ., 
quoted  by  Merat  and  de  Lens,  ii.  531.)  Dr.  Eberle  speaks  of  it  favour- 
ably from  his  own  observation  and  experience.  (Mat.  Med.  and  Therap., 
4th  ed.,  i.  321.)  Many  other  physicians  have  borne  a  somewhat  hesita- 
ting or  equivocal  testimony  in  its  favour.  I  tried  it  myself  in  a  number 
of  cases,  soon  after  it  first  came  into  notice,  with  some  success,  but  with 
so  many  failures  that  I  soon  abandoned  it.  The  medicine  has  been 
given  with  supposed  success  also  in  chorea  and  epilepsy,  but  associated 
generally  with  others,  so  as  to  leave  the  real  agvnt  of  cure  doubtful,  and 
sometimes  in  such  doses  as  to  leave  no  doubt  as  to  the  inefficiency  of 
the  Prussian  blue.  Thus,  M.  Burguet,  of  Bordeaux,  gave  from  one- 
eighth  of  a  grain  to  four  grains  a  day;  and  Dr.  Kirckhoff,  of  (Jhrnt,  sup- 
posed that  he  cured  epilepsy  with  from  half  a  grain  to  six  grains  in  the 
day.  Dr.  Bridges,  of  Philadelphia,  employed  it  in  a  case  of  obstinate 
facial  neuralgia,  with  considerable  relief,  after  the  ordinary  remedies 
had  been  tried  with  little  or  no  effect.  It  will  have  been  observed  that 
all  these  diseases,  in  which  efficiency  has  been  claimed  for  it,  are  of  a 
character  to  be  readily  affected  through  the  mind;  and  in  which  any- 
thing will  occasionally  effect  apparent  cures  in  which  the  patient  may 
have  confidence,  or  even  strong  hope.  I  am  not  prepared,  however,  to 
say,  that  the  mere  presence  of  an  insoluble  agent  in  the  primie  vise, 
acting  only  mechanically  on  the  mucous  surface,  may  not  prove  useful 
in  nervous  diseases,  and  local  affections  of  the  membrane  itself. 

The  dose,  as  given  by  different  practitioners,  varies  extremely.  Gen- 
erally, from  four  to  six  grains  have  been  given  several  times  a  day.  In- 
stances are  mentioned  above  in  which  the  dose  was  reduced  to  the  eighth 


CHAP.  I.]  MANGANESE. — PHOSPHATE  OF  LIME.  479 

of  a  grain,  and  Dr.  Jackson,  late  of  Northumberland,  gave  in  some  cases 
two  drachms  during  the  interval  in  intermittents,  finding  it  to  lie  easily 
on  the  stomach.  This  latter  fact  tends  strongly  to  favour  the  idea  of  its 
inertness,  in  reference  to  any  direct  influence  on  the  system  in  general. 


Besides  the  preparations  of  iron,  other  substances  have  been  to  a  certain 
extent  remedially  employed,  under  the  impression  that  they  might  supply 
deficiences,  in  the  system,  of  certain  constituents  derived  from  the  min- 
eral kingdom. 

Manganese,  having  been  found  in  the  blood,  has  been  like  iron  sup- 
posed to  constitute  a  normal  ingredient  of  that  fluid;  and,  under  this 
impression,  has  been  used  in  certain  conditions  of  anaemia  as  an  adjuvant 
of  the  chalybeates,  or  a  substitute  for  them.  At  one  time  the  compounds 
of  this  metal  were  considerably  prescribed ;  but,  with  one  exception,  the 
permanganate  of  potassa,  they  have  fallen  into  comparative  neglect; 
and  this  owes  its  importance  to  quite  other  properties  than  those  of  a 
reconstructive  tonic.  This  salt  will  be  treated  of  with  the  Disinfect- 
ants;  and  I  may  then  take  occasion  to  allude  to  some  other  prepara- 
tions of  this  metal;  but,  for  a  full  account  of  them,  the  reader  is  referred 
to  the  IT.  S.  Dispensatory. 

Phosphate  of  Lime  has  been  supposed  to  be  useful  in  certain  cases  of 
diseased  bones,  by  supplying  a  deficiency  of  earthy  matter,  as  in  rickets, 
scrofulous  affections  of  the  bones,  etc.;  but  it  is  not,  I  believe,  the  defi- 
ciency of  material  that  here  constitutes  the  difficulty,  so  much  as  the  power 
of  assimilating  them ;  and  phosphate  of  lime  is  probably  almost  always 
sufficiently  supplied  with  the  food.  Nevertheless,  it  may  be  used  with- 
out disadvantage,  even  if  productive  of  no  great  benefit.  It  has  been 
adopted  in  the  U.  S.  Pharmacopoeia,  under  the  title  of  Precipitated 
Phosphate  of  Lime  (C aids  Phosphas  Prsecipitata,  U.  S.),  and  directions 
are  given  for  preparing  it  from  calcined  bones.  (See  U.  S.  Dispensatory, 
12th  ed.)  It  is  a  white,  inodorous,  tasteless  powder,  insoluble  in  water, 
but  readily  dissolved  by  diluted  nitric,  muriatic,  and  acetic  acids.  The 
acid  being  tribasic,  it  consists  of  three  eqs.  of  lime  and  one  of  phospho- 
ric acid.  Beneke  has  suggested  its  use  in  diseases  of  defective  nutri- 
tion, as  scrofula,  phthisis,  etc.,  from  the  circumstance  that  it  is  an  ingre- 
dient in  the  ultimate  cells ;  but  the  same  reason  for  doubt  exists  here  as 
in  the  former  case  of  diseased  bones;  it  is  not  the  material,  but  the 
assimilating  power  that  is  wanting ;  for,  in  many  of  these  cases,  the  insol- 
uble phosphates  are  discharged  in  excess  by  the  kidneys,  showing  that 
there  is  no  deficiency  of  them  in  the  blood.  The  dose  is  from  ten  to 
thirty  grains.  It  may  be  given  in  powder,  or  dissolved  in  water,  with 


480  GENERAL    STIMULANTS.  [PART  II. 

the  aid  of  a  little  muriatic  or  nitric  acid,  which  will  often  probably 
greatly  add  to  its  efficiency. 

Hypophoaphites.  On  the  same  view  of  supplying  a  supposed  defi- 
ciency of  material  in  the  system,  the  hypophosphites  have  been  em- 
ployed to  furnish  phosphorus  to  the  tissues;  and  with  this  object  have 
been  especially  recommended  in  the  treatment  of  phthisis.  Experience, 
however,  has  shown  their  entire  want  of  control  over  this  disease ;  and 
there  does  not  appear  to  me  to  be  sufficient  reason  for  introducing  them 
into  the  already  overburdened  catalogue  of  remedies.  All  needful  in- 
formation in  relation  to  them  will  be  found  in  the  third  part  of  the  U. 
8.  Dispensatory  (12th  ed.). 


CHAP.  I.]  DIFFUSIBLE   STIMULANTS.  481 


SECTION  SECOND. 
Diffusible  Stimulants. 

UNDER  this  division  of  General  Stimulants  are  included  those  which 
act  quickly  and  energetically,  but  only  for  a  comparatively  short  period. 
In  the  degree  in  which  they  possess  the  stimulant  property  they  differ 
much  among  themselves ;  but,  as  a  general  rule,  they  greatly  exceed,  in 
this  respect,  the  permanent  stimulants,  embracing  the  astringents  and 
tonics,  which  have  just  been  under  consideration.  One  of  the  laws  of 
all  stimulation,  whatever  may  be  its  degree,  is  that  it  is  followed  by  a 
depression  proportionate,  at  least  approximately,  to  the  previous  exalta- 
tion of  the  function  or  functions  excited.  Hence,  the  remedies  belonging 
to  the  present  section,  as  they  exceed  the  astringents  and  tonics  in  rapid- 
ity and  extent  of  stimulant  action,  leave  behind  them  a  more  speedy  and 
greater  depression. 

General  Therapeutic  Remarks  on  Diffusible  Stimulation. 

The  condition  to  which  this  therapeutic  process  is  applicable,  is  ob- 
viously that  of  general  depression  of  the  actions  or  powers  of  the  sys- 
tem. To  a  considerable  extent,  the  observations  made  upon  tonic 
stimulation  in  reference  to  the  possible  injury  from  its  abuse,  and  to  the 
conditions  of  depression  or  debility  admitting  and  calling  for  its  employ- 
ment, are  applicable  also  to  this  variety,  and  need  not  be  repeated.  Only 
a  few  remarks,  more  particularly  bearing  on  the  subject  at  present  under 
consideration,  are  required. 

As  a  general  rule,  the  diffusible  stimulants  may  be  resorted  to  in 
cases  of  considerable,  and  especially  of  rather  sudden  or  acute  pros- 
tration, which  tonics  and  nutritious  food  are  either  too  slow  in  action,  or 
too  feeble  in  stimulant  power  to  counteract.  But  some  cautions  are 
necessary. 

Sometimes  there  is  great  prostration  of  the  vital  actions,  depending 
on  the  concentration  of  blood  and  nervous  power  in  some  large  organ, 
or  extensive  structure  in  the  interior  of  the  body,  in  a  state  of  high  in- 
flammation. This  may  without  caution  be  mistaken  for  real  debility, 
and  fatally  treated  under  that  impression.  It  occurs  usually  at  or  near 
the  commencement  of  the  inflammatory  attack,  and  will  in  general  IK' 
readily  diagnosticated  by  the  evidences  of  the  existing  inflammation,  if 
VOL.  i. — 31 


482  GENERAL   STIMULANTS.  [PART  IT. 

the  practitioner  be  on  his  guard.  In  these  cases,  bleeding  is  the  great 
remedy,  if  it  can  be  employed;  the  system  reacting  as  the  interior  or- 
gans are  unloaded,  and  the  pulse  rising  under  the  lancet.  But  sometimes 
the  least  amount  of  blood  lost  so  far  impairs  the  powers  of  the  heart  a> 
still  further  to  depress  the  pulse.  Under  such  circumstances,  stimula- 
tion may  become  necessary  in  order  to  excite  the  heart,  and  rouse  up  the 
circulation  generally,  so  that  loss  of  blood  may  be  borne,  until  the  relief 
of  the  internal  congestion  shall  remove  the  depressing  force.  But  it  is 
obvious  that  the  stimulation  must  be  such  as  will  not  be  likely  to  con- 
tinue into  the  period  of  reaction,  as  it  would  much  aggravate  the  dan- 
ger of  inflammation.  Therefore,  reliance  should  mainly  be  placed  on 
external  stimulation,  which  can  be  withdrawn  at  any  moment  when  de- 
sirable ;  and,  if  this  should  prove  insufficient,  the  stimulants  of  briefest 
action  should  be  preferred,  as  heat,  the  ammoniacal  preparations,  and 
those  of  ether. 

Another  analogous  condition,  in  which  precisely  the  same  cautions 
should  be  observed,  is  that  collapse  of  system  which  generally  attends 
violent  concussion  of  the  brain,  and  not  unfrequently  occurs  after  any 
severe  shock  upon  the  system,  as  from  accidental  injury,  or  a  surgical 
operation.  The  nervous  centres  are  here  prostrated,  and  all  the  vital 
functions  fail  in  consequence.  Sometimes  reaction  never  takes  pla< •« • : 
but  when  it  does,  inflammation  and  fever  almost  always  ensue,  and  might 
be  greatly  aggravated  by  the  previous  injudicious  use  of  stimulants. 
But  these  are  sometimes  essential  to  assure  reaction.  The  external,  and 
those  of  brief  action  are  here  also  indicated  ;  and  those  especially  should 
be  avoided  which  would  peculiarly  stimulate  the  organ  likely  to  become 
the  seat  of  inflammation,  as  the  brain  in  concussion. 

Again,  collapse  calling  loudly  for  diffusible  stimulation  sometimes 
occurs  in  the  cold  stage  of  febrile  diseases,  particularly  those  of  a  typhous 
and  malignant  character,  and  the  exanthematous.  Here  also  reaction 
will  take  place  if  the  patient  survive  ;  and,  although  equal  caution  in 
regard  to  prolonged  stimulation  is  not  necessary  as  in  the  former  in- 
stances, the  reaction  itself  being  often  tainted  with  debility,  yet  injury 
may  be  done  by  a  too  zealous  employment  of  the  measure,  and  the  stim- 
ulants of  long-continued  action,  and  greatest  influence  on  the  brain, 
should  be  resorted  to  only  when  it  becomes  obvious  that  external  and 
brief  internal  stimulation  will  not  answer. 

But  when  debility  occurs  in  the  course  of  acute  disease,  as  in  the  va- 
rious febrile  affections,  diffusible  stimulation  may  be  employed  without 
scruple,  and  usually  in  a  degree  exactly  corresponding  with  the  apparent 
call  for  it.  Here  there  is  no  danger  of  subsequent  reaction.  The  prom- 
inent indication  is  to  support  the  system  until  the  depressing  agency 
shall  have  ceased,  and  either  the  system  have  recovered  its  energies,  or 
the  disease  run  its  course. 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. 

Even  the  coexistence  of  inflammation  does  not,  under  such  circum- 
stances, altogether  contraindicate  the  use  of  stimulants,  though  it  should 
dispose  to  greater  watchfulness  not  to  exceed  the  necessary  point.  Va- 
rious inflammations  occur  in  the  course  of  fevers  of  the  low  or  typhoid 
character,  in  which  the  blood  and  nervous  force  are  both  greatly  impaired, 
and  often  will  not  sustain  life  unless  by  the  aid  of  the  diffusible  stimu- 
lants. Local  measures,  even  moderate  cupping  or  leeching,  fomentations, 
blisters,  etc.,  and  the  careful  use  of  the  mercurials,  may  be  employed  for 
the  inflammation,  while  stimulants  may  be  freely  used  to  support  the 
functions,  and  nutritive  matter  to  supply  a  better  blood.  This  remark, 
too,  is  applicable  even  when  the  inflammation  may  have  been  the  original 
affection,  provided  the  symptoms  of  typhous  debility,  and  a  depraved  or 
poisoned  blood  supervene.  Examples  of  this  kind  we  have  in  typhous 
pneumonia,  typhous  dysentery,  malignant  sore-throat,  and  the  prostrate 
or  malignant  forms  of  scarlet  fever,  smallpox,  and  erysipelas;  and  there 
is  scarcely  one  of  the  exanthematous  fevers,  or  of  the  local  inflammations 
to  which  the  remark  will  not  apply. 

Another  condition  of  debility,  often  demanding  the  free  use  of  the  dif- 
fusible stimulants,  is  that  which  attends  acute  febrile  affection  or  inflam- 
mation occurring  in  persons  previously  worn  out  by  enfeebling  disease, 
bad  living,  or  habits  of  intemperance.  In  the  last  case,  it  is  generally 
necessary,  even  when  the  lancet  may  be  employed  for  the  cure  of  the 
inflammation,  to  administer  stimulants  to  support  the  heart  and  nervous 
centres,  which  would  refuse  to  act  without  them.  This  is  an  important 
therapeutic  principle  in  the  treatment  of  habitual  drunkards,  and  even 
of  those  who  have  been  long  in  the  habit  of  using  ardent  spirits  in  great 
excess,  though  never  obviously  intoxicated. 

Again,  when  the  system  is  exhausted  by  profuse  evacuations,  as  in 
the  hemorrhages,  cholera,  diarrhoea,  etc.,  by  long-continued  disease  of 
almost  any  kind,  or  by  copious  suppuration,  the  result  of  antecedent  in- 
flammation, or  is  prostrated  under  the  influence  of  gangrene  from  the 
same  or  some  other  cause,  diffusible  stimulants  are  often  necessary  to 
support  life  until  the  system  recovers  its  powers,  or  the  processes  referred 
to  shall  have  terminated,  as  they  usually  have  a  tendency  to  do,  in  health. 
Often,  in  these  cases,  tonics  and  a  nutritious  diet,  or  even  the  latter 
alone,  may  be  sufficient;  but  frequently  also  the  diffusible  stimulants  are 
essential. 

Whenever,  moreover,  the  blood  becomes,  so  impaired  by  an  absorbed 
or  otherwise  introduced  poison,  as  to  be  incompetent  alone  to  the  support 
of  the  vital  functions,  diffusible  stimulants  must  be  freely  used,  in  order 
to  sustain  life  as  long  as  possible,  in  the  hope  that  the  poison  may  be 
thrown  off,  or  that  the  blood  and  solid  tissues  may  pass  through  the 
series  of  morbid  changes  set  on  foot  by  the  poison,  and  return  to  the 
sound  condition.  Thus,  purulent  infection,  the  state  of  system  resulting 


484  GENERAL   STIMULANTS.  [PART  II. 

from  poisoned  wounds,  as  in  dissection,  and  the  poisonous  condition 
produced  by  the  bites  of  serpents  and  other  venomous  animals,  will  some- 
times recover  under  potent  stimulation,  when  the  patient  might  perish 
without  it. 

Finally,  there  are  diseases  in  which  the  nervous  centres  appear  to 
be  prostrated,  without  any  observable  vitiation  of  the  blood,  and  without 
at  first  any  considerable  failure  in  the  actions  of  the  heart;  in  which, 
however,  powerful  stimulation  is  sometimes  essential.  Not  to  mention 
delirium  tremens,  in  which  this  condition  of  the  nervous  centres  results 
from  the  withdrawal  of  a  wonted  stimulus,  and  which  often  imperiously 
demands  stimulation  to  save  life,  there  are  tetanus,  and  various  other 
violent  spasmodic  and  nervous  affections,  among  which  mania  may  be 
sometimes  included,  in  which  the  same  remedial  measure  is  often  of  great 
importance. 

Division  of  Diffusible  Stimulants. 

Most  of  the  general  excitant  influences,  though  they  may  in  a  greater 
or  less  degree  affect  the  whole  system,  are  characterized  by  having  a 
preferable  tendency  to  some  one  of  the  subordinate  systems  rather  than 
to  another ;  and  hence  the  stimulants  belonging  to  this  section  are  divided 
into  the  arterial,  the  cerebral,  and  the  nervous,  according  as  they  exhibit 
a  tendency  to  excite  more  especially  the  circulation,  the  brain,  or  the  ner- 
vous tissue  generally.  To  this  rule,  however,  there  is  one  striking  ex- 
ception. Heat  is  a  vital  stimulus  essential  to  the  support  of  every  func- 
tion in  its  normal  state,  and  capable,  therefore,  when  operating  in  excess, 
of  producing  over-excitement  in  all  parts  of  the  body.  It  is  a  universal 
stimulant,  and  is  capable  of  being  remedially  employed  as  such  with 
very  great  advantage.  The  consideration  of  it  as  a  remedy  falls  within 
the  scope  of  this  work,  and,  in  relation  to  its  stimulant  powers,  belongs 
especially  to  the  present  section.  Having,  however,  other  therapeutic- 
properties,  it  will,  in  reference  to  these,  be  treated  of  in  connection  with 
the  several  classes  to  which  it  may  belong,  as  the  diaphoretics,  rube- 
facients,  epispastics,  and  escharotics.  The  following  observations  apply 
only  to  its  properties  and  uses  as  a  diffusible  stimulant.  Electricity  is 
.another  diffusible  stimulant,  which,  though  employed  more  especially  in 
reference  .to  its  action  on  the  nervous  system,  is  really  universal  in  its 
influence,  and  can  be  brought  to  bear,  as  a  rapid  and  powerful  excitant, 
upon  any  one  of  the  systems  or  organs  of  the  body.  This,  therefore, 
must  be  considered  as  belonging  to  the  present  division  of  remedies,  and 
will  be  treated  of  after  heat 


CHAP.  I.]  DIFFUSIBLE   STIMULANTS. — HEAT.  485 


I.  HEAT  AS  A  DIFFUSIBLE  STIMULANT. 

It  is  only  when  of  higher  degree  than  the  temperature  of  the  body,  or 
of  that  part  of  the  body  to  which  it  may  be  applied,  that  heat  is  used 
therapcutically.  No  precise  degree,  therefore,  can  be  fixed,  at  which  it 
will  take  rank  among  remedies;  for  the  temperature  of  the  body  which 
must  determine  this  point,  is  itself  variable.  But,  as  a  general  rule,  it 
may  be  said  that  a  heat  of  95°  F.  or  upwards,  may  be  remedial;  for  this 
is  above  the  average  temperature  of  the  surface  of  the  body ;  and  a  de- 
cided sensation  of  heat  will  be  excited  by  the  contact  of  a  conducting 
substance,  at  that  temperature,  with  the  skin.  But,  should  the  surface 
be  very  cold,  a  much  lower  temperature  than  that  mentioned  might 
prove  stimulant;  and,  on  the  contrary,  should  it  be  very  hot,  a  higher 
might  be  applied  Avithout  any  effect  of  the  kind.  It  will  be  remembered, 
therefore,  that  when  precise  degrees  may  be  mentioned  hereafter,  they 
are  to  be  considered  not  as  fixed,  and  applicable  under  all  circumstances; 
but  merely  as  an  average,  and  of  course  to  be  varied  with  the  particular 
condition  of  the  body  at  any  given  time.  It  will  be  found  also,  in  the 
progress  of  these  observations,  that  the  mode  in  which  heat  is  applied 
influences  very  much  the  degree  at  which  it  will  act  as  a  remedy. 

1.  Effects  of  Heat  on  the  System. 

The  first  effect  of  heat  is  to  excite  its  own  peculiar  sensation  in  the 
seat  of  application.  In  a  moderate  degree,  this  may  not  be  unpleasing; 
indeed,  when  the  temperature  has  been  depressed  below  the  normal 
-lundard,  it  is  often  highly  grateful;  but,  if  increased,  it  begins  at  length 
to  become  painful,  and  in  its  higher  degrees  is  often  extremely  so.  The 
excitant  influence  is  speedily  extended  to  the  capillaries,  which  dilate 
under  the  stimulation,  admitting  a  larger  amount  of  blood,  and  thus 
reddening  the  surface,  and  producing  a  greater  or  less  distension  of  the 
tissue  generally.  The  blood  of  the  part,  thus  increased  in  amount,  and 
at  the  same  time  flowing  more  rapidly  with  the  increased  action  of  the 
vessels,  receives  an  increment  of  he/it  from  without,  which  it  carries 
through  the  system,  to  produce  everywhere  a  degree  of  the  same  stimu- 
lant effect  first  produced  upon  the  surface  of  application.  The  impression 
upon  the  nerves,  moreover,  is  transmitted  to  the  cerebral  and  spinal 
centres,  exciting  them  to  increased  action.  A  universal  stimulant  influ- 
ence is  thus  exerted.  The  heart  beats  more  rapidly  and  energetically ; 
and  the  pulse  is  consequently  fuller,  stronger,  and  more  frequent.  The 
respiration  is  hurried.  The  general  temperature,  under  the  universal 
excitation,  is  elevated  in  a  degree  much  greater  than  would  result  from 


486  GENERAL   STIMULANTS.  [PART  II. 

the  mere  addition  of  caloric  from  without,  The  secretions  are  promoted ; 
all  of  them  probably  at  first,  under  a  gentle  operation  of  the  stimulant : 
but,  when  the  heat  is  considerable  and  continued,  the  mucous  mem- 
branes and  the  kidneys  appear  to  be  irritated  beyond  the  point  of  free 
secretion,  as  indicated  by  a  dryish  state  of  the  mouth,  and  diminished 
discharge  of  urine ;  while  the  secretory  functions  of  the  liver  and  skin 
are  augmented,  so  that  there  is  usually  a  freer  flow  of  bile,  and  greater 
or  less  increase  of  perspiration.  An  explanation  of  this  difference  in 
effect,  and  of  its  uses,  will  be  given  hereafter  under  the  head  of  dia- 
phoretics. At  present  it  is  sufficient  to  observe  that,  in  some  instances, 
even  the  liver  and  skin  appear  to  be  so  much  irritated  as  to  be  unable 
to  perform  their  functions,  and  the  patient  consequently  suffers  with 
hepatic  congestion,  and  general  heat  and  dryness  of  the  surface.  Along 
with  the  exaltation  of  the  organic  functions,  the  nervous  also  become 
excited.  A  moderate  influence  of  the  cause  is  usually  attended  with 
agreeable  effects.  Sensibility  is  rendered  more  acute,  muscular  motion 
invigorated,  and  the  intellect,  imagination,  and  feelings  more  or  less  ex- 
alted. But  these  functions,  under  a  higher  degree  of  the  exc-itation,  be- 
come deranged,  and  at  a  still  higher  are  impaired ;  so  that  a  feeling  of 
fulness  and  even  painful  distension  of  the  head,  vertigo,  and  other  ab- 
normal cerebral  sensations,  and  hebetude  of  the  intellectual  and  emo- 
tional functions,  are  often  experienced.  This  result  is  simply  in  con- 
formity with  the  general  law,  that,  by  moderate  over-excitation  or 
irritation,  the  functions  are  increased  in  a  normal  direction,  by  a  greater 
amount  of  it,  are  deranged,  and  by  a  still  greater,  are  diminished  or 
'suppressed.  The  generative  functions  obey  the  same  general  law;  and 
the  sexual  feelings  are  excited,  the  menstrual  act  promoted,  and  the 
capacity  for  conception  probably  increased,  under  the  genial  influence 
of  a  moderately  elevated  temperature ;  while  they  may  be  perverted  or 
suppressed  by  its  excess.  Should  the  heat  be  very  considerable,  or  con- 
tinued too  long,  a  universal  acute  derangement  of  the  functions  may 
take  place,  constituting  fever;  and  this  is  the  condition  of  system  existing 
in  the  disease  called  sun-stroke,  and  for  which  the  name  of  heat-fer>  /• 
has  been  proposed,  under  this  idea  of  its  nature.* 

As  in  the  case  of  almost  every  other  stimulant,  the  excitement  pro- 
duced by  heat  in  the  functions,  i^  followed  by  a  proportionate  depres- 
sion. The  excitability,  exhausted  by  excessive  exercise,  now  fails  to 
respond  to  the  ordinary  vital  stimuli,  and  action  is  of  course  diminished. 
As  before  stated,  this  may  be  considered  as  a  nearly  universal  law  of 
stimulation.  Hence  the  soft,  compressible,  and  often  feeble  pulse,  tin- 
cool,  pale,  and  relaxed  skin,  the  muscular  debility,  the  lassitude  or  indis- 
position to  exertion,  the  mental  languor,  and  the  tendency  to  sleep. 

*  See  the  article  on  Heat-fever  in  the  sixth  edition  of  my  Treatise  on  the  Prac- 
tice of  Medicine.  (Note  to  the  third  edition.) 


CHAP.  I.]  DIFFUSIBLE   STIMULANTS. — HEAT.  487 

after  the  subsidence  of  the  general  excitement  produced  by  the  hot  bath. 
Hence,  too,  the  enfeebled  state  of  system,  the  habitual  languor  and  lassi- 
tude, experienced  after  a  prolonged  exposure  to  the  heats  of  summer,  or 
a  residence  of  some  months  in  a  tropical  climate. 

2.  General  Therapeutic  Application. 

Two  main  purposes  are  fulfilled  by  heat  acting  as  a  stimulant;  first, 
to  elevate  the  depressed,  or  support  the  failing  functions;  and  secondly, 
to  equalize  the  distribution  of  the  blood  and  nervous  energy,  by  attract- 
ing them  away  from  parts  where  they  may  exist  in  excess  towards  the 
seat  of  its  own  immediate  action.  These  two  indications  not  unfre- 
quently  exist  in  the  same  case,  and  are  fulfilled  by  the  same  application 
of  the  remedy;  as  in  those  instances  of  great  prostration,  with  concen- 
tration of  the  blood  in  the  interior,  which  are  presented  in  the  initial  or 
cold  stage  of  malignant  fevers.  Here  the  stimulant  influence  of  heat, 
applied  to  the  surface,  rouses  the  prostrated  nervous  centres  and  the 
heart,  while  it  calls  forth  the  accumulated  blood  from  within,  and  un- 
loads the  oppressed  vital  organs.  Frequently  also  the  two  purposes  are 
separately  fulfilled ;  as  when  heat  is  applied,  in  one  instance,  to  aid 
internal  stimulants  in  supporting  the  sinking  system  in  the  advanced 
stage  of  febrile  diseases,  and,  in  another,  to  draw  excitement  away  from 
the  brain  or  lungs,  towards  the  lower  extremities  in  threatened  apo- 
plexy or  pulmonary  congestion.  But  it  will  be  most  convenient  to 
treat  of  the  special  uses  of  the  remedy,  in  connection  with  the  several 
modes  of  applying  it,  which  are  next  to  be  considered. 

3.  Modes  of  Applying  Heat  Therapeutically. 

Of  the  heat  generated  within  the  body  by  exercise,  stimulation,  rich 
diet,  friction,  etc.,  I  shall  not  here  treat,  because  it  is  a  result  of  other 
measures,  and,  though  it  may  be  one  of  the  means  by  which  those 
measures  prove  remedial,  it  cannot  be  itself  considered  in  the  light  of  a 
remedy. 

There  are  two  modes  of  obtaining  the  direct  influence  of  heat;  first, 
by  preventing  the  escape  of  the  natural  heat  of  the  body,  and  thus  caus- 
ing its  accumulation,  and  secondlypby  imparting  it  to  the  body  from 
other  heated  substances. 

1.  Confining  the  Heal  of  the  Body.  This  is  effected  by  surrounding 
the  person  with  a  badly  conducting  medium  in  the  form  of  clothing,  or 
bed-covering  at  night,  or  in  that  of  a  dry  atmosphere,  which  is  a  very 
slow  conductor. 

a.  Clothing.  Much  may  be  done  in  the  management  of  morbid  tend- 
encies, and  even  of  disease  itself,  by  a  proper  regulation  of  the  clothing. 


488  GENERAL   STIMULANTS.  [PART  II. 

Furs,  feathers  or  down,  and  wool  are  the  worst  conductors  of  heat; 
tissues  made  of  raw  silk  are,  perhaps,  next  in  order;  then  tissues  of 
cotton,  and  after  this  linen,  which  is  the  most  rapid  conductor  of  all  the 
materials  used  for  clothing.  It  is  obvious  that,  when  the  object  is  to 
keep  the  surface  warm,  a  selection  should  be  made  from  these  substances, 
whether  for  body  clothing,  for  bedding  and  bed-covering  at  night,  or  for 
occasional  use  under  extraordinary  exposures  to  cold,  according  to  the 
degree  of  protection  Avanted ;  the  worst  conductors  being  chosen  when 
it  is  most  important  to  confine  the  animal  heat.  Upon  the  whole,  the 
most  suitable  under-clothing  for  keeping  up  an  equable  temperature  of 
the  body  is  flannel,  or  the  elastic  woollen  tissue  now  so  much  worn, 
which  has  the  advantage  over  flannel  that  it  shrinks  less  by  washing, 
and  is  not  apt  to  become  so  hard  and  stiff.  When  it  is  specially  im- 
portant to  preserve  an  equable  temperature,  this  should  be  worn  through 
the  whole  year,  summer  as  well  as  winter;  the  quality  being  accommo- 
dated to  the  degree  of  heat.  The  fabric  may  be  had  of  every  diversity 
of  texture,  from  the  coarseness  of  the  heaviest  flannel,  to  the  fineness 
almost  of  gossamer ;  and  the  lightest  should  be  chosen  for  summer  wear. 
It  is  scarcely  less  important  in  the  warm  than  the  cold  season ;  for  the 
changes  of  summer  are  very  great,  and  the  surface  is  even  more  suscep- 
tible to  cold  than  in  winter,  in  consequence  of  its  frequent  relaxation 
under  a  high  temperature.  Should  even  the  lightest  woollen  fabric  be 
insupportable  in  the  most  intense  heat  of  the  season,  a  similar  tissue 
made  of  raw  silk  may  be  substituted,  or,  if  this  cannot  be  had,  of  cot- 
ton; but,  in  cases  of  delicate  health,  where  the  preservation  of  the  tem- 
perature is  important,  linen  should  never  be  worn  next  the  surface  of  the 
body,  unless  when  the  skin  is  excessively  irritable ;  and.  in  that  case, 
wool,  silk,  or  cotton  should  be  worn  over  it.  Persons  in  whom  this 
kind  of  caution  is  essential,  should  be  peculiarly  careful  to  keep  the  feet 
warm  and  dry,  either  by  woollen  stockings,  or,  what  is  sometimes  pref- 
erable, double  stockings,  one  pair  of  silk,  and  the  other  of  cotton.  Oc- 
casionally, woollen  hose  keep  the  feet  in  a  constant  perspiration,  which 
moistens  the  covering,  and  serves  to  convey  away  the  heat;  so  that 
these  parts  are  always  cold.  This  evil  may  often  be  corrected  by  wear- 
ing the  double  hose  just  referred  to.  In  wet  weather,  the  boots  or  shoes 
should  always  be  water-tight,  when  the  person  is  exposed  out  of  doors; 
but  they  should  be  exchanged  for*others  within  doors,  as  they  confine 
the  perspiration,  and  cause  the  feet  to  be  cold  by  making  them  damp. 
The  outer  covering  should  always  be  proportioned  to  the  degree  of  cold. 
when  the  body  is  necessarily  exposed  to  it.  Some  delicate  individuals 
think  they  can  harden  themselves  against  cold,  by  habitual  exposure ; 
and  hence  encounter  the  severest  weather  with  insufficient  covering. 
This  is  a  great  mistake.  They  frequently,  I  believe,  expose  themselves 
in  this  way  to  the  great  danger  of  aggravating  a  morbid  diathesis  into 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. HEAT.  489 

positive  disease.  The  proper  rule  is  never  to  allow  one's  self  to  become 
chilled  for  any  length  of  time.  An  excellent  mode  of  preventing  the 
evil  results  of  the  present  fashion  of  open  dressing  over  the  chest,  is  to 
suspend  from  the  neck,  under  the  shirt,  a  piece  of  doubled  silk  with  cot- 
ton wadding  quilted  within,  or  a  dressed  rabbit's  skin.  At  night,  equal 
attention  is  necessary  tfl  preserve  a  due  degree  of  warmth.  The  cover- 
ing should  be  sufficient  to  render  the  person  comfortable;  and,  with  deli- 
cate persons,  it  is  better  to  err  on  the  side  of  excess  of  warmth  than 
that  of  cold.  The  habit  of  using  mattresses  in  summer  is  very  well; 
but  feather  beds  should  be  employed,  in  winter,  by  all  persons  in  whom 
the  indication  for  sustaining  a  warm  temperature  of  the  body  exists.  I 
think  I  have  known  the  most  serious  evils  result  from  an  attempt,  on  the 
part  of  individuals  of  scrofulous  predisposition,  to  harden  themselves  to 
the  influence  of  cold;  and  carelessness  en  this  point  may  be  equally  in- 
jurious. It  will  be  observed  that  I  am  not  applying  these  remarks  to 
the  healthy  and  robust.  For  these,  equal  caution  is  not  necessary; 
though  even  they  would  do  well  to  exercise  some  care  in  the  point 
under  consideration. 

The  predispositions  and  affections  to  which  these  observations  are 
especially  applicable  are  those  of  a  scrofulous  or  tuberculous  character. 
A  continued  depression  of  temperature  beneath  that  of  full  health  is  pe- 
culiarly injurious  in  all  the  forms  of  tuberculosis,  whether  before  or  after 
the  deposition,  and  in  all  cases  of  a  strumous  character  or  tendency. 
Hence  the  advantage,  on  the  part  of  such  individuals,  of  a  residence  in 
warm  climates ;  but,  when  this  is  impossible,  much  can  be  done  by  a 
due  attention  to  clothing,  by  day  and  by  night,  and  at  all  seasons.  I  do 
not  say  that  temporary  exposures  to  cold  may  not  sometimes  be  useful 
in  these  persons,  through  the  tonic  influence  of  the  reaction.  But  such 
exposures  should  always  be  purposed,  not  accidental ;  should  be  em- 
ployed in  a  remedial  capacity,  and  not  left  to  the  caprices  of  chance; 
and,  when  they  are  resorted  to,  the  utmost  care  should  be  taken  that  due 
reaction  shall  ensue.  When  this  takes  place  with  difficulty,  they  should 
be  at  once  abandoned.  The  above  remarks  may  seem  trivial  to  the  in- 
experienced;  but  those  who  have  seen  much  of  disease  know,  that 
influences  of  the  kind  here  alluded  to  are  quite  as  important  as  medi- 
cines, and  will  agree  with  me  in  the  necessity  of  attention  to  them. 

JJut  it  is  not  in  the  scrofulous  cachexia  only  that  a  due  preservation 
of  warmth  is  important.  All  low  forms  of  disease,  and  especially  the 
1 1 >w  fevers,  are  promoted  by  constant  chilliness;  and  no  fact  is  more 
universally  admitted  in  medicine,  than  that  change  of  temperature,  and 
especially  exposure  to  cold  after  heat,  is  one  of  the  most  fruitful  causes 
of  the  various  inflammations.  The  preservation  of  a  moderate  warmth 
of  surface,  not  sufficient  to  induce  perspiration,  is  one  of  the  great  hy- 
gienic rules  which  should  be  attended  to  under  all  circumstances. 


490  GENERAL    STIMULANTS.  [PART  II. 

b.  Dry  Air.  Another  method  of  sustaining  the  warmth  of  the  body 
is  to  surround  it  with  dry  air,  which  is  a  very  bad  conductor.  But  dry 
air  favours  greatly  the  evaporation  of  liquids,  and  thus  tends  to  act  inju- 
riously, in  many  instances,  on  the  mucous  membrane  of  the  air-passages, 
and  on  the  skin.  It  is,  therefore,  only  under  peculiar  circumstances  that 
it  can  be  resorted  to  remedially.  It  is  indicated  in  patients  of  a  debili- 
tated habit,  with  a  disposition  to  excessive  moisture  of  the  surface,  and 
excessive  bronchial  secretion  from  chronic  disease  of  the  air-passages. 
In  certain  cases  of  pituitous  catarrh,  or  humoral  asthma  as  it  was  for- 
merly called,  with  a  cool  perspiratory  state  of  the  surface,  confinement  to 
such  air  may  prove  useful.  This  is  readily  accomplished,  in  winter,  by 
warming  the  external  cold  dry  air  by  passing  it  over  heated  surfaces, 
without  supplying  water  to  moisten  it,  in  its  passage  into  the  chamber. 
Great  facility  for  this  purpose  is  afforded  by  the  present  plan  of  heating 
houses  from  furnaces  in  the  cellar. 

2.  Imparting  Heat  to  the  Body.  The  methods  of  accomplishing  this 
object  are  numerous,  and  each  requires  a  special  notice.  They  may  all 
be  included  in  two  divisions ;  the  first  embracing  those  in  which  the 
heating  body  used  is  dry,  the  second  those  in  which  it  is  moist.  There 
is  an  important  difference  between  these  two  methods.  By  the  first  we 
obtain  the  effects  of  heat  alone ;  in  the  second,  the  sedative  influence  of 
moisture,  and  the  conducting  power  of  water,  modify  these  effects  often 
very  materially.  These  influences  will  be  considered  when  we  come  to 
the  methods  of  applying  moist  heat, 

a.  Dry  Heat.  This  is  imparted  either  by  radiation,  or  by  the  direct 
contact  of  the  heated  medium. 

Insolation,  or  exposure  to  the  rays  of  the  sun,  is  the  most  effective 
mode  of  obtaining  the  influence  of  radiant  heat.  It  is  sometimes  agree- 
ably stimulant  to  the  old,  feeble,  and  paralytic,  and  appears  to  act  as  a 
restorative  in  the  debility  of  convalescence.  As  the  combination  of  heat 
and  light,  in  the  direct  rays  of  the  sun,  is  essential  to  the  perfect  devel- 
opment of  vegetables,  so  is  it  probably  also  to  that  of  animals;  and 
there  is  little  doubt  that  this  is  one  of  the  influences  which,  combined 
together  in  a  journey  through  the  country  in  the  warmer  seasons,  tend 
so  powerfully  to  build  up  a  system  dilapidated  by  disease,  worn  out  by 
over-exertion,  or  languishing  from  the  confinement,  impure  air,  and  in- 
door dwelling  of  a  town  life.  To  the  scrofulous  and  consumptive,  exer- 
cise in  the  pure  sunny  air  is  peculiarly  beneficial ;  and  the  direct  warmth 
of  the  sun,  by  a  positive  stimulation  and  invigoration  of  all  the  vital 
processes,  contributes  considerably,  I  have  little  doubt,  to  the  favourable 
influence  of  a  residence  in  warm  climates  over  a  tuberculous  diathesis. 
An  excess  of  it  may,  of  course,  be  injurious,  and  must  be  guarded 
against,  especially  its  immediate  action  on  the  brain. 

The  radiant  heat  of  a  fire  may  be  used  as  a  substitute  for  insolation 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. — HEAT.  491 

in  the  old  and  feeble,  during  winter.  The  same  mode  of  heating  is  often 
used  for  equalizing  the  temperature  in  cases  of  cold  hands  and  feet;  and, 
in  attacks  of  spasmodic  colic,  or  of  subacute  and  neuralgic  rheumatism 
from  exposure  to  cold,  a  thorough  heating  of  the  feet,  before  a  good  fire, 
will  sometimes  produce  a  cure.* 

Substances  used  to  impart  dry  heat  to  the  body  by  conduction  are 
solid  or  aeriform. 

Of  the  former  class  are  bottles  filled  with  hot  water  or  heated  sand;  tin 
vessels  made  to  fit  certain  parts  of  the  body,  and  filled  in  the  same 
manner;  metallic  bodies,  such  as  flat-irons  heated;  hot  bricks;  bay* 
filled  with  heated  oats,  sand,  or  ashes,  and  shaped  so  as  to  lie  conven- 
iently along  various  parts  of  the  body;  and  towels  heated  as  hot  as 
the  skin  will  bear  them,  and  applied  folded  to  the  surface.  These  means 
may  be  had  recourse  to  in  the  cold  stage  of  febrile  diseases ;  the  ad- 
vanced stage  of  the  same  diseases,  with  general  feebleness  and  coldness 
of  the  extremities;  the  collapse  of  cholera  and  other  bowel  affections ; 
asphyxia,  complete  or  partial ;  the  external  paleness  and  chilliness  attend- 
ant on  severe  colic,  and  violent  spasms  of  the  stomach,  gall-duct,  and 
ureters;  in  short,  whenever  there  is  an  indication  for  the  general  stimu- 
lation of  heat,  or  its  derivative  influence  from  irritated,  congested,  or 
inflamed  organs.  In  cases  of  great  emergency,  when  some  powerful 
impression  may  be  necessary  to  rouse  the  failing  sensibilities  of  the 
system,  a  red-hot  coal  may  be  applied  to  the  surface,  especially  to  the 
epigastrium.  I  have  known  of  an  instance  of  this  kind  in  malignant 
typhus,  in  which  the  patient,  who  had  sunk  below  the  reach  of  all  ordi- 
nary stimulants,  was  roused  by  this  means,  and,  on  recovering  after- 
wards, said  that  the  sensation  of  the  burning  coal  had  been  positively 
agreeable  to  him,  in  the  state  of  horrible  vacancy  of  feeling  to  which  he 

*  A  very  interesting  case  of  resuscitation,  in  a  new-born  infant,  under  the  influ- 
ence of  heat,  is  recorded  by  Dr.  Jos.  G.  Richardson,  of  Cayuga  Co.,  New  York,  in 
the  American  Journal  of  Medical  Sciences  (January,  1867,  p.  128).  Induced  by  the 
success  of  Dr.  Richardson,  of  London,  in  restoring  the  action  of  the  heart  by  in- 
jecting heated  blood  into  the  coronary  arteries,  he  conceived  the  idea  of  imitating 
the  experiment  on  the  living  body;  and,  in  the  case  of  the  infant  referred  to,  find- 
ing all  other  methods,  including  artificial  respiration,  but  partially  successful,  he 
caused  the  lower  extremities  of  the  child  to  be  heated  before  a  fire  as  highly  as 
could  be  borne  without  producing  local  mischief,  and  then  by  pressing  the  heated 
blood  in  the  veins  of  the  limbs  towards  the  heart,  he  endeavoured  to  introduce  it 
in  that  state  into  the  coronary  vessels.  The  effect,  he  states,  was  "almost  miracu- 
lous." The  heart,  which  had  before  acted  feebly  and  involuntarily,  quickly  began 
to  pulsate  energetically,  the  respiration  became  continuous,  and  the  prospect  of  a 
thorough  restoration  was  very  encouraging;  but  subsequently,  in  the  absence  of 
the  physician,  death  occurred  from  the  officiousness  of  the  nurse  in  giving  nourish- 
ment, contrary  to  the  injunction  of  the  physician  to  avoid  it.  (A'ote  to  (he  third 
edition.) 


492  GENERAL   STIMULANTS.  [PART  II. 

had  been  reduced.  When  the  solid  bodies  above  enumerated  are  brought 
into  contact  with  the  surface,  care  must  be  taken  that  they  are  not  hot 
enough  to  burn  the  skin ;  and  this  caution  is  the  more  necessary,  because 
the  patient  is  often  himself  too  insensible  at  the  time  to  give  notice  of 
the  danger.  It  is  sometimes  advisable  to  wrap  them  in  flannel,  in  order 
to  interpose  a  slow  conductor  between  them  and  the  skin. 

Heated  air  may  be  employed  for  the  same  purposes.  The  body 
will  support  a  much  higher  temperature  of  the  surrounding  air  when  it 
is  dry,  than  when  moist,  because  in  the  former  state  it  is  a  much  worse 
conductor.  Persons  have  even  remained,  for  a  short  time,  in  chambers 
heated  considerably  above  the  boiling  point,  without  suffering  material 
inconvenience.  According  to  AIM.  Berger  and  Delaroche,  when  the 
temperature  is  between  150°  and  190°,  a  smarting  sensation  is  produced 
in  the  surface,  particularly  in  the  conjunctiva  and  nostrils,  the  veins 
swell,  the  skin  becomes  burning  hot,  the  pulse  is  very  greatly  acceler- 
ated, even  to  1GO  in  a  minute,  the  respiration  is  laboured,  and  vertigo, 
headache,  and  other  disordered  cerebral  phenomena  are  experienced ;  but 
very  soon  a  copious  perspiration  breaks  out,  and  tends  in  a  considerable 
degree  to  obviate  the  unpleasant  effects.  (Forbes,  Cyclop,  of  Pract. 
Med.,  Am.  ed.,  i.  286.)  It  is  very  seldom  necessary,  however,  in  order 
to  obtain  any  desirable  stimulant  effect,  that  the  temperature  should 
exceed  150°;  and  often  a  much  lower  heat  will  answer.  The  stimula- 
tion is  greatest  when  the  patient  is  wholly  immersed  in  the  hot  air,  so  as 
to  inhale  it  into  the  lungs;  but  it  is  a  safer  and  equally  effectual  plan,  for 
all  practical  purposes,  to  allow  the  hot  air  to  be  applied  only  to  the  sur- 
face of  the  body,  while  the  patient  breathes  air  of  the  ordinary  temper- 
ature. As,  in  many  of  the  cases  to  which  the  remedy  is  applicable, 
there  is  an  indication  for  revulsion  from  the  interior  to  the  surface,  the 
latter  plan  is  preferable  on  this  account.  For  the  modes  of  preparing 
the  hot-air  bath,  sec  page  70,  in  the  first  part  of  this  work. 

The  hot-air  bath  is  probably  more  frequently  used  with  a  view  to  pro- 
duce perspiration  than  as  a  mere  stimulant.  For  the  latter  purpose,  how- 
ever, it  may  be  resorted  to  with  much  benefit  in  certain  cases  of  prostra- 
tion, with  coldness  of  the  surface,  to  which  more  particular  reference 
will  be  made  when  the  therapeutic  applications  of  the  hot-water  bath 
are  considered.  As  this  cannot  always  be  commanded,  the  hot-air  bath. 
which  can  generally  be  quickly  prepared  and  applied  with  facility,  may 
often  be  substituted  for  it  with  advantage.* 

*  Through  the  efforts  of  Mr.  Urquhart  and  others,  the  use  of  the  hot-air  bath 
has  recently  received  great  extension  in  England,  with  extraordinary  therapeutic 
rcMilts.  Of  the  various  public  and  private  baths,  erected  within  the  last  seven  or 
eight  years,  one  connected  with  the  Newcastle  Infirmary,  under  the  supervision  of 
Sir  John  Fife,  has  yielded  a  large  experience  of  this  mode  of  cure,  which,  in  the 
course  of  five  years,  has  been  employed  in  more  than  20,000  cases.  The  complaints 


CHAP.  I.]  DIFFUSIBLE   STIMULANTS. — HEAT.  493 

b.  Moist  Heat.  In  moist  heat,  two  quite  distinct  agents  are  combined, 
which  must  be  considered  separately  before  their  joint  influence  can  be 
well  understood.  Heat  is  purely  stimulant ;  water,  purely  sedative ;  and 
the  result  of  their  combined  action  will  depend  on  the  proportion  in  which 
they  respectively  exist  in  the  combination.  The  influence,  too,  of  cold, 
that  is,  of  the  diminution  of  heat  below  the  normal  standard  of  the  sur- 
face of  our  bodies,  must  be  taken  into  account.  This  is  sedative;  but 
differs  in  this  respect  from  the  sedative  influence  of  water,  that  its  de- 
pressing effect  is  always  attended  with  a  disposition  to  reaction,  which 
is  wanting  in  the  operation  of  the  latter.  The  sedative  properties  of  cold 
and  water  will  be  more  fully  considered  in  a  more  appropriate  place. 
They  are  here  alluded  to,  merely  to  make  more  intelligible  the  properties 
and  effects  of  heat  and  moisture  combined.  Water  may  be  applied  to 
the  body,  with  a  view  to  remedial  action,  at  three  different  temperatures; 
below,  at,  and  above  that  of  the  surface  in  health ;  so  as  to  produce,  in 
the  first  instance,  the  sensation  of  cold;  in  the  second,  no  sensation  either 
of  cold  or  heat;  and  in  the  third,  that  of  heat.  It  is  obvious  that,  by  a 
bath  answering  to  the  first  condition,  the  joint  depressing  influence  of 
cold  and  of  water  would  be  produced ;  to  the  second,  the  purely  sedative 
influence  of  water;  and  to  the  third,  the  combined  sedative  influence  of 
water,  ;ui(l  stimulant  influence  of  heat.  The  first  two  conditions  of  the 
bath  may  be  left  out  of  view  in  this  place,  as  not  belonging  to  the  sub- 
ject of  stimulation.  It  is  to  the  third  only  that  our  attention  is  to  be  now 
directed;  that,  namely,  in  which  the  temperature  of  the  bath  is  above 
that  of  the  surface,  so  as  to  occasion  the  sensation  of  heat. 

Hut  Balk.  In  a  bath  of  this  kind,  the  effects  are  both  stimulant  and 
sedative;  and  whether  one  effect  or  the  other  shall  predominate,  must 
depend  on  the  degree  of  the  temperature  above  that  of  the  surface  of  the 
body.  AVhen  the  elevation  is  but  moderate,  the  two  influences  may 
balance  each  other ;  so  that  neither  elevation  nor  depression  of  the  vital 
functions  shall  be  perceptible ;  and  this  is  the  condition  in  which  the  bath 
can  be  longest  borne,  and  which  should  be  aimed  at  when  the  mere 
cleansing  effect  of  water,  with  as  little  impression  as  possible  of  any  kind 
upon  the  system,  is  required.  But  this  equation  of  effect  is  obtained 
only  after  a  short  period  of  inversion.  Heat  acts  more  quickly  than 

in  which  satisfactory  results  are  said  to  have  been  obtained  from  it,  are,  among 
others,  acute  and  chronic  rheumatism,  gout,  neuralgia,  catarrh,  various  throat  affec- 
tions, diarrhoea,  dysentery,  diseases  of  the  liver  and  stomach,  dropsy,  scrofulous 
affections,  and  incipient  phthisis.  It  is  not,  however,  as  a  general  stimulant  exclu- 
sively that  it  operates  in  guch  cases.  Its  strong  revulsive  influence  must  greatly 
contribute  to  its  efficiency;  and,  as  a  powerful  means  of  producing  diaphoresis, 
it  acts  both  as  an  evacuant,  and  as  an  eliminative  agent  with  great  effect.  In  ref- 
erence to  these  effects  of  the  hot-air  bath,  it  will  be  more  particularly  noticed  here- 
after. (Note  to  the  third  edition.) 


4!H  GENERAL   STIMULANTS.  [PART  II. 

water;  and  its  excitant  influence,  even  when  it  is  only  in  very  moderate 
excess,  is  experienced  before  the  water  has  fairly  begun  to  operate;  so 
that  a  short  time  must  elapse  before  the  balance  is  established.  Nor 
docs  the  exact  balance  continue  long.  Under  the  stimulus  of  heat,  the 
excitability  is  impaired,  and  the  excitation  consequently  gradually  ceases, 
and  is  at  length  followed  by  depression,  according  to  the  general  law ; 
while  the  sedative  effect  of  the  water  is  increased,  the  longer  that  agent 
continues  to  operate.  Hence,  the  short  period  during  which  the  two 
are  balanced  is  followed  by  a  period  of  depression  much  greater  than  the 
antecedent  elevation,  and  increasing  with  the  continuance  of  the  agent. 
The  bath,  therefore,  of  which  the  temperature  is  but  slightly  above  that 
of  the  surface,  can  scarcely  be  considered  as  a  stimulant  agent ;  the  ex- 
citant effects  being  moderate  and  very  brief,  and  the  sedation  soon  pre- 
dominating. It  is,  therefore,  as  a  sedative  remedy  that  it  is  almost  uni- 
formly employed ;  and  as  such  it  will  be  considered  hereafter,  under  the 
name  of  the  warm  bath.  The  title  of  hot  bath  should  be  confined  to  that 
in  which  the  heat  is  felt  at  first  rather  disagreeably,  and  in  which  the 
excitant  effect  decidedly  predominates,  and  continues  to  predominate  for 
a  considerable  time.  It  is  the  operation  of  this  variety  of  the  bath  that 
is  now  to  be  considered. 

The  limits  of  the  hot  bath,  as  determined  by  the  sensations,  may  be 
placed,  in  reference  to  the  lower  extreme,  at  the  point  when  the  heat  is 
merely  somewhat  uncomfortable ;  in  reference  to  the  higher,  at  that  in 
which  it  is  barely  not  insupportable.     As  indicated  by  thermometrical 
degrees,  they  cannot  be  fixed  precisely;    because  they  vary  with  the 
variable  sensibility  and  temperature  of  the  surface;  but  the  lowest  point 
may  be  considered  as  somewhere  between  95°  and  100°  Fahr.,  and  the 
highest  between  100°  and  112°  ;  and  it  is  never  advisable  to  exceed  the 
decree  last  mentioned.     At  the  mean  of  103°,  the  bath  is  actively  stim- 
ulant, producing  a  strong  sensation  of  heat,  reddening  and  expanding 
the  surface  of  the  body,  increasing  the  frequency,  force,  and  fulness  of 
the  pulse,  hurrying  the  respiration,  and  causing  at  first  an  agreeable  ex- 
citement of  the  brain,  not  unlike  the  effect  produced  by  wine,  but  ending. 
if  the  immersion  continue,  in  painful  sensations  of  fulness,  distension,  and 
vertigo.     After  a  time,  perspiration  breaks  out  upon  those  parts  of  the 
body  not  covered  with  the  water;  and,  if  the  patient  is  removed  from 
the  bath,  and  placed  in  bed,  the  whole  surface  usually  becomes  relaxed, 
and  bathed  in  a  copious  sweat.    The  excitement  gradually  subsides;  and 
is  followed,  if  the  regular  succession  of  events  is  not  modified  through 
some  abnormal  state  of  the  system,  by  universal  relaxation,  with  depres- 
sion of  the  pulr-e,  muscular  weakness,  feelings  of  languor  and  drowsiness, 
and  ultimately  sleep.     The  immersion  may  continue  from  four  or  five 
minutes  to  half  an  hour,  according  to  the  effects;  the  patient  being  always  , 
removed  when  unpleasant  cerebral  phenomena  are  produced,  and  never 


CHAP.  I.]  DIFFUSIBLE   STIMULANTS. — HEAT.  495 

allowed  to  remain  when  the  stimulant  effect  is  the  main  indication,  until 
evidences  of  depression  supervene. 

The  operation  of  the  water  in  the  hot  bath  is  at  first,  through  its  con- 
ducting power,  to  hasten  the  stimulating  effects  of  the  heat,  but  after- 
wards, by  the  relaxation  it  produces,  to  favour  the  secondary  depression  ; 
and  the  latter  result  often  adds  greatly  to  the  beneficial  influence  of  the 
remedy,  when  it  is  designed  to  act  rather  as  a  revulsive  agent  than  as 
:i  general  excitant. 

The  conditions  indicating  the  use  of  the  hot  bath  are  1.  coldness  of 
the  surface,  with  either  general  prostration,  or  powerful  and  concentrated 
internal  irritation,  inflammation,  or  congestion;  and  2.  an  abnormal 
state  of  system,  in  which  a  strong  impression  is  required,  to  break  up 
long-continued  and  obstinate  morbid  associations.  The  following  are 
affections  in  which  these  indications  are  presented. 

In  the  cold  stage  of  febrile  diseases,  particularly  those  of  a  malignant 
or  pernicious  character,  there  is  sometimes  a  degree  of  prostration  and 
indisposition  or  inability  to  react,  which  is  extremely  dangerous.  The 
nervous  centres  seem  to  have  become  almost  inert  under  the  violence  of 
the  morbid  cause,  and  the  most  important  vital  functions  are  prostrate 
under  the  want  of  their  necessary  influence.  The  heart  acts  feebly,  the 
surface  is  cold  and  pale,  and  the  great  internal  organs  are  loaded  with 
the  venous  blood,  which  accumulates  in  them  because  the  moving  forces 
are  unable  to  carry  it  forward.  Sometimes  death  takes  place  without 
any  reaction  ;  sometimes  feeble  and  insufficient  efforts  at  reaction  are 
made,  and  the  patient  sinks  back  into  the  same  alarming  prostration  as 
at  first.  In  aid  of  other  stimulant  measures,  the  hot  bath  may  often  be 
resorted  to,  in  these  cases,  with  great  advantage.  Through  its  powerful 
impression  on  the  surface,  it  rouses  the  nervous  centres  from  their  torpor, 
and  tlm*  indirectly  excites  the  circulatory  and  respiratory  functions;  by 
heating  the  blood  as  it  passes  through  the  vessels  of  the  skin,  it  renders 
that  fluid  more  stimulating  to  the  great  interior  organs,  as  the  heart, 
lungs,  and  brain,  into  which  it  is  conveyed ;  and,  while  thus  acting  as  a 
powerful  general  stimulant,  it  is  no  less  powerfully  revulsive,  irritating 
the  whole  of  the  cutaneous  capillaries  to  an  active  expansion,  and  draw- 
ing into  them  the  blood  before  accumulated  in  the  central  viscera  arnd 
great  venous  trunks.  It  is  one  of  the  most  efficient  agents,  in  such  cases, 
in  bringing  about  reaction.  Typhus  fever,  pernicious  miasmatic  fever, 
smallpox,  scarlatina,  and  epidemic  erysipelas  are  among  the  diseases,  in 
the  initial  or  cold  stage  of  which  the  hot  bath  not  unfrequently  proves 
useful  on  the  principles  here  stated.  It  has,  too,  the  great  advantage 
over  internal  stimulants,  that  it  can  be  at  once  withdrawn  when  needed 
no  longer,  and  does  not  add,  by  a  prolonged  influence,  to  the  violence  of 
the  reaction  when  this  is  brought  about. 

In  sudden  prostration  occurring  in  the  advanced  stages  of  low  fevers, 


496  GENERAL   STIMULANTS.  [PART  II. 

in  prolonged  asphyxia,  in  the  collapse  of  cholera,  haemalemesis,  and 
melsena,  similar  indications  are  afforded  by  the  cold  surface,  the  pros- 
trated vital  functions,  and  the  interior  congestion. 

In  the  retrocession  of  cutaneous  eruptions,  the  hot  bath  is  often  use- 
ful. In  some  instances,  the  apparent  retrocession  is  nothing  more  than 
a  sudden  general  prostration,  in  which  the  actions  of  the  surface  fail 
with  those  of  the  whole  system,  and  which  differs  in  nothing  from  the 
sinking  spells  of  low  fevers  noticed  in  the  last  paragraph  ;  but,  in  most 
cases,  it  is  owing  to,  or  connected  with  the  occurrence  of  severe  internal 
irritation,  which  it  is  highly  desirable  to  recall  as  quickly  as  possible  to 
the  surface.  Not  unfrequently,  a  similar  condition  existing  previously 
to  the  eruption,  retards  its  appearance,  and  sometimes  it  may  even  keep 
back  the  cutaneous  affection  altogether,  to  the  great  detriment  of  the 
patient.  Under  these  circumstances,  the  hot  bath  proves  serviceable  by 
powerfully  exciting  the  skin,  and  making  this  the  seat  of  afflux  for  the 
irritative  tendencies.  The  eruption  again  appears,  or  comes  forth  if  not 
previously  existing,  and  the  symptoms  of  internal  disorder  cease  almost 
instantaneously. 

Painful  internal  spasms  are  generally  more  beneficially  treated  by 
the  relaxing  warm  bath  than  by  the  stimulant  hot  bath  ;  but  sometimes 
they  are  so  severe,  and  attended  with  so  much  general  prostration,  that 
thft  former  remedy  is  quite  inefficient,  and  it  becomes  desirable  to  have 
recourse  to  the  greater  energy  of  the  latter.  Violent  attacks  of  nervous 
gout  in  the  stomach  and  bowels,  of  colic,  and  of  spasm  of  the  dia- 
phragm, are  examples  of  this  kind.  The  remedy  acts  by  a  revulsive 
impression  on  the  general  surface. 

Internal  inflammation  is  usually  not  a  proper  subject  for  the  influ- 
ence of  the  hot  bath,  which  too  much  excites  the  circulation,  and  sends 
the  blood  too  forcibly  into  the  parts  affected;  but,  in  certain  cases,  the 
inflammation  is  so  violent  and  extensive  as  to  concentrate  the  blood  and 
the  nervous  energy  of  the  system  in  its  own  scat,  with  the  effect  of  pros- 
trating the  general  functions,  and  inducing  great  apparent  debility,  for 
which,  indeed,  the  condition  has  sometimes  been  fatally  mistaken.  The 
cold  and  pale  surface,  and  feeble  pulse  seem  to  call  for  active  stimula- 
tion ;  while,  in  fact,  prompt  and  free  bleeding  is  indicated,  and  is  some- 
times the  only  remedy  which  will  save  the  patient.  Gem-rally,  under 
these  circumstances,  if  a  vein  is  opened,  the  blood  will  flow,  slowly  and 
scantily  at  first,  but  with  a  gradually  increasing  current;  and,  so  far 
from  still  further  failing,  the  pulse  will  rise,  and  become  fuller  and 
stronger,  as  the  operation  proceeds.  This,  however,  is  not  always  the 
case;  and  it  is  found  impossible  to  continue  the  bleeding  without  endan- 
gering fatal  prostration.  In  such  a  case,  the  hot  bath  is  an  admirable 
remedy.  By  its  powerful  revulsive  action  it  calls  the  blood  from  the 
interior  to  the  surface,  stimulating  the  heart  at  the  same  time;  and 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. — HEAT.  497 

though  of  itself  it  would  be  altogether  inadequate  to  the  cure,  and,  if 
continued,  might  act  injuriously  upon  the  inflamed  organ  by  sending 
the  blood  into  it  too  vigorously,  yet  it  prepares  the  system  for  the  use 
of  the  lancet,  and  thus  opens  the  way  for  a  cure  which  might  not  other- 
wise be  possible.  It  should  of  course  be  withdrawn  the  moment  that 
it  has  answered  its  purpose.  In  cases  of  this  kind,  the  warm  bath, 
though  useful  in  ordinary  internal  inflammations,  would  be  quite  inert; 
and  might  even  be  injurious  by  its  sedative  action  on  the  surface  and  the 
heart.  Extensive  inflammation  of  the  peritoneum,  dysentery  of  extra- 
ordinary intensity,  and  violent  pneumonia  in  the  congestive  stage,  and 
occupying  both  lungs,  sometimes  present  the  condition  referred  to. 

Obstinate  chronic  enteritis,  with  little  or  no  excitement  of  the  circula- 
tion, and  an  habitually  dry,  palish,  and  cool  skin,  may  also  be  advanta- 
geously treated  with  the  hot  bath,  repeated  every  day,  especially  if 
made  somewhat  more  permanently  irritant  to  the  skin  by  the  addition 
of  common  salt :  and  the  same  remark  will  apply  to  inflammation  of 
other  abdominal  viscera,  presenting  the  same  conditions.  In  the  first 
mentioned  affection,  I  have  found  the  hot  salt-bath  one  of  the  most  effica- 
cious remedies. 

It  was  stated  above  that  the  hot  bath  is  indicated  in  some  obstinate 
long-continued  affections,  in  which  it  appears  to  act  by  breaking  up  mor- 
bid associations.  Possibly  it  may  operate  by  a  penetrating  stimulation 
of  all  the  tissues,  which  are  thus  roused  out  of  their  habit  of  morbid, 
action  into  an  over-excitement,  from  which  they  may  afterwards  subside 
into  health.  In  some  such  method  as  this,  it  sometimes  proves  benefi- 
cial in  cases  of  chronic  rheumatism  and  gout,  occupying  at  the  same 
time  various  parts  of  the  system,  distorting  the  joints,  contracting  the 
tendons,  and  not  unfrequently,  to  a  greater  or  less  extent,  paralyzing  the 
muscles.  It  is  not  impossible,  however,  that  the  diaphoretic  action  of 
the  bath  may  add  to  its  efficiency.  The  bathing  at  hot  springs  has 
proved  peculiarly  useful  in  these  diseases. 

Perhaps  in  the  same  category  may  be  placed  certain  chronic  and  indo- 
lent affections  of  the  skin,  in  which  the  tissue  requires  to  be  roused  alike 
out  of  its  torpor,  and  out  of  its  morbid  habit  of  acting.  Caution  is 
necessary  not  to  use  the  bath  at  too  early  a  stage ;  and  if,  as  often 
happens  with  stimulating  applications  made  prematurely,  it  should  be 
found  to  excite  inflammation  or  high  irritation,  it  should  be  immediately 
suspended.  It  should  also  be  accompanied  with  alterative  measures,  to 
change  the  constitutional  condition,  while  the  attempt  is  made  to  relieve 
the  local  disease. 

In  paralytic  cases  of  long  standing,  in  which  the  original  cause,  if 
affecting  the  nervous  centres,  has  quite  ceased  to  operate,  and  the  dis- 
ease is  sustained  by  a  morbid  indolence  of  the  tissues  concerned,  whether 
VOL.  i. — 32 


GENERAL    STIMULANTS.  [PART  II. 

nervous  or  muscular,  some  good  may  be  hoped  for  from  the  hot  bath,  in 
connection  with  other  measures. 

The  contraindications  to  the  use  of  the  hot  bath  are  a  plethoric  state 
of  system,  determination  of  blood  to  the  head,  active  heinorrhagic  tend- 
encies, general  vascular  irritation  with  active  congestion,  aneurisms  and 
hypertrophy  of  the  heart,  acute  inflammation  with  well-developed  fever, 
the  febrile  state  generally  with  a  hot  skin,  and  a  peculiarly  irritable  state 
of  the  nervous  system. 

Local  Hot  Bathing.  Hot  water  may  be  employed  locally  by  semicupium, 
coxseluvium,  pediluvium,  maniluvium,  fomentation,  or  cataplasm.  For 
an  account  of  these  methods  of  application,  the  reader  is  referred  to  page 
69.  They  act  on  the  same  principles  as  the  general  hot  bath,  but  are 
much  less  powerful,  and,  with  the  exception  of  the  semicupium,  or  half- 
bath,  which  is  usually  employed  as  a  milder  substitute  for  the  general 
bath,  and  in  cases  where  determination  to  the  head  or  trunk  is  feared, 
are  used  less  for  general  .stimulation,  than  for  their  excitant  effect  on 
some  one  part  or  organ  of  the  body,  or  for  their  revulsive  influence. 

Thus,  the  hot  hip-bath  is  used  to  stimulate  the  uterus  in  amenorrhoea; 
and  the  hot  foot-bath  and  hand-bath  to  act  revulsively  from  the  head  or 
interior  organs  towards  the  extremities,  whenever  the  latter  are  cold,  and 
evidences  exist  in  the  former  of  active  .congestion  without  fever,  and  espe- 
cially when  gout  or  rheumatism  has  retroceded  from  the  extremities,  and 
it  is  desirable  to  restore  it  to  its  original  seat.  Hot  fomentations,  or  hot 
cataplasms,  are  employed  to  relieve  by  revulsion  either  inflammation, 
spasm,  or  other  irritation  of  interior  organs  over  which  they  may  be 
applied,  or  to  stimulate  the  part  to  increased  action,  as  when  it  is  desir- 
able to  hasten  a  languid  external  inflammation  onward  to  suppuration, 
and  through  this  to  a  more  speedy  cure. 

Another  form  of  local  application  is  the  hot  douche,  or  stream  of  water 
falling  from  a  height,  or  directed  with  some  force  upon  the  part.  This 
unites  the  effects  of  shock  and  pressure  to  the  stimulant  action  of  the 
heat,  and  proves  sometimes  more  efficient  than  the  simple  application  of 
hot  water,  in  chronic  rheumatic  and  gouty  swellings,  obstinate  local 
palsies,  and  indolent  tumefactions  and  indurations  of  inflammatory 
origin. 

Hot  Vapour  Bath.  In  some  countries  there  are  public  vapour  baths. 
in  which  numbers  may  be  collected  in  the  same  chamber;  and  this  is 
occasionally  so  arranged,  with  seats  rising  one  above  another,  that  per- 
sons may  be  exposed  to  various  temperatures;  the  heat  of  the  apartment 
increasing  from  below  upward,  because  it  is  the  tendency  of  the  vapour 
to  ascend.  Thus,  upon  the  level  of  the  floor  the  heat  may  be  only  110° 
Fahr.,  while  in  the  uppermost  part  of  the  chamber  it  may  be  as  high  as 
160°  or  180°.  Of  course,  the  patient  inhales  the  hot  moistened  air,  as 
well  as  feels  its  effects  upon  the  surface.  The  vapour  may  be  introduced 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. — HEAT.  499 

into  the  chamber  from  without,  or  by  throwing  water,  within,  upon 
stones  heated  to  redness  by  a  furnace  beneath.  But,  in  this  country,  it 
is  only  the  solitary  vapour  bath  which  is  employed.  For  the  various 
modes  of  preparing  it,  see  page  71,  in  the  first  part  of  this  work.  It  may 
be  so  arranged  that  the  patient  can  breathe,  at  his  pleasure,  either  the 
moistened  air  of  the  bath,  or  the  cold  external  air.  The  heating  effect 
of  the  former  is  greater ;  but  its  revulsive  influence  is  less ;  and,  as  it  has 
a  tendency  to  suppress  the  pulmonary  exhalation,  it  may  sometimes  act 
injuriously  when  the  latter  would  be  quite  safe. 

In  consequence  of  the  less  conducting  power  of  vapour  than  of  water, 
the  former  can  be  borne  at  a  much  higher  temperature  than  the  latter; 
while,  for  a  corresponding  reason,  the  vapour  bath  may  be  intolerable  at 
a  temperature  at  which  dry  air  could  be  borne  without  inconvenience, 
the  latter  being  a  slower  conductor.  According  to  Dr.  Forbes,  the  heat- 
ing  effect  of  the  hot  bath,  at  from  98°  to  106°,  is  equal  to  that  of  the 
vapour  bath,  when  the  air  is  breathed,  at  from  110°  to  130°,  and  when 
it  is  not  breathed,  at  from  120°  to  160°  (Cyc.  of  Pract.  Med.,  Am. 
ed.,  i.  255);  and  these  are  the  temperatures  within  which  the  methods 
respectively  may  be  employed ;  though,  in  each,  the  heat  may  be  raised 
with  impunity  considerably  above  the  highest  point  mentioned.  The 
effects  of  the  vapour  bath,  and  of  the  hot  bath,  are  essentially  the  same 
in  reference  to  stimulation  and  revulsion ;  but  the  former  is  attended 
with  much  more  copious  perspiration  during  its  continuance  than  the 
latter;  the  contact  of  water  with  the  surface  having  great  effect  in  pre- 
venting extravasation  from  the  blood.  Another  difference  is  that  the 
relaxing  or  sedative  effect  of  the  vapour  is  less  than  that  of  the  water; 
and  that  consequently  the  stimulation  of  the  former,  though  more  slowly 
induced,  is  longer  sustained,  and  is  accompanied  with  a  less  degree  of 
soothing  influence.  The  vapour  bath  may  be  used  for  the  same  purposes 
us  the  hot  bath,  but  is,  upon  the  whole,  less  efficient  and  less  agreeable. 
In  its  extemporaneous  form,  it  may  be  employed  when  circumstances 
may  render  it  impossible,  or  extremely  inconvenient  to  prepare  and  apply 
the  bath  of  heated  water.  It  is  also  preferable,  in  some  instances,  when 
the  indication  is  to  produce  profuse  perspiration  with  a  stimulant  effect, 
as  in  certain  cases  of  chronic  rheumatism. 

Local  vapour  baths  may  be  applied  by  exposing  any  part  of  the  body 
to  the  steam  escaping  from  boiling  water,  which  may  be  readily  confined 
by  a  suitable  arrangement  of  woollen  or  other  clotlis.  But  they  are 
employed  more  for  the  relief  afforded  to  inflammatory,  and  other  painful 
affections,  by  the  copious  perspiration  they  induce  in  the  part,  than  as 
stimulant  agents. 

The  same  may  be  said  of  the  hot  vapour  douche,  which  consists  in  a 
jet  of  heated  vapour  directed  on  some  part  of  the  surface.  It  differs  from 
the  simple  application  of  steam  only  in  exposing  the  part  to  successive 


500  GENERAL   STIMULANTS.  [PART  II. 

portions  of  vapour,  instead  of  continuously  to  the  same ;  and  the  effect 
is  consequently  somewhat  greater.  It  may  be  applied  by  causing1  steam 
to  pass  through  a  pipe  from  a  vessel  of  boiling  water ;  or,  in  relation 
to  the  meatus  auditorius  of  the  ear,  by  holding  the  orifice  of  the  rueatus 
over  the  small  end  of  a  funnel,  the  larger  end  of  which  is  placed  over  a 
vessel  of  water  boiling  hot.  In  the  latter  case,  the  remedy  may  be  used, 
as  a  stimulant  to  the  ear,  in  cases  of  defective  hearing  from  deficiency  of 
nervous  power. 

Finally,  healed  vapour  may  be  applied  exclusively  to  the  lungs  by  in- 
halation, and  thus  made  to  act  as  a  stimulant  to  the  bronchial  tubes 
when  enfeebled,  and  exposed  to  the  excessive  production  of  mucus  in 
consequence  of  this  relaxed  state ;  but  the  measure  would  require  to  be 
conducted  with  much  caution.  At  a  lower  temperature,  so  as  to  pro- 
duce, not  the  stimulant  effects  of  heat,  but  the  soothing  and  emollient 
effects  of  mere  moisture,  it  may  often  be  used  with  benefit.  But  this 
action  of  the  remedy  belongs  to  another  section.  For  the  modes  of  ap- 
plying vapour  by  inhalation,  see  page  75. 

Hot  Water  as  Drink.  Hot  water  has  the  same  stimulant  effect,  when 
taken  internally,  as  when  applied  to  the  surface ;  but  it  is  almost  never 
used  except  as  a  vehicle  for  other  substances,  the  action  of  which  it  often 
very  much  promotes,  and,  even  in  this  mode  of  administration,  is  much 
less  employed  with  a  view  to  its  stimulant  action,  than  as  a  diaphoretic. 
In  cases  of  great  prostration,  it  may  sometimes  be  advisable  to  exhibit 
stimulant  drinks  heated  rather  than  cool,  as  their  effects  are  thus  both 
hastened  and  augmented. 


H.  ELECTRICITY  AS  A  DIFFUSIBLE  STIMULANT. 

In  treating  of  electricity  as  a  remedial  agent,  I  shall  take  it  for  granted 
that  the  reader  is  already  acquainted  with  its  chemical  and  physical  prop- 
erties, and  with  the  prevalent  opinions  of  its  nature.  In  this  place  it  is 
to  be  considered  only  in  relation  to  its  physiological  and  therapeutical 
effects,  and  to  the  methods  of  employing  it  as  a  remedy.  As  these 
effects  are  materially  modified  by  the  modes  in  which  it  is  developed  or 
excited,  and  applied,  the  latter  division  of  the  subject  must  be  first 
treated  of,  in  order  that  what  may  be  said  on  the  former  may  be  understood. 

I  wish  here  to  express  my  indebtedness  for  much  which  follows  to  the 
excellent  work  of  M.  Duchenne  de  Boulogne,  who,  by  his  thorough  and 
laborious  experimental  investigation  of  electricity  in  its  medical  rela- 
tions, the  sagacity  with  which  he  has  traced  the  various  ramifications  of 
its  influence,  and  the  ingenuity  and  perseverance  with  which  he  has  ap- 
plied the  knowledge  thus  obtained  to  successful  therapeutic  results,  has 
given  a  precision  to  the  subject  which  it  before  much  wanted,  and  lui* 
opened  a  new  era  in  the  history  of  the  remedy. 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. — ELECTRICITY.  501 

1.  Modes  of  Development  or  Excitation. 

For  medical  purposes  electricity  is  developed  or  excited  in  four  some- 
what distinct  methods;  1.  by  friction,  in  the  form  of  common  elec- 
tricity; 2.  by  contact  and  chemical  reaction,  in  the  form  of  galvanism  ; 
3.  by  magnetic  induction,  in  the  form  of  electro-magnetism ;  and  4.  by 
a  combination  of  magnetic  and  galvanic  induction,  as  by  the  volta- 
electric  apparatus. 

a.  Excitation  by  Friction. 

General  Observations.  Electricity  excited  by  friction  is  usually  de- 
nominated static,  conveying  the  idea  that  it  is  stationary  or  not  in  action, 
while  in  the  form  of  galvanism  it  is  said  to  be  dynamic,  as  being  essen- 
tially in  movement,  and  exercising  power.  Though  this  distinction  is 
not  very  precise,  it  may  serve  at  least  the  purposes  of  nomenclature.  A 
very  great  difference  exists  between  the  phenomena  exhibited  by  these 
»two  forms  of  electricity ;  the  static  having  in  a  high  degree  the  proper- 
ties of  attraction  and  repulsion,  and,  when  brought  into  movement,  ex- 
ercising great  mechanical  power ;  the  dynamic  exhibiting  its  energy  more 
in  developing  heat,  and  producing  chemical  change.  It  is  supposed  that 
this  difference  depends,  not  on  any  essential  diversity  of  character,  but 
on  the  different  states  of  the  electricity  developed  in  the  two  methods ; 
that  excited  by  friction  having  little  quantity,  but  great  tension  or  inten- 
sity, by  which  it  is  able  to  overcome  resistance,  while  that  set  in  move- 
ment by  contact  and  chemical  reaction  has  feeble  tension,  but  large 
quantity.  These  terms,  however,  are  rather  conventional,  intended  to 
represent  certain  qualities  in  convenient  language,  than  absolutely  ex- 
pressive of  the  fact ;  for  it  is  by  no  means  universally  admitted  that 
electricity  is  a  distinct  substance,  to  which  the  term  quantity  is  at  all 
applicable,  unless  as  a  figure  of  speech. 

.Means  of  Excitation.  Static  electricity  is  developed  by  means  of  fric- 
tion between  two  substances,  and  this  is  usually  effected  by  an  apparatus 
called  the  electrical  machine,  constructed  in  different  methods,  for  an 
account  of  which  I  must  refer  to  works  on  chemistry  or  natural  philoso- 
phy. To  every  ^achine  is  attached  an  insulated  conducting  body  called 
the  prime  conductor,  which  receives  upon  its  surface  the  electricity  as  it 
is  excited,  and  retains  it  for  a  considerable  time,  in  consequence  of  the 
non-conducting  property  of  the  dry  air  around  it.  Thus  developed,  the 
electricity  acquires  a  degree  of  tension,  proportionate  to  the  power  and 
working  of  the  apparatus,  by  which  it  is  enabled  to  break  its  way 
through  the  resisting  air  to  neighbouring  bodies,  producing  a  stream  of 
light  in  its  passage,  and  a  very  perceptible  sound.  When  the  tension  is 
very  great,  the  spark,  as  this  flash  istcalled,  may  be  many  inches  long; 
when  very  slight,  it  may  be  even  less  than  an  inch.  In  order  that  the 


502  GENERAL   STIMULANTS.  [PART  II. 

electricity  may  escape  in  this  way,  the  body  approaching  the  conductor 
must  be  rounded  or  flat;  as,  if  pointed,  it  receives  the  electricity  quietly, 
and  almost  insensibly  from  the  conductor. 

Silent  Conduction.  If  any  part  of  the  person  be  brought  into  contact 
with  the  prime  conductor,  the  electricity  passes  silently  into  and  through 
it,  or  along  its  surface,  into  the  earth,  in  search  of  the  equilibrium  to 
which  it  always  tends. 

Sparks.  If,  instead  of  coming  into  absolute  contact  with  the  excited 
prime  conductor,  a  part  of  the  body  be  made  to  approach  it  within  a  cer- 
tain distance,  greater  or  less  according  to  the  degree  of  electric  tension, 
the  fluid  passes  to  the  body  by  sparks,  which  produce  a  decided  sensation 
as  they  are  received.  By  means  of  rods  or  chains  of  metal,  or  other  con- 
ducting substance,  in  contact  at  one  end  with  the  prime  conductor,  and 
having  a  rounded  knob  at  the  other,  the  electricity  may  be  conveyed  to 
any  convenient  distance  from  the  machine,  and  applied  by  sparks  to  any 
part  of  the  body.  These  communicating  instruments  are  called  directors, 
and  must  be  insulated  from  the  hand  of  the  operator  by  some  non-con- 
ducting substance,  such  as  glass,  which  may  at  the  same  time  serve  as 
a  handle. 

Electrical  Bath.  Another  method  of  applying  static  electricity  is  by 
placing  the  patient  upon  a  stool,  insulated  by  glass  legs,  and  then  con- 
necting him  with  the  prime  conductor.  His  body  thus  shares  the  elec- 
tricity with  the  conductor,  and  acquires  precisely  the  same  relations 
towards  the  machine  and  other  surrounding  objects.  In  this  way  it  may 
become  saturated  with  the  fluid,  which  escapes  very  slowly  and  silently 
from  the  hairs,  finger  and  toe  nails,  and  the  surface  of  the  body  generally  ; 
the  hairs  rising  up  and  standing  apart  under  its  repellent  force.  Sparks 
may  now  be  drawn  from  any  part  of  the  body  by  the  approach  of  a  blunt 
conducting  substance;  and,  liy  keeping  the  machine  constantly  in  action, 
this  condition  may  be  indefinitely  prolonged.  By  communicating  with 
the  negatively  excited,  instead  of  the  positive  prime  conductor,  it  is  ob- 
vious that  the  body  may  itself  become  negatively  excited  ;  and,  by  vary- 
ing the  connection,  the  peculiar  effects  of  either  of  these  two  modes  <>f 
the  electric  influence  may  be  separately  obtained.  This  method  of  ap- 
plying electricity  is  denominated  the  electric  bath.  $ 

Electric  Aura.  This  is  a  current  of  electricity  directed  to  any  pan  of 
the  body,  through  the  air,  by  means  of  a  pointed  insulated  director,  con- 
nected at  one  end  with  the  excited  prime  conductor  by  a  chain,  and,  at 
the  other  and  pointed  extremity,  held  near,  but  not  in  contact  with  tin- 
portion  of  surface  to  be  acted  on.  The  electricity  silently  and  invisibly 
issues  from  the  point,  and,  expanding  cone-like  as  it  passes  through  the 
air,  spreads  itself  out  broadly  upon  the  surface.  Exactly  the  reverse 
takes  place,  when  a  similar  point  is  held  near  the  body,  itself  in  a  state 
of  electric  excitation  upon  an  insulated  stool.  Little  if  any  sensation  is 
in  either  case  experienced. 


CHAP.  I.]  DIFFUSIBLE   STIMULANTS. — ELECTRICITY.  503 

Leyden  Jar  and  Electric  Battery.  By  these  instruments  the  greatest 
force  of  the  electricity  of  friction  is  obtained.  The  jar  is  a  broad-mouthed 
glass  bottle,  coated  within  and  without  by  tin-foil,  excepting  the  upper 
part  of  both  surfaces,  where  it  is  bare.  With  the  inner  coating  is  in 
contact  a  chain,  connected  with  a  metallic  rod,  which  passes  upward 
through  a  cork,  or  other  material  closing  the  mouth  of  the  bottle,  and 
ends  in  a  round  metallic  ball  at  top.  When  this  ball  is  put  in  communi- 
cation with  the  excited  prime  conductor  of  the  machine,  the  inner  coat- 
ing becomes  positively  charged,  while,  at  the  same  time,  by  the  laws  of 
electric  induction,  the  outer  coating  passes  into  the  negative  or  opposite 
state.  If  now  a  conducting  substance  be  connected  with  the  inner  coat 
by  means  of  the  knob,  and  directly  or  indirectly  with  the  outer,  the 
equilibrium  is  instantly  restored,  and  the  whole  force  of  the  movement  is 
exerted  upon  the  connecting  material.  If  this  be  the  body,  a  shock  is 
felt,  proportionate  in  degree  to  the  extent  of  the  coated  surfaces,  and  the 
amount  of  the  charge.  It  may  be  so  slight  as  to  occasion  little  incon- 
venience, or  so  powerful  as  to  destroy  life  like  a  flash  of  lightning,  which, 
indeed,  is  nothing  more  than  the  spontaneous  discharge  of  an  analogous 
electric  arrangement  in  the  atmosphere,  or  between  that  and  the  earth. 
But  to  obtain  a  shock  of  such  extreme  violence,  it  would  be  necessary 
to  make  the  bottle  of  an  unwieldy  magnitude  ;  and  the  same  end  is  at- 
tained by  connecting  together  a  number  of  bottles  by  their  inner  and 
outer  surfaces  respectively,  so  that  the  whole  may  be  discharged  at  once. 
Such  an  arrangement  is  called  the  electric  battery,  and  affords  an  instru- 
ment of  immense  power. 

The  current  of  electric  force  may,  with  either  the  jar  or  battery,  be 
made  to  penetrate  through  the  skin,  and  enter  deeply  into  the  body;  and, 
by  means  of  directors  connected  with  the  opposite  excited  surfaces,  may 
be  conveyed  from  one  end  of  the  body  to  the  other,  or  through  it  from 
side  to  side,  or  from  one  part  to  another  of  a  limb,  or  through  very  lim- 
ited portions  of  the  body,  at  the  pleasure  of  the  operator.  The  directors 
must  of  course  have  insulated  handles,  and  their  knobbed  free  extrem- 
ities must  be  applied  at  the  opposite  extremities  of  the  part  through 
which  the  current  is  to  pass.  If  the  object  be  to  direct  the  electricity 
into  a  single  muscle,  both  extremities,  as  directed  by  M.  Duchenne,  should 
be  applied  immediately  over  the  muscle,  with  the  space  of  an  inch  or 
more  between  them. 

A  repetition  of  graduated  effects  may  be  obtained  through  the  jar,  by 
placing  its  ball  in  communication  with  the  excited  prime  conductor,  and 
its  external  surface,  in  any  convenient  method,  with  one  of  Lane's  elec- 
trometers, in  such  a  manner,  that  the  ball  of  the  electrometer  shall  not 
be  in  absolute  contact  with  it,  but  within  striking  distance  of  the  elec- 
trical spark.  By  means  of  chains,  insulated  directors  may  be  connected 
with  the  prime  conductor  and  the  electrometer,  and  their  knobs  applied 


504  GENERAL   STIMULANTS.  [PART  II. 

at  the  required  points  of  the  surface.  When  the  machine  is  set  in  mo- 
tion, and  the  jar  becomes  charged,  at  the  moment  of  connection  through 
the  body,  the  electrical  current  passes  between  the  knob  of  the  electro- 
meter and  the  outer  coating  of  the  jar,  to  establish  the  equilibrium.  If 
the  intervening  space  is  large,  the  shock  will  be  necessarily  severe,  for 
great  tension  will  be  necessary  to  overcome  the  resistance  of  the  air;  if 
very  small,  the  shock  may  be  slight ;  so  that  its  severity  may  be  regu- 
lated by  regulating  this  interval,  and  at  the  same  time  attending  to  the 
working  of  the  machine.  Care  should  be  taken  that  the  jar  should  be 
fully  discharged  before  commencing  operations ;  and  then  the  handle  of 
the  machine  should  be  turned  more  or  less  frequently,  and  more  or  less 
rapidly,  according  to  the  effect  required. 

b.  Excitation  by  Contact  and  Chemical  Action. 

Galvanism,  or  the  dynamic  form  of  electricity,  is  excited  by  the 
contact  of  two  metals,  or  other  conducting  bodies,  with  the  presence  of  a 
fluid  capable  of  chemical  action  on  one  only  of  the  two,  or  on  one  more 
than  on  the  other.  A  change  of  electrical  condition  takes  place  in  the  one 
most  easily  affected  chemically;  the  other  assumes  an  opposite  condi- 
tion ;  and  at  the  moment  of  communication  between  them,  whether  by 
the  absolute  contact  of  the  two,  or  by  means* of  another  metal,  an  at- 
tempt to  restore  the  equilibrium  takes  place,  with  the  effect  of  develop- 
ing electrical  phenomena.  The  apparent  current  of  force  is  from  the 
metal  chemically  affected,  through  the  liquid,  to  the  one  not  affected,  and 
then  through  the  connecting  material  to  the  point  of  origin.  But,  as  the 
cause  is  constantly  operating,  the  electrical  condition  is  constantly  dis- 
turbed, and  no  equilibrium  is  in  fact  established,  but  a  constant  circle  of 
•  action  maintained  until  the  exciting  agency  is  exhausted.  Anything 
susceptible  of  change  by  electrical  influence,  if  placed  in  the  circuit,  will 
feel  the  effects  in  a  degree  proportionate  to  its  susceptibility,  and  the 
force  developed.  From  a  simple  circle,  as  above  described,  but  slight 
effect  is  obtained -9  yet  enough  to  be  very  sensible. 

To  increase  the  effect,  these  simple  circles  or  elfiuents  must  be  multi- 
plied, so  as  to  form  what  are  called  galvanic  batteries,  or  voltaic  piles ; 
and  the  power  developed  is  in  proportion  to  the  number  of  the  elements 
employed.  Numerous  methods  of  attaining  this  eml  have  been  devised, 
which  it  is  not  my  object  to  describe.  One  thing  is  common  to  all  of 
them ;  namely,  that  the  associated  metals,  or  other  conductors,  in  earh 
pair,  and  the  several  pairs  themselves  always  bear  the  same  relation  to 
one  another;  and  the  successive  pairs  must  be  connected  by  a  conduct- 
ing medium.  The  extremes  of  the  arrangement  are  consequently  of 
opposite  character;  and,  when  they  are  made  to  communicate,  the  accu- 
mulated force  of  the  whole  battery  is  exerted  in  the  line  of  communica- 
tion. These  extremes  are  usually  denominated  poles,  the  one  at  which 


CHAP.  I.]  DIFFUSIBLE   STIMULANTS. — ELECTRICITY.  505 

the  metal  most  acted  on  is  placed  being;  the  negative,  and  the  other,  to- 
wards which  the  current  of  force  is  directed,  the  positive. 

Zinc  and  either  copper  or  silver  are  the  metals  usually  chosen,  and  a 
diluted  acid,  especially  the  sulphuric  or  nitric,  the  exciting  and  conduct- 
ing liquid;  but  other  metals  and  other  liquids,  and  even  non-metallic 
substances  may  be  substituted,  and  various  other  arrangements  have 
been  shown  to  have  a  similar  agency ;  chemical  action,  however,  being 
common  to  all. 

As  before  stated,  the  tension  of  galvanic  electricity  is  very  slight, 
and  consequently  but  slight  sparks  are  afforded  by  approaching  the 
poles,  and  relatively  slight  sensation  produced;  but  the  influences  de- 
pendent on  quantity  are  strong,  such  as  chemical  decomposition,  the 
development  of  caloric,  and,  in  the  animal  system,  the  production  of 
organic  change. 

Application.  The  simplest  galvanic  arrangement  may  be  applied  with 
great  facility.  A  small  circular  or  oval  plate  of  zinc,  and  a  silver  coin 
an  inch  in  diameter,  placed  in  the  mouth,  one  above  and  the  other  below 
the  tongue,  and  then  allowed  to  touch,  afford  evidence  of  their  action  to 
the  sense  of  taste ;  and  a  similar  pair,  soldered  together,  may  be  used 
for  very  gentle  stimulation  to  these  parts ;  the  saliva  acting  as  the  excit- 
ing liquid. 

Another  simple  arrangement  is  to  place  upon  two  separate  parts  of 
the  body,  between  which  it  is  desired  to  establish  a  galvanic  current,  two 
thin  oval  or  circular  plates  of  zinc  and  silver,  an  inch  or  two  in  diameter, 
one  on  one  of  the  parts,  and  the  other  on  the  other,  and  to  connect  the 
two  by  means  of  a  delicate  wire  attached  to  an  eye,  upon  the  outer  sur- 
face of  each  plate.  The  skin  beneath  should  be  moist,  so  as  to  allow  the 
galvanic  influence  to  penetrate  through  the  cuticle,  which  is  a  bad  con- 
ductor; and  for  this  purpose  a  layer  of  any  wet  conducting  substance 
may  intervene  between  the  plates  and  the  skin.  Even  distant  parts  of 
the  body  may  be  connected  in  this  way. 

Galvanic  Chains.  A  series  of  small  hexagonal  plates,  composed  each 
of  a  zinc  and  a  silver  plate  soldered  together  by  one  of  their  surfaces,  and 
connected  by  wires  so  as  to  move  freely,  forms  a  sort  of  chain,  which 
may  be  worn  next  the  body,  and  becomes  active  through  the  perspira- 
tion. The  chain  of  Pulvermacher,  made  of  couples  of  minute  coils  of 
wire  around  cylinders  of  wood,  and  connected  together  by  wire,  acts 
with  considerable  energy.  The  number  of  elements  may  extend  to  sev- 
eral hundreds.  Excited  by  being  steeped  in  an  acid  liquor,  it  continues 
to  act  for  several  hours,  and  may  be  usefully  employed  in  the  treatment 
of  superficial  affections.  The  advantage  of  these  and  other  arrange- 
ments with  small  elements  is,  that  the  peculiar  galvanic  stimulation  may 
l>e  obtained  with  less  of  the  heating  effect,  which  is  proportionate,  in 
some  degree,  to  the  size  of  the  metallic  plates,  while  the  former  depends 
more  upon  their  number. 


506  GENERAL    STIMULANTS.  [PART  II. 

Batteries  or  piles  are  made  of  various  forms,  and  of  variable  numbers 
of  pairs,  according  to  the  amount  of  effect  desired.  They  are  applied 
by  means  of  wires  connected  at  one  end  with  their  opposite  poles,  and 
terminating  at  the  other  in  various  modes  for  convenience  of  use,  by 
which  the  galvanic  influence  is  conveyed  to  the  person  at  any  distance 
from  the  battery.  These  conductors  must  be  insulated,  in  some  portion 
of  their  course,  by  glass  tubes  or  otherwise,  so  that  the  operator  himself 
may  not  interrupt  the  current.  Of  the  different  methods  of  termination 
of  these  conductors  more  will  be  said,  in  connection  with  other  electric 
arrangements  to  be  considered  immediately.  I  may  mention  here  that 
the  object  is  sometimes  effected  by  applying  the  agency  through  the  me- 
dium of  water.  Thus,  both  feet  may  be  placed  in  vessels  of  water  con- 
nected with  the  opposite  poles,  or  both  hands,  or  one  foot  and  one  hand ; 
and  thus  the  currents  varied  in  their  direction  through  or  over  the  body. 
Indeed,  the  whole  body  may  be  immersed;  so  that,  when  the  bath  is  con- 
nected with  one  pole,  and  the  body  with  the  other,  the  electric  current 
may  diffuse  itself  through  the  system,  in  its  attempts  to  escape  at  the 
surface.  Disadvantages  of  the  ordinary  batteries  used  for  chemical  pur- 
poses, as  Cruikshank's,  Wollaston's,  etc.,  are  the  disagreeable  odour 
given  out  in  consequence  of  the  decompositions  which  take  place,  their 
unwieldy  size,  and  the  difficulty  of  suitably  regulating  their  action.  They 
are  not,  therefore,  much  employed ;  though  circumstances  occasionally 
arise  which  render  a  resort  to  them  advisable. 

The  ordinary  galvanic  batteries,  though  they  give  a  continuous  cur- 
rent of  a  certain  duration,  are  unable  to  furnish  that  continuity  and 
duration  of  the  galvanic  action  which  is  necessary  to  fulfil  all  the  de- 
mands of  the  most  recent  galvanic  therapeutics.  To  obviate  this  defect, 
several  batteries  have  been  contrived,  known  from  their  authors  as 
Grove's,  Bunsen's,  and  DanielFs  batteries,  which  have  stood  the  trst 
of  trial,  and  one  of  which  is  now  generally  used,  where  the  greatest 
simple  galvanic  effects  are  required. 

c.  Excitation  by  Magnetic  Induction. 

When  a  magnet  is  placed  within  a  coil  of  wire  insulated  by  being  cov- 
ered with  silk  thread,  the  latter  assumes  a  polar  condition  the  reverse  of 
that  of  the  magnet;  and,  if  the  magnetic  circuit  and  that  of  the  coil  be 
closed  at  the  same  time,  a  current  takes  place  in  the  latter  in  a  direction 
opposite  to  that  of  the  former.  A  powerful  horse-shoe  magnet  is  thus 
capable  of  inducing  an  electric  movement  in  a  coil  of  wire,  which  gives 
rise  to  sensible  phenomena,  and  with  certain  arrangements  may  be  made 
to  act  with  great  energy.  When  the  body  is  connected  with  the  two 
opposite  poles  by  any  conducting  material,  a  slight  shock  is  felt  upon 
the  closing  of  the  magnetic  circuit,  after  which  no  sensation  is  perceived, 
and  no  obvious  effect  produced,  until  the  circuit  is  broken,  when  another 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. ELECTRICITY.  507 

sensation  stronger  than  the  first  is  experienced,  by  the  instant  alteration 
of  the  current  before  its  entrance  into  repose.  If,  by  any  contrivance, 
this  interruption  of  the  circuit  be  made  rapidly,  the  quick  succession  of 
the  shocks  becomes  painful,  and  the  effect  may  be  increased  so  as  to  be 
quite  insupportable.  Upon  this  principle  it  is  that  the  electro-magnetic 
machine  is  composed. 

Electro- Magnetic  or  Magneto-Electric  Machines. 

Different  machines  of  this  kind  have  been  devised  by  different  persons. 
Among  them  probably  those  of  Clark,  Dujardin,  and  the  Messieurs  Bre- 
ton are  best  known.  The  current  is  broken  in  these  instruments  by  a 
rotary  movement  given  to  the  armature  of  soft  iron,  by  which  it  is  altern- 
ately brought  into  and  removed  from  apposition  with  the  magnet;  but 
the  coil  of  insulated  wire,  called  the  intensity  coil,  is  in  some  of  them 
placed  around  the  armature,  and  in  others  around  the  magnet.  This 
difference  is  of  no  great  account,  as  the  armature  always  becomes  tem- 
porarily a  magnet  when  in  connection  with  the  proper  magnet,  and  con- 
sequently induces  a  current  in  the  coil  around  it.  But  M.  Duchenne, 
considering  none  of  them  capable  of  effecting  all  the  objects  attainable 
by  a  perfect  machine  of  this  order,  endeavoured,  by  combining  the  best 
parts  of  those  in  use  with  improvements  of  his  own.  to  make  an  instru- 
ment approaching  nearer  to  his  conception  of  what  is  desirable  than  any 
one  hitherto  invented.  As  this  instrument,  at  the  time  when  the  first 
edition  of  this  work  was  published,  was,  I  believe,  quite  unknown  in 
this  country,  I  gave  in  a  note  a  figure  of  it  copied  from  one  in  M.  Du- 
chenne's  treatise,  with  his  explanation  of  its  construction  and  principles. 
This  description,  as  no  longer  necessary,  has  been  omitted  in  the  second 
and  present  editions.  I  would  simply  state,  in  relation  to  the  instrument, 
that  the  chief  additions  made  by  M.  Duchenne  were  a  graduator  of  the 
currents,  by  which  the  intensity  may  within  certain  limits  be  increased 
or  diminished  at  pleasure,  and  a  second  superimposed  coil  of  insulated 
wire,  much  finer  than  the  first,  by  which  the  intensity  is  greatly  increased, 
and  which,  though  used  in  the  volta-electric  machines,  had  not  previously 
been  applied  to  the  electro-magnetic. 

d.  Electric  Excitation  by  Galvano-magnetic  Induction. 

If  within  a  coil  of  insulated  wire  a  piece  of  soft  iron  be  placed,  and  a 
galvanic  current  be  passed  through  the  coil,  the  soft  iron  becomes  mag- 
netized, and  continues  so  as  long,  and  only  as  long,  as  the  current  is 
maintained.  Now  this  temporary  magnet  exercises  an  inductive  power 
on  the  wire,  similar  to  that  produced  by  a  permanent  magnet,  and  in- 
creases the  force  of  the  galvanic  current  in  the  former.  If,  over  the  coil 
of  wire  alluded  to,  another  be  placed  consisting  of  smaller  wire,  this  also 
acquires  an  induced  state  of  electric  action,  and  the  intensity  of  the  gal- 


508  GENERAL    STIMULANTS.  [PART  II. 

vanic  current  is  still  further  augmented.  If,  again,  the  current  be  inter- 
rupted, phenomena  are  produced  of  the  same  character  as  those  already 
referred  to  as  resulting  from  a  similar  interruption  of  the  current  in  the 
electro-magnetic  apparatus.  Upon  these  principles  instruments  have 
been  invented  for  the  therapeutic  application  of  electricity,  which  have 
of  late  been  much  in  use,  and,  together  with  the  electro-magnetic 
machine,  have  almost  superseded  the  methods  formerly  employed. 

Volta- Electric  Machines.     Galvano- Magnetic  Induction  Machines. 
Electro- Dynamic  Machines. 

A  large  number  of  these  machines  have  been  contrived  in  England, 
France,  and  Germany,  as  those  of  Newman,  the  Messrs.  Breton,  Keller, 
etc.  The  following  are  the  essential  parts  of  the  apparatus:  1.  a  pri- 
mary and  secondary  coil  or  helix  of  insulated  wire;  2.  a  bundle  of  soft 
iron  wires  to  be  introduced  within  the  coil ;  3.  a  contact-breaker,  by 
which  the  current  is  interrupted,  and  which  is  made  to  act  through  the 
influence  of  the  galvanic  current  itself;  4.  a  galvanic  battery  or  pile, 
consisting  of  one  or  more  pairs,  which  is  to  furnish  the  influence  by 
which  the  whole  apparatus  is  set  in  operation;  and  5.  a  pair  of  insulated 
metallic  directors  or  conductors,  which  are  to  be  connected  with  the 
poles  of  the  apparatus,  and  by  means  of  which  the  electricity  is  applied 
to  the  body.  The  terminations  of  these  directors  are  called  by  M.  Du- 
cbenne  excitors,  and  are  of  various  character  and  form  to  meet  special 
indications.  (See  page  509.) 

To  put  the  machine  in  operation,  the  galvanic  battery  is  first  made  to 
act,  and  the  electric  influence  is  conveyed  to  the  ends  of  the  larger  and 
inner  wire,  which  thus  becomes  the  connecting  medium  between  the 
poles  of  the  battery.  A  galvanic  circuit  is  thus  established,  the  inten- 
sity of  which  is  greatly  increased  by  the  reaction  upon  each  other  of  the 
spirals  through  which  the  influence  is  propagated.  At  the  same  time  the 
bundle  of  wires  within  becomes  mairnrti/ed.  and  the  outer  wire  acquires 
an  induced  state  of  great  energy,  and  in  an  opposite  direction  to  the 
original  current.  It  is,  however,  by  the  frequently  repeated  interruption 
of  the  currents  that  they  acquire  their  great  physiological  and  remedial 
power,  as  in  the  electro-magnetic  machine.  The  contact-breaker  which 
produces  this  effect  operates  on  a  very  simple  principle.  A  slip  of  metal 
movable  at  one  end,  and  kept  in  its  place  by  a  spring,  is  so  situated  that 
the  movable  end  forms  a  part  of  the  circuit,  which  passes  through  its 
point  of  contact.  But  being  also  near,  though  not  in  contact  with  the 
iron  which  becomes  magnetized  by  the  current,  as  soon  as  this  is  estaln 
lished,  it  is  attracted  by  the  nuuriietic  force,  and  separated  from  its  pre- 
vious connection.  The  circuit  is  thus  broken,  the  magnet  loses  its 
power,  the  attraction  ceases,  and  the  spring  forces  the  movable  slip  back 
to  its  original  position.  This  restores  the  current,  and  the  same  opera- 


CHAP.  I.]  DIFFUSIBLE   STIMULANTS. — ELECTRICITY. 


509 


tion  is  repeated  as  before ;  so  that  there  is  a  constant  and  rapid  succes- 
sion of  intermissions,  as  long  as  the  machine  acts;  the  contact-breaker 
producing  a  sensible  sound,  as  it  flies  rapidly  backward  and  forward  be- 
tween the  metallic  boundaries  of  its  movements. 

The  wires  which  serve  to  convey  the  influence  of  the  machine  to  the 
patient,  and  which  are  of  course  attached  to  its  opposite  poles,  are  often 
themselves  made  to  increase  the  intensity  of  the  current,  by  being  thrown 
for  a  portion  of  their  length  into  the  spiral  form. 

I  shall  not  attempt  to  describe  the  various  instruments  employed,  and 
must  content  myself  here  with  referring  the  reader  to  a  note,  in  the  first 
edition  of  this  work,  in  which  an  account  is  presented  of  one  of  the  most 
recent  and  most  perfect,  which  has  been  arranged  by  M.  Duchenne.  By 
consulting  this  account,  he  will  be  put  into  possession  of  all  that  will  be 
necessary  to  enable  him  to  understand  and  apply  not  only  this,  but  other 
apparatuses  of  the  same  kind.* 

*  Exciters,  or  Terminations  of  the  Directors.  Before  proceeding  to  treat  of  the 
effects  of  electricity  on  the  system,  it  will  be  expedient  to  make  a  few  remarks  on 
the  different  modes  of  application,  by  the  directors. 

The  form  of  the  terminations  of  the  free  ends  of  the  conducting  wire  or  chain,  by 
which  the  influence  is  conveyed  to  the  patient,  is  of  some  importance.  These  term- 
inations are  called  excitors  by  M.  Duchenne.  When  electricity  is  to  be  applied  by 
the  aura,  they  should  be  pointed ;  when  by  sparks,  rounded ;  when  by  contact,  they 
may  be  of  any  form  which  the  practitioner  may  deem  most  convenient;  the  mere 
touching  of  (he  excitors  by  any  part  of  the  surface  being  sufficient.  Spherical,  olive- 
shaped,  or  conical  terminations  (Fig.  2)  are  very  common.  Sometimes  cylindrical 
pieces  of  metal  are  used,  which  the  patient  can  hold  in  his  hand.  Sometimes  a  me- 
tallic shoe  is  made  to  fit  the  foot,  which  terminates  one  pole,  while  the  other  is 
applied  to  some  other  part  of  the  body.  The  excitors  may  be  straight  or  variously 


Fig.  1. 


Fig.  2. 


Fig.  3. 


curved,  and  when  to  be  applied  by  an  operator,  must,  as  before  stated,  have  an  in*u- 
lating  handle. 

It  is  often  necessary  that  the  surface  of  the  body  to  which  they  are  applied 
should  be  moist,  to  enable  the  influence  to  penetrate  through  the  cuticle.     In  such 


510  GENERAL   STIMULANTS.  [PART  II. 

2.  Effects  of  Electricity  on  the  System. 

As  electricity  is  probably  identical  under  whatever  aspect  it  may  pre- 
sent itself,  its  effects  under  similar  circumstances  are  probably  also  iden- 
tical; but,  in  the  different  conditions  in  which  it  is  actually  developed,  it 
exhibits  striking  differences  of  operation,  which  render  necessary  the 
consideration  of  it,  in  the  present  relation,  as  before  in  regard  to  the 
methods  of  development,  under  its  several  distinct  forms.  Its  charac- 
teristic effects,  as  a  general  rule,  are  to  excite  sensation  and  muscular 
contraction,  and,  indeed,  to  augment  the  functions  of  all  the  organs  on 
which  it  may  be  brought  specially  to  act;  consequently,  under  favouring 
circumstances,  to  promote  digestion,  absorption,  circulation,  animal  tem- 
perature, secretion,  and  the  nutritive  and  assimilative  processes ;  in  other 
words,  it  appears  to  be  capable  of  acting  as  a  universal  stimulant,  though 
more  especially  directed  to  the  vital  properties  of  sensibility  and  muscu- 
lar contractility.  In  its  influence  upon  sensation,  it  produces  effects 
corresponding  with  the  functions  of  the  several  senses ;  causing  pain, 
when  acting  on  the  nerves  of  general  sensation ;  the  perception  of  light, 
when  on  the  organ  of  vision ;  a  peculiar  taste,  when  on  the  tongue  and 
palate;  smell,  when  on  the  olfactory  organs;  and  sound,  when  on  the 
ears.  Muscular  contraction  is  caused  by  it,  whether  directed  to  the 
muscle  exclusively,  to  the  nerves  of  motion,  or  to  the  nervous  centres  of 
motion  In  the  higher  exertion  of  its  powers,  like  some  other  stimu- 
lants, it  has  the  effect  of  overwhelming  the  vital  functions,  and  producing 
apparent  direct  prostration,  even  to  a  fatal  issue.  Witness  the  effects 
of  a  violent  shock,  and  especially  of  a  stroke  of  lightning,  which  often 
destroys  life  instantaneously,  and,  when  it  fails  to  do  this,  generally 
leaves  the  patient  for  a  time  more  or  less  prostrate,  senseless,  and 
paralyzed. 

a.  Effects  of  Electricity  Excited  by  Friction. 

The  effects  of  a  mere  accumulation  of  electricity  in  the  system  have 
not  been  satisfactorily  determined.  We  feel  often  very  differently  before 
and  after  a  thunder-storm.  Many  persons  imagine  they  can  detect  by 
their  sensations  the  approach  of  certain  changes  in  the  weather,  before 
any  evidence  of  such  changes  is  presented  by  ordinary  signs.  I  know 
neuralgic  persons  who  suffer  much  more  in  certain  kinds  of  weather  than 
in  others,  though  completely  protected  against  any  influence  of  cold  or 

instances,  the  ends  of  the  excitors  should  be  covered  with  buckskin  or  other  similar 
material,  which  will  imbibe  nnd  retain  moisture.  A  sort  of  hollow  cylinder  con- 
taining a  wet  sponge  (Fig.  1)  should  be  used,  when  it  is  desirable  to  cover  some 
extent  of  surface.  M.  Duchcnne  uses  sometime-*  a  bunch  of  fine  wires,  iu  the  form 
of  a  brush  or  broom  (Fig.  3),  the  wires  being  fixed  at  one  end  iu  u  hollow  cylinder, 
irom  which  they  project  at  the  other,  and  the  cylinder  being  screwed  upon  an  insu- 
lating handle. 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. ELECTRICITY.  511 

moisture.  These  results  have  been  vaguely  ascribed  to  the  electrical 
condition  of  the  system,  and  possibly  with  some  justice ;  but  it  would 
be  difficult  to  adduce  positive  proof  of  the  fact ;  and,  when  we  attempt 
to  reduce  the  phenomena  within  any  general  rules,  they  quite  elude  our 
grasp. 

Silent  Conduction.  When  the  body,  by  contact  with  an  excited  prime 
conductor,  becomes  the  route  through  which  the  electric  current  passes, 
however  powerful  may  be  the  machine,  and  however  rapid  the  current, 
no  observable  effect  is  produced  either  upon  the  sensations,  or  any  of  the 
functions. 

The  Aura.  This  is  said  to  operate  as  a  mild  stimulant  to  the  portion 
of  surface  upon  which  it  is  made  to  act ;  and  has  sometimes  been  em- 
ployed for  this  purpose  in  affections  of  very  delicate  organs,  as  the  eye. 
But  the  influence,  if  any,  must  be  extremely  slight. 

The  Electric  Bath.  Very  different  statements  have  been  made  as  to 
the  effects  of  electricity  accumulated  in  the  system,  in  a  state  of  insula- 
tion. Some  have  found  it  to  increase  the  frequency  of  the  pulse,  and 
promote  the  secretions,  especially  those  of  the  skin,  kidneys,  and  salivary 
glands,  and  have  obtained  great  supposed  advantages  from  it  in  rheu- 
matic neuralgia,  and  paralytic  diseases.  Giacomini,  while  admitting 
that  the  positive  electric  bath  produces  no  impression  on  any  one  of  the 
interior  functions,  imagined  the  negative  to  be  powerfully  depressing,  and 
capable  of  advantageous  use  as  a  contra-stimulant  agent  It  is  not  im- 
possible that,  in  certain  very  susceptible  individuals,  the  bath  may  have 
some  influence ;  but  I  have  found  no  effect  from  it  in  my  own  person, 
and  the  same  I  believe  to  be  the  experience  of  most  who  have  tried  it ; 
and,  without  calling  into  question  the  accuracy  or  trustworthiness  of 
those  who  have  made  opposite  statements,  we  are,  I  think,  justified  in 
:it  loast  suspecting,  that  the  phenomena  observed  were  really  ascribable 
to  the  mental  state  of  the  persons  acted  on,  and  in  no  degree  to  the  elec- 
tricity. As  to  the  supposed  cures  of  rheumatism,  neuralgia,  and  palsy, 
we  know  well  how  powerful  mental  influence  is  in  many  cases  of  those 
affections,  and  how  often  the  favourable  changes  which  have  taken 
place  spontaneously  with  time,  have  been  ascribed  to  the  last  remedy 
used.  But,  though  we  may  doubt  the  remedial  influence  of  simple  elec- 
trical accumulation,  yet  the  bath  may  be  made  a  means  of  gentle  stimu- 
lation to  the  surface,  by  the  sensation  produced  when  the  electricity  is 
drawn  from  the  body,  under  these  circumstances,  by  sparks. 

Sparks.  The  spark,  whether  drawn  from  an  excited  prime  conductor 
by  the  body,  or  from  the  excited  and  insulated  body  by  other  substances, 
is  attended  with  more  or  less  sensation,  of  a  sharp,  pungent  character, 
very  slight  when  the  spark  is  small,  but  painful  when  the  electric  tension 
is  very  great,  though  seldom  so  severe  that  it  cannot  be  readily  borne. 
The  electricity  scarcely  penetrates  beyond  the  surface ;  yet  it  in  some 


512  GENERAL    STIMULANTS.  [PART  II. 

degree  excites  the  skin,  and,  if  the  operation  is  continued,  produces 
rubefacient  swelling,  and  some  tenderness  to  the  touch.  It  may  there- 
fore, be  occasionally  used  with  advantage  in  this  method,  as  a  gentle 
excitant  in  inactive  states  of  the  surface,  and  as  a  revulsive  in  internal 
diseases  of  no  great  severity.  It  may  be  concentrated  in  one  spot,  or 
applied  extensively  over  the  surface ;  and,  for  the  latter  purpose,  the 
bath  probably  affords  the  most  convenient  means.  By  the  interposition 
of  flannel,  which  may  cover  the  ball  of  the  director,  or  be  applied  to  the 
surface  of  the  body,  a  great  number  of  minute  sparks  may  be  drawn 
rapidly,  with  less  discomfort  to  the  patient. 

Leyden  Jar.  When  the  body  is  made  the  connecting  medium  between 
the  two  surfaces  of  a  Leyden  jar,  a  quick  painful  sensation  is  expe- 
rienced, denominated  the  shock,  which  is  always  disagreeable,  and  may 
be  so  violent  as  to  be  quite  insupportable.  This  is  attended  with  a  quick, 
jerking,  muscular  contraction,  and  even  the  deep-lying  muscles  may  be 
brought  into  energetic  action.  If  applied  to  the  hands,  the  sensation  is 
felt  chiefly  in  the  wrists,  elbows,  and  breast.  If  directed  so  as  to  reach 
the  nervous  centres,  the  shock  radiates  through  the  whole  system.  When 
severe,  its  first  observable  effect,  independently  of  the  sensation  and 
spasm  produced,  is  to  depress  function  by  overwhelming  it.  Thus,  the 
skin  for  a  short  distance  around  the  point  of  entrance  is  whitened,  and 
its  temperature  lessened,  while  the  follicles  project  in  consequence  of  the 
shrinking  of  the  tissue.  The  part  is  also  more  or  less  benumbed.  If  the 
shock  is  passed  through  a  nerve  of  sensation,  numbness  is  apt  to  be  felt 
in  the  parts  supplied  by  it ;  and  a  severe  shock  through  the  brain  or 
spinal  marrow,  produces,  in  the  former  case,  mental  confusion,  forgetful- 
ness,  dimness  of  vision,  etc.,  in  the  latter,  feebleness  approaching  to 
paralysis  of  the  lower  limbs.  The  violence  of  the  effect  is  proportionate 
both  to  the  electric  intensity  and  quantity.  A  small  jar,  highly  charged, 
will  produce  a  greater  effect  than  a  larger  one  feebly  charged ;  but,  the 
intensity  being  equal,  the  degree  of  effect  is  then  proportionate  to  the 
quantity,  or  to  the  magnitude  of  the  apparatus.  The  shock  from  an 
electric  battery  is  capable  of  producing  temporary  insensibility,  and  prob- 
ably death.  After  fatal  effects  from  lightning,  streaks  of  redness  are 
said  to  be  sometimes  observed  along  the  surface  ;  and  the  blood  is,  in 
general,  fluid,  and  the  muscles  flaccid,  as  if  universal  death  had  taken 
place  immediately.  The  depression  occasioned  by  the  shock  from  the 
jar  speedily  passes  off,  and  is  followed  by  more  or  less  reaction.  In  this 
method  of  application,  electricity  may  sometimes  be  usefully  employed 
for  exciting  parts  which  lie  deeply,  and  are  extremely  insusceptible,  or 
in  rousing  a  torpid  system  by  the  shock,  or  for  depressing  nervous  excite- 
ment by  its  first  overwhelming  effects;  but  it  is  impossible  to  limit  it* 
action  precisely  to  any  one  muscle  or  part ;  and  there  may  be  hazard,  in 
cases  of  great  depression,  of  dangerously  adding  the  prostration  of  the 
shock  to  that  already  existing.  Allusion  has  been  before  made  (seepages 


CHAP.  I.]  DIFFUSIBLE   STIMULANTS. — ELECTRICITY.  513 

502-3)  to  a  mode  of  regulating  the  remedy  which  will  obviate  this  latter 
danger.  In  some  instances,  the  subcutaneous  adipose  tissue  is  so  thick,  or 
the  cellular  tissue  so  edenaatous,  that  the  dynamic  currents  will  not  pen- 
etrate them.  ID  such  cases  recourse  may  be  had  to  the  jar. 

b.  Effects  of  Dynamic  Electricity. 

This  includes  both  galvanism,  strictly  speaking,  and  the  electricity 
developed  by  induction.  Dynamic  electricity  differs,  in  its  attendant 
physiological  phenomena,  materially  from  the  static.  It  produces  sen- 
sation, but  in  a  much  less  degree,  in  proportion  to  other  effects.  Thus, 
a  galvanic  battery,  capable  of  powerful  chemical  action,  will  give  only 
a  slight  tingling  sensation  to  the  part  at  which  the  current  enters;  while 
the  continuance  of  the  current  gives  rise  to  effects  which  never  proceed 
from  a  continuous  current  of  machine  electricity.  The  dynamic  current 
causes  also  contraction  of  the  muscles,  and  even  energetic  contraction, 
but  without  the  violent  shock  to  the  system  produced  by  the  other  form. 
Another  important  point  of  difference  is  that  its  influence  can  be  directed 
to  a  certain  part,  and  in  a  considerable  degree  limited  to  that  part ;  so 
that  a  diseased  muscle,  for  example,  which  may  have  lost  its  sensibility, 
and  iu  which  the  electric  stimulation  may  be  strongly  indicated,  may  be 
acted  on  by  means  of  the  galvanic  or  inductive  current,  with  little  or 
no  disturbance  or  injury  to  neighbouring  and  more  excitable  tissues. 
This  alone  gives  a  vast  superiority  to  this  form  of  electricity  over  the 
st;it if.  as  a  therapeutic  agent.  For  the  methods  of  effectually  localizing 
the  action  of  galvanism,  we  are  greatly  indebted  to  M.  Duchenne. 
Formerly  no  attempts  of  the  kind  were  made,  or  quite  ineffectually, 
until  the  method  of  acupuncture  was  applied  .by  M.  Sarlandiere  to  this 
object;  but  the  necessity  for  this  has  been  superseded  by  the  methods  of 
M.  Duchenne,  which,  while  less  unpleasant,  are  even  more  effectual. 

1.  Effects  of  Galvanism.  In  the  physiological  operation  of  galvan- 
ism, there  are  effects  produced  which  cannot  be  completely  separated, 
and  which  often  interfere  injuriously  with  one  another  when  the  agent  is 
employed  therapeutically.  The  current  may  be  either  continuous  or  inter- 
mittent; and  the  effects  of  the  two  modes  of  application  differ  materially. 

The  continuous  current,  while  it  produces  sensation  in  the  skin,  exer- 
cises also  an  influence  over  the  organic  actions,  giving  rise  to  heat,  irri- 
tation, and  inflammation  in  various  degrees,  according  to  its  power  and 
continuance,  sometimes  ending  in  absolute  cauterization.  The  most 
powerful  current,  if  introduced  into  a  muscle,  occasions  but  slight,  irreg- 
ular, or  partial  contractions,  while  it  causes  a  sense  of  burning  heat, 
even  in  the  depths  of  the  tissues  along  its  course. 

In  the  intermittent  current,  the  organic  action  of  the  battery,  or  its 
tendency  to  produce  heat,  inflammation,  and  disorganization,  is  dimin- 
ished ;  while  its  power  of  exciting  sensation  and  muscular  contraction  is 
VOL.  i. — 33 


514  GENERAL    STIMULANTS.  [PART  II. 

greatly  increased.  This  difference  is  readily  explicable.  At  every  break- 
ing of  the  current,  there  are  three  physiological  actions;  one  at  tin- 
entrance  of  the  current,  one  at  its  cessation,  and  a  third  in  the  interval. 
Sensation  and  muscular  contraction  are  produced  chiefly  at  the  entrance, 
and  much  less  at  the  moment  of  interruption,  while  in  the  interval,  or 
during  the  continuance  of  the  current,  there  is  little  comparative  influ- 
ence on  the  sensibility,  none  or  scarcely  any  on  muscular  contractility, 
but  a  strong  tendency  to  provoke  inflammation  or  organic  change.  It 
follows,  therefore,  that  if  the  current  be  frequently  interrupted,  sensation 
and  contraction  will  be  proportiouably  increased,  and  organic  action 
diminished ;  and  thus  the  intermittent  current  can  be  more  effectively 
applied  to  the  former  purposes,  the  continuous  to  the  latter. 

There  is  one  effect  which,  according  to  M.  Duchenne.  tin;  galvanic 
current  produces  beyond  all  other  modes  of  electric  action.  It  has  great 
influence  on  the  organ  of  vision,  and,  if  made  to  operate  on  the  face  or 
scalp,  where  the  fifth  pair  of  nerves,  which  are  mainly  sensitive,  are  dis- 
tributed, it  occasions  dazzling  luminous  sensations.  These  flashes  art- 
produced  strongly  at  the  entrance  of  the  current,  feebly  at  its  cessation, 
and  very  slightly,  so  as  to  be  appreciable  only  in  a  dark  room,  during  it> 
continuance.  By  a  rapidly  recurring  intermission  of  the  current,  there 
may  be  kept  up  a  constant  succession  of  the  luminous  phenomena.  They 
are  produced  chiefly  on  the  side  to  which  the  application  is  made,  more 
powerfully  as  the  median  line  is  approached,  and  on  both  sides,  when  the 
excitors  connected  with  the  two  poles  are  both  placed  at  that  line.  An 
important  inference  is  deducible  from  this  fact,  in  determining  the  thera- 
peutic application  of  the  agency;  namely,  that  galvanism  is  to  be  pre- 
ferred when  the  indication  is  to  excite  the  retina,  and  its  application  to 
the  face  avoided  in  the  opposite  indication. 

I  need  scarcely  state  that  the  interruption  of  the  galvanic  current  may 
be  effected  by  withdrawing  the  excitors,  and  a  succession  of  .intermis- 
sions more  or  less  rapid  obtained,  by  their  more  or  less  rapid  withdrawal 
and  reapplication. 

But  there  is  much  inconvenience  in  this  manual  operation;  it  is  almost 
necessarily  effected  comparatively  slowly  and  irregularly ;  and,  even  at 
best,  the  continuous  current,  while  it  lasts,  is  exercising  its  organic  in- 
fluence, and  may  at  times  be  productive  of  great  inconvenience.  While, 
therefore,  the  galvanic  battery  is  preferable  in  all  ca.-es  in  which  the 
object  is  to  excite  inflammation  or  other  organic  change,  it  is  highly 
desirable  to  obtain  the  means  of  exciting  at  will  the  nervous  properties 
of  sensibility  and  muscular  contraction,  without  endangering  the  integ- 
rity of  the  tissues.  Such  means  are  supplied  by  the  form  of  electricity 
developed  by  induction,  whether  through  the  electro-magnetic,  or  volta- 
electric  instruments. 

2.  Effects  of  Induced  Electricity.  In  the  operation  of  the  instruments 
above  referred  to,  it  is  at  the  moments  when  the  circle  is  closed,  and 


CITAP.  I.]  DIFFUSIBLE   STIMULANTS. — ELECTRICITY.  515 

when  it  is  broken,  that  the  effects  are  produced ;  no  phenomena  what- 
ever being  excited  between  these  two  points  of  time.  While  the  circle 
remains  closed,  the  electric  force  appears  to  be  quite  quiescent.  This  is 
the  important  point  in  which  the  induced  electricity  differs,  in  its  physio- 
logical and  therapeutical  effects,  from  the  galvanic.  That  the  fact  is  as 
stated  may  be  shown  by  a  simple  experiment.  If  a  frog's  muscle  be 
placed  in  the  electric  circle,  it  contracts  instantaneously  when  the  circle 
is  closed,  then  becomes  perfectly  quiescent,  and  continues  so  until  the 
circle  is  broken,  when  it  again  contracts,  and  more  strongly  than  at  first 
But,  though  there  are  thus  shown  to  be  two  actions,  one  at  the  closing, 
and  the  other  at  the  breaking  of  the  current,  it  is  only  the  latter  which  is 
strong  enough  to  be  effective  in  the  human  subject;  the  one  occurring  at 
the  closure  of  the  circle  being  scarcely  perceptible,  though  sufficiently 
powerful  to  produce  contraction  in  the  muscles  of  a  frog.  It  is  to  this 
power  of  strongly  exciting  sensation  and  motion,  without  producing  in- 
flammation, that  the  inductive  instruments  owe  their  great  superiority, 
as  therapeutic  agents,  over  other  galvanic  arrangements,  for  the  general 
purposes  which  are  aimed  at  in  the  use  of  electricity.  However  pow- 
erful their  operation,  or  however  long  continued,  though  they  may  pro- 
duce insupportable  pain,  and  the  most  energetic  muscular  contraction, 
they  never  cause  disorganizing  inflammation  ;  and,  though  a  little  erythe- 
matic  redness  of  the  skin  may  be  produced,  with  erection  of  the  papillae, 
the  effect  quickly  subsides  upon  the  cessation  of  the  action. 

It  is  obvious  that,  the  more  rapid  the  succession  of  the  intermissions, 
the  more  rapid  will  also  be  the  succession  of  the  muscular  contractions 
produced  by  them ;  and  thus  a  method  is  offered  of  controlling  the  effect, 
to  a  considerable  degree,  by  diminishing  or  increasing  the  number  of  in- 
termissions. The  contractions,  however,  are  severally  more  powerful, 
when  at  long  than  short  intervals;  but,  by  their  very  frequent  repetition, 
the  muscle  may  be  kept  in  an  apparent  state  of  steady  contraction,  sim- 
ilar to  that  produced  under  the  influence  of  the  will.  There  is  a  sort  of 
vibratory  movement  in  the  fibres ;  but,  to  the  touch,  the  muscle  feels  as 
though  steadily  contracting.  An  influence  analogous  to  the  healthful 
stimulus  is  thus  obtained,  which  has  a  tonic  effect  on  the  muscle,  and 
promotes  its  nutrition.  Hence  its  application  in  cases  of  relaxation  from 
debility,  and  in  atrophy  of  the  muscles.  Though  the  contractions  are 
more  powerful  at  long  intervals,  yet,  in  relation  to  sensation,  the  more 
rapid  the  succession  of  intermissions,  the  greater  is  the  effect.  Hence, 
when  it  is  important  to  awaken  sensibility,  as  in  cutaneous  paralysis, 
the  instrument  should  be  made  to  act  rapidly.  On  the  contrary,  a 
rapid  movement  is  contraindicated  in  disease  of  the  brain,  upon  which 
the  pain  may  react  injuriously;  in  cases  of  great  natural  susceptibility; 
and  in  operating  on  delicate  organs,  as  the  tympanum  of  \/he  ear,  different 
parts  of  the  face,  and  the  testicle. 

But  this  is  not  all  the  merit  of  these  machines.     By  varying  their 


516  GENERAL   STIMULANTS.  [PART  II. 

mode  of  application,  different  physiological  effects  are  obtained,  each  sus- 
ceptible of  beneficial  therapeutic  use.  Thus,  the  current  of  the  two 
wires,  the  larger  and  smaller,  or,  as  M.  Duchenne  designates  them,  the 
currents  of  the  first  and  second  order,  differ  materially  in  their  effects. 
The  machine  with  the  double  wire  operates  much  more  powerfully  on 
the  face  and  eyeballs  in  producing  luminous  phenomena  than  that  with 
only  one  wire;  and  the  effect,  according  to  M.  Duchenne,  is  much  greater 
from  the  electro-magnetic  than  the  volta-elcctric  apparatus.  Even  with 
a  feeble  action  of  the  former,  considerable  reaction  is  produced  upon  the 
retina;  while  the  latter  operates  in  this  way  only  when  somewhat  in- 
tensely excited,  and  when  the  exciters  are  applied  to  the  emerging  points 
of  the  fifth  pair,  or  to  the  globe  of  the  eye  itself.  The  current  from  the 
first  order  (larger  wire)  of  the  electro-magnetic  instrument  produces  no 
stronger  an  impression  than  the  volta-elcctric.  But  the  luminous  phe- 
nomena, excited  by  these  machines,  even  by  the  second  current  of  the 
electro-magnetic,  are  much  feebler  than  those  which  result  from  simple 
galvanism. 

Moreover,  the  current  of  the  first  wire  appears  to  have  a  special  influ- 
ence over  muscular  contractility,  that  of  the  second  over  cutaneous  sen- 
sibility; that  is,  though  both  currents  act  on  both  properties,  yet  one 
produces  a  greater  relative  effect  on  the  one,  the  other  on  the  other. 
(Electrisation  Localisee,  pp.  15,  16.)  Cutaneous  insensibility  will  often 
yield  promptly  to  the  current  of  the  second  order  (small  wire),  when 
that  of  the  first  has  no  effect  whatever;  but,  in  very  susceptible  persons, 
it  will  be  advisable  to  have  recourse  to  that  of  the  first  or  larger  wire, 
because  less  disturbing  to  the  sensibility. 

,  3.  Methods  of  Application. 

In  describing  the  instruments  for  the  development  of  static  and  gal- 
vanic electricity,  and  the  effects  of  these  two  modes  of  electrical  excite- 
ment, I  have  probably  said  us  much  as  may  be  necessary  in  relation  to 
their  method  of  application.  But  the  following  observations  upon  the 
application  of  induced  jelectricity,  derived  almost  exclusively  from  the 
work  of  M.  Duchenne,  appear  to  be  necessary,  to  place  the  reader  on  a 
level  with  the  state  to  which  therapeutical  electrization  has  been  brought 
by  that  indefatigable  investigator. 

1.  To  the  Muscles. — Faradisation  of  the  Muscles  (Duchenne).* — To 

*  The  term  faraditation  was  invented  by  M.  Duchenne,  and  applied  in  honour  of 
the  distinguished  chemist,  Faraday,  who  has  done  so  much  for  elecirical  science. 
As  the  name  of  electricity  is  given  to  the  static  form  of  this  agency,  and  galvanism 
to  that  developed  by  contact,  with  chemical  action,  M.  Duchenne  considered  himself 
authorized  to  give  that  offaradism  to  the  induced  form  of  dynamic  electricity,  and 
faraditation  to  its  application.  (Note  to  the  second  edition.) 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. ELECTRICITY.  517 

affect  the  musc-lcs,  we  may  operate  either  through  the  nervous  plexuses 
and  trunks,  or  directly  on  the  muscles  themselves.  In  the  former  case, 
we  necessarily  influence  at  the  same  time  several  associated  muscles ; 
in  the  latter,  we  may  limit  the  action  to  a  single  muscle. 

The  two  exciters,  or  terminations  of  the  directing  conductors,  should 
be  placed  near  to  each  other,  at  distances  varying  from  one  to  four 
inches.  If  the  skin  is  well  moistened,  the  electric  influence  penetrates 
readily  through  it  to  the  parts  beneath.  When  it  is  required  to  operate 
on  the  larger  muscles,  as  those  of  the  trunk  for  example,  the  cylinder 
with  the  moist  sponge  (Fig.  1,  page  509)  should  be  used.  For  small 
muscles,  as  those  of  the  face  or  intercostals,  or  for  deep-seated  muscles, 
the  conical  exciters  (Fig.  2,  page  509),  covered  with  thoroughly  moist- 
ened leather,  as  the  finger  of  a  glove,  are  to  be  preferred.  The  latter  also 
are  preferable  when  it  is  desirable  to  excite  the  muscles  through  a  nerve. 
The  moist  skin  is  a  better  conductor  than  the  wet  sponge;  and,  when  a 
powerful  effect  is  demanded,  the  conical  cxcitors  may  be  sometimes  ad- 
vantageously used  even  for  large  muscles,  being  in  this  case  moved 
from  point  to  point.  To  apply  the  instrument  efficiently,  the  practi- 
tioner must  of  course  have  made  himself  acquainted  with  the  precise 
situation  of  the  muscles,  and  course  of  the  nerves  supplying  them.  Their 
depth  below  the  skin  must  also  be  well  understood.  The  influence  is 
never  to  be  directed  to  the  tendons.  To  act  on  a  muscle  duly,  its  whole 
surface  must  be  covered ;  and  consequently,  if  this  is  large,  the  excitors 
must  be  moved  from  point  to  point  successively  until  the  purpose  has  been 
accomplished.  The  muscle  is  known  to  be  contracting  by  its  firmness 
or  hardness  under  the  fingers ;  and  it  often  happens  that  one  part  of  a 
single  muscle  will  be  relaxed,  while  another  contracts.  The  thicker  the 
muscle,  the  more  intense  must  be  the  current  applied.  In  the  face,  it  is 
difficult  to  avoid  affecting  the  nerves  so  abundantly  distributed  over  it. 
One  of  these  is  known  to  be  touched  when  the  contraction  extends  to 
several  muscles  simultaneously.  Should  this  happen,  the  excitors  should 
be  moved  a  very  short  distance  from  the  point,  until  the  effect  is  no 
longer  produced.* 

When  a  muscle,  on  account  of  its  depth,  cannot  be  reached  directly 
by  the  electric  influence,  it  may  be  excited  by  means  of  its  supplying 
nerve.  The  excitement  of  a  nerve,  or  of  a  muscle,  always  produces  in 
the  healthy  state  both  a  sensation  and  contraction.  But  the  suscepti- 

*  M.  Duchenne  found  that  the  muscles  contract  most  readily  if  certain  points  are 
touched  by  the  excitors.  Dr.  R.  Remak,  of  Berlin,  ascertained  that  these  points 
correspond  with  the  points  at  which  the  nerves  enter  the  muscles;  and  that  the 
degree  of  contraction  produced  is  exactly  proportionate  to  the  number  of  motory 
nerve  fibres  embraced  by  the  current  at  its  place  of  entrance.  (Med.  Times  and  Gaz,, 
May,  1858,  p.  479.) — Note  to  the  tecond  edition. 


518  GENERAL   STIMULANTS.  [PART  II. 

bility  of  different  nerves  and  muscles  is  very  different  in  degree ;  and  a 
force  which  will  affect  one  but  slightly,  will  on  another  act  with  gre^u 
energy.  Again,  while  one  part  is  unusually  excitable  in  relation  to  con- 
tractility, another  is  more  so  in  relation  to  sensibility.  It  is  against  the 
latter  that  the  operator  must  be  particularly  on  his  guard,  prepared  to 
withhold  his  hand,  or  diminish  the  force  of  the  instrument,  when  the  in- 
fluence becomes  excessive.  Sometimes  the  sensibility  to  pain  is  so  great, 
as  to  preclude  this  method  of  electrization.  It  is  apt  to  be  particularly 
strong  in  the  muscles  of  the  face,  supplied  by  the  fifth  pair.  The  excitor 
should  never  be  placed  over  the  points  corresponding  with  the  suborbitar 
or  mental  nerve ;  and  the  excitation  of  the  frontal  nerves  produces  severe 
pain,  which  radiates  through  the  head.  The  muscles  of  the  eyelids,  of 
the  alse  nasi,  and  of  the  upper  and  lower  lips,  are  peculiarly  susceptible. 
Of  the  muscles  of  the  neck,  the  platysma  myoides,  the  upper  half  of  the 
sterno-mastoid,  and  the  external  edge  of  the  upper  half  of  the  trapezius, 
are  much  more  excitable  than  the  remainder.  The  great  pectoral  and 
the  muscles  of  the  subspinal  fossa  are  rather  sensitive ;  the  deltoid  and 
the  muscles  of  the  arms  somewhat  less,  the  anterior  being  much  more  so 
than  the  posterior.  The  long  dorsal  and  the  sacro-lumbar  are  but 
slightly  sensitive.  The  gluteal  and  fascia  lata  muscles  are  very  much 
so,  compared  with  those  on  the  outer  and  posterior  parts  of  the  thigh ; 
those  of  the  internal  crural  region  more  so  than  those  of  the  external. 
The  posterior  muscles  of  the  leg  are  but  slightly  sensitive  compared 
with  the  anterior  and  external. 

At  the  moment  of  contact,  even  when  the  surface  is  moist,  severe  pain 
is  sometimes  felt  in  the  skin,  which  soon  ceases.  In  such  cases,  in  order 
to  obviate  the  effect,  the  exciters  should  be  brought  into  contact  before 
application,  so  as  to  restore  the  equilibrium,  and  then  gradually  separated 
to  the  necessary  distance. 

2.  To  the  Skin.  If  static  electricity  is  employed  for  exciting  the  skin. 
it  is  necessary  that  it  should  be  of  feeble  intensity,  as  it  would  otherwise 
penetrate  the  deeper  tissues.  The  dynamic  form  is  preferable;  care 
being  taken  to  have  the  surface  of  the  excitors  quite  dry,  so  as  to  confine 
the  influence  to  the  skin.  But  the  electricity  of  induction,  thefaradttm 
of  M.  Duchenne,  is  here  specially  advantageous,  when  mere  excitation 
without  organic  disturbance  of  the  surface  is  wanted ;  as  it  never,  like 
galvanism,  produces  severe  inflammation  or  cauterization.  If,  however. 
a  powerful  revulsive  effect  is  desired,  for  the  relief  of  chronic  internal 
affections,  galvanism  is  preferable. 

An  excitor  containing  the  moist  sponge  having  been  applied  to  one 
point  of  the  surface,  the  other  excitor,  quite  dry,  is  to  be  held  by  the 
operator,  and,  after  the  skin  has  been  thoroughly  dried  by  rubbing  upon 
it  lycopodium  or  other  absorbent  powder,  is  to  be  passed  rapidly  over 
the  part;  or  cylindrical  or  olive-shaped  dry  excitors  may  be  moved  from 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. — ELECTRICITY.  519 

point  to  point  over  the  skin.  Sometimes  advantage  may  accrue  from 
using  the  wire  brush  (Fig.  3,  page  509)  as  an  excitor,  which  may  be 
moved  over,  or  struck  lightly  on  the  surface.  M.  Duchenne  calls  this 
latter  process  fustigation.  The  wires  may  also,  in  certain  cases,  be  kept 
in  contact  with  the  skin ;  but  this  cannot  be  long  borne,  in  consequence 
of  the  violent  pain  produced.  The  latter  mode  of  electrization  he  calls 
electric  moxa,  as  having,  I  presume,  the  powerful  irritant  and  revulsive 
influence  of  that  agent,  without  its  organic  results.  It  is  applicable  only 
when  there  is  great  cutaneous  insensibility,  or  it  is  desired  to  promote 
the  dispersion  of  white  swellings,  and  other  chronic  tumours  or  tume- 
factions. 

The  application  of  the  electrified  hand  of  the  operator,  under  the  in- 
fluence of  an  intense  current,  excites  lively  sensation  in  the  face,  but  is 
insufficient  for  other  parts  of  the  body.  'The  rounded  metallic  excitors 
act  powerfully  on  the  face,  even  with  a  slight  intensity  of  current,  and 
sufficiently  on  the  skin  of  the  trunk  and  other  parts  of  the  body,  except 
that  of  the  hands  and  the  soles  of  the  feet.  For  the  last-mentioned  parts 
the  wire  brush  must  be  used,  which  has  three  times  the  power  of  the 
blunt  excitors.  The  inner  and  middle  parts,  however,  of  the  soles  of  the 
feet  have  more  susceptibility. 

No  single  therapeutic  agency  is  so  efficacious  in  exciting  cutaneous 
sensibility  as  "faradisation."  It  may  be  graduated  to  any  required  de- 
gree of  impression,  from  a  slight  tingling  to  the  most  violent  pain ;  the 
excitement  in  its  higher  grades  is  not  exceeded  by  that  of  a  burn,  yet  no 
disorganization  takes  place,  not  even  so  much  as  vesication ;  it  may  be 
carried  rapidly  over  the  whole  surface  of  the  body ;  and  the  pain  sub- 
sides instantly,  and  almost  completely,  when  the  operation  ceases. 

To  Internal  Organs.  Most  of  these  may  be  reached  either  directly  by 
the  excitors,  or  through  the  nerves  which  supply  them. 

In  affections  of  the  rectum,  one  of  the  metallic  olive-shaped  excitors, 
upon  a  stem  insulated  by  a  covering  of  caoutchouc,  may  be  introduced 
into  the  bowel,  while  the  other  is  carried  from  point  to  point  about  the 
anus.  If  the  sphincters  are  debilitated  or  paralyzed,  the  excitor  may  be 
brought  into  apposition  with  them;  if  the  muscular  coat  of  the  rectum, 
it  should  be  passed  successively  over  the  whole  inner  surface  of  the 
bowel.  Constipation,  incontinence  of  the  feces,  and  prolapsus  of  the 
rectum  may  often  be  advantageously  treated  in  this  way.  In  the  same 
manneifphe  hypogastric  plexus  posterior  to  the  rectum  may  be  excited. 

The  bladder  and  rectum  are  but  slightly  sensitive  to  pain  from  the 
electric  impression.  The  latter,  therefore,  may  be  resorted  to  in  oper- 
ating on  the  former,  an  excitor  being  introduced  into  both;  but  care  must 
always  be  taken,  in  using  instruments  for  the  purpose,  that  the  stem 
should  be  completely  insulated.  The  vesical  excitor  may  be  carried  over 
the  whole  surface  of  the  bladder.  Should  the  rectum  be  too  irritable 


520  GENERAL    STIMULANTS.  [PART  II. 

for  tlie  purpose,  the  two  excitors  may  be  introduced  through  a  double 
caoutchouc  canula  into  the  bladder;  the  instrument  being  so  contrived 
that  the  excitors  should  not  be  allowed  to  meet.  The  bladder,  however, 
should  be  quite  emptied  of  urine,  as  this  fluid  would  otherwise  serve  to 
connect  the  poles. 

The  uterus  may  be  operated  on  by  a  somewhat  similarly  contrived 
double  instrument.  This  organ  also  has  but  little  sensitiveness  unless  in 
pregnancy. 

The  pharynx  may  be  entered  by  an  olive-shaped  excitor,  properly 
supported,  which  may  be  passed  along  the  posterior  part,  while  the  other 
pole  is  applied  to  the  nape  of  the  neck.  It  is  necessary  to  avoid  the  lat- 
eral portions  of  the  pharynx,  for  fear  of  injuriously  exciting  the  pneu- 
mogastric,  glosso-pharyngeal,  and  accessory  nerve  of  Willis,  which  are 
in  this  vicinity.  • 

In  complaints  of  the  larynx,  as  aphonia,  one  of  the  excitors  may  be 
passed  down  the  pharynx  below  the  posterior  part  of  the  larynx,  while 
the  other  is  applied,  moistened,  to  the  external  parts  answering  to  the 
crico-thyroid  muscle.  The  inner  excitor  is  then  to  be  brought  forward 
against  the  larynx,  and  passed  upwards  and  downwards. 

The  stomach,  liver,  lungs,  and  heart  cannot  be  acted  on  directly,  but 
may  be  reached  through  the  pneumogastric  nerve.  By  making  the  ap- 
plication to  the  lower  portion  of  the  oesophagus,  which  may  be  done  by 
the  introduction  of  a  suitable  instrument,  insulated  by  a  caoutchouc  cov- 
ering, except  at  its  extremity,  and  placing  the  other  excitor  at  the  pit  of 
the  stomach,  the  influence  may  be  directed  to  the  stomach  and  liver.  If 
the  upper  part  of  the  nerve  is  acted  on  by  applying  the  pharyngeal  ex- 
citor to  the  upper  and  lateral  part  of  the  pharynx,  and  the  second  to 
the  nape  of  the  neck,  all  the  viscera  mentioned  will  be  put  under  the 
electric  influence.  But  these  operations  require  much  caution,  as  the 
vital  organs  concerned  might  be  unduly  and  dangerously  affected;  and 
M.  Duchenne  relates  a  case,  in  which  a  patient  fainted  under  the  second 
of  the  operations  just  mentioned,  and,  upon  recovery,  stated  that  \\c  had 
experienced  a  feeling  of  suffocation,  and  indescribable  precordial  sensa- 
tions. On  a  repetition  of  the  operation,  with  intermissions  of  a  second, 
the  patient  did  not  faint,  but  had  the  same  precordial  sensation  each 
time. 

To  the  Special  Senses.  For  the  sight,  galvanism  is  preferable  to  elec- 
tricity by  induction,  as  it  is  more  powerfully  stimulant  to  thd(Brgan  of 
vision.*  If  either  of  the  inductive  machines  be  used,  the  electro-mag- 

*  Dr.  Julius  Althaus,  of  London,  who  is  high  authority  on  electrical  subjects,  st.ites 
that  a  very  feeble  galvanic  current  applied  to  the  face,  such  as  may  be  excited  by 
the  contact  of  a  silver  and  copper  coin,  is  sufficient  to  cause  a  flash  of  light ;  while. 
if  a  number  of  large  plates  are  used,  as  in  Grove's  or  Daniell's  battery,  the  influence 
on  the  retina  is  so  great,  that  instantaneous  blindness  might  result.  The  effect  is 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. ELECTRICITY.  621 

netic  with  a  double  wire  should  be  preferred,  as  the  more  energetic  of 
the  two.  The  application  may  be  made  carefully  to  the  ball,  and  around 
the  orbit. 

In  operating  on  the  ear,  the  external  meat  us  should  be  half  filled  with 
warm  water,  and  a  metallic  wire  from  one  of  the  poles  should  be  intro- 
duced into  the  liquid,  while  the  other  excitor  is  applied  to  the  nape  of 
the  neck ;  or  the  second  excitor,  protected  by  caoutchouc,  except  at  the 
end,  may  be  introduced  through  the  nostrils,  so  as  to  come  into  contact 
with  the  Eustachian  tube.  As  the  tympanum,  however,  is  very  sen- 
sitive, great  caution  must  be  observed. 

When  the  electric  influence  is  wanted  in  the  organ  of  smell,  a  small 
sound,  protected  as  usual  except  at  the  extremity,  may  be  passed  over 
the  Schneiderian  membrane;  when  in  that  of  taste,  the  same  instrument 
may  be  passed  over  the  sides  of  the  tongue  and  the  palate;  the  second 
excitor,  in  both  cases,  being  applied  to  the  back  of  the  neck. 

To  the  Male  Genitals.  The  testicle  being  very  sensitive,  must  be 
operated  on  with  caution;  two  excitors  being  placed  near  each  other 
upon  the  scrotum.  For  operating  on  the  vesiculse  seminales,  one  ex- 
citor may  be  introduced  into  the  rectum,  and  the  second  into  the  bladder, 
if  there  be  no  contraindication ;  otherwise  the  latter  may  be  applied  on 
the  external  surface.  In  insensibility  of  these  organs  generally,  the  in- 
fluence should  be  directed  along  the  whole  course  of  the  urethra,  as  well 
as  to  the  different  parts  externally. 


Notwithstanding  the  localization  effected  by  these  methods,  a  secondary 
influence  will  sometimes  be  extended  to  the  nervous  centres,  against  which 
it  is  necessary  that  the  operator  should  be  on  his  guard.  The  pain  itself 
produced  in  the  part  necessarily  affects  the  cerebral  centres;  and,  when 
care  is  taken  to  limit  the  current  by  keeping  the  poles  near  together,  this 
is  the  chief,  if  not  exclusive  source  of  general  disturbance  that  may  be 
apprehended.  In  cases  of  paralysis  of  sensation,  as  well  as  motion,  none 
of  this  effect  is  experienced.  The  muscle  may  contract;  but,  however 
long  the  operation  may  be  continued,  the  patient  is  sensible  of  no  incon- 


greater  when  the  current  is  directed  to  the  mucous  membrane,  whether  of  the  eye, 
the  nostril,  or  the  mouth,  than  to  the  skin,  and  greater  when  to  the  skin  previously 
moistened  than  dry.  But,  though  thus  energetic  in  its  action  on  the  organ  of 
vision,  tW  continuous  or  galvanic  current  exerts  little  influence  over  the  muscles  of 
the- face,  which  are  powerfully  acted  on  by  faradism  or  the  interrupted  current, 
while  the  latter  has  little  action  on  the  eye.  Hence  the  great  importance  of  a  proper 
discrimination  in  the  application  of  the  different  currents  to  affections  of  the  face. 
For  deficiency  in  the  nervous  power  of  the  retina,  galvanism  would  be  the  remedy; 
in  palsy  of  the  muscles,  faradisation ;  and  if,  in  the  latter  case,  galvanism  should  be 
employed,  it  would  not  only  do  no  good  to  the  muscles,  but  might  seriously  disturb 
the  healthy  vision.  (Med.  T.  and  Gaz.,  Aug.  1862,  p.  219.) — tfole  to  the  third  edition. 


522  GENERAL   STIMULANTS.  [PART  II. 

venience.  Even  reflex  action  from  the  spinal  centres  is  excited  by  this 
localixed  contraction  only  in  certain  pathological  conditions.  But  when 
there  is  no  loss  of  sensibility,  much  care  is  necessary.  Certain  indi- 
viduals are,  from  idiosyncrasy,  so  exceedingly  susceptible,  that  a  slight 
influence,  even  insufficient  to  cause  local  sensation,  occasions  faintness, 
giddiness,  dimness  of  vision,  nausea,  vomiting,  and  general  feelings  of 
torpor  or  numbness.  These  persons  are  unfit  subjects  for  the  use  of  the 
remedy.  The  pain  occasioned  by  the  interrupted  current  has  been  em- 
ployed successfully  in  overcoming  the  obstinacy  often  exhibited  in  feigned 
diseases.  Under  the  impression  that  the  electricity  is  employed  as  a 
remedial  agent,  the  malingerer,  unwilling  longer  to  submit  to  the  pain, 
acknowledges  himself  cured  by  the  remedy.  (Dr.  Addinel  Hevvson,  Am. 
J.of  Mtd.  Sci.,  Jan.  1861,  p.  111.) 


Acupuncture.  In  1825,  M.  Sarlandiere  proposed  the  direct  application 
of  the  electric  influence  to  deep  seated  parts  by  means  of  acupuncture; 
and,  seconded  as  the  measure  was  by  the  recommendation  of  Magendie, 
it  acquired  for  a  time  great  reputation,  and  was  extensively  resorted  to. 
It  consisted  in  introducing  very  sharp  needles  through  the  skin  into  the 
part  or  organ  which  it  was  desired  to  excite,  particularly  the  muscles, 
and  passing  the  current  through  them,  so  that  in  proceeding  from  point 
to  point  of  the  needles  it  must  necessarily  traverse  the  part.  But  the 
results  have  not  corresponded  with  the  first  sanguine  expectations,  and 
the  measure  is  at  present  seldom  resorted  to.  Nor  is  it  now  necessary 
medical  practice;  as  the  methods  of  M.  Duchenne  accomplish  the 
same  end  more  effectually  and  less  disagreeably.  The  objections  urged 
by  M.  Duchenne  against  it  are,  1.  that  the  electrization  of  the  muscle 
cannot  be  separated  from  that  of  the  skin ;  2.  thaf  the  cutaneous  excite- 
ment being  confined  to  the  course  of  the  needle,  surfaces  of  considerable 
extent  could  not  be  stimulated;  3.  that  the  contractions  caused  by  it  are 
irregular  and  cannot  be  foreseen  ;  4.  that  to  excite  the  whole  of  a  muscle, 
especially  a  large  one,  so  many  needles  must  be  introduced  that  few 
patients  would  be  found  willing  to  bear  the  pain;  and  5.  that,  if  it  be  de- 
sired to  excite  the  muscle  by  passing  the  needle  through  the  nerve,  the 
operation  is  almost  always  impracticable.  Nevertheless,  acupuncture 
may  sometimes  be  usefully  employed  by  surgeons  for  the  discussion  of 
tumours,  and  for  promoting  the  coagulation  of  the  blood  in  aWirisms. 
Platinum,  or  gold  needles,  should  be  used  preferably  to  steel;  as  the 
latter  may  become  oxidized,  and  thus  irritate  the  parts.  When  a  gal- 
vanic battery  is  used,  the  parts  penetrated  by  the  needle  are  apt  to 
become  inflamed,  and  a  caustic  effect  is  not  unfrequently  produced. 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. — ELECTRICITY.  523 

Great  importance  has  been  attached  to  the  transmission  of  the  electric 
current  along  the  nerve,  and  in  one  direction  rather  than  another,  in  imi- 
tation of  the  course  of  nervous  influence.  But  much  of  what  has  been 
said  on  these  points  has  been  purely  theoretical.  M.  Duchenne  has  come 
to  the  following  conclusions.  1.  In  man,  whatever  may  be  the  direction 
of  the  currents,  or  the  degree  of  vitality  of  the  nerves  they  traverse,  the 
same  results  are  always  produced,  when  the  conductors  are  applied  to 
any  portion  of  the  course  of  the  nerves ;  namely,  muscular  contractions 
and  sensations.  2.  A  current  prolonged  for  a  considerable  time  along  a 
healthy  nerve,  whether  it  be  continuous,  or  interrupted  with  rather  short 
intermissions,  weakens  neither  the  contractions,  the  sensations,  nor  the 
voluntary  movements,  and  produces  no  reflex  phenomenon  above  the 
point  excited.  3.  A  current  long  protracted  in  a  nerve  considerably  de- 
bilitated, notably  lessens  its  excitability,  but  without  influencing  the 
voluntary  motions.  4  Changes  in  the  direction  of  the  current  exercise 
no  appreciable  influence  over  the  muscular  contractility  or  sensibility  in 
man.  5.  Electrization  of  the  terminal  nerves  of  a  limb  produces  sensa- 
tions only  in  the  points  excited.  6.  The  currents  which  pass  from  the 
nervous  extremities  to  the  nervous  centres,  act  principally  on  the  sensi- 
bility of  the  limb,  and  produce,  above  the  point  excited,  contractions 
which  are  irregular,  and  little  proportionate  to  the  intensity  of  the  sensa- 
tions. 7.  Finally,  the  mode  of  electrization,  by  reflex  action,  has  little 
efficacy  in  the  treatment  of  palsy,  and  sometimes  causes  persistent  neu- 
ralgia in  the  excited  limb.  (Duchenne,  pp.  99,  100.)  Should  there  be 
cerebral  lesion  existing  at  the  time,  it  might  do  serious  mischief.  (Ibid., 
p.  9t.)  A  fact  worthy  of  recollection  is,  that  electric  excitation  of  the 
surface  is  more  effective  in  bringing  on  reflex  muscular  contraction,  than 
excitation  of  the  muscles  themselves.  (Ibid.,  p.  33.) 

4.  Therapeutic  Applications. 

Under  the  impression  that  nervous  power  is  nothing  more  than  a 
form  of  electricity,  which  some  physiologists  were  at  one  time  disposed 
to  believe,  it  was  imagined  that  the  latter  agent  might  be  made  ex- 
tremely useful  in  disease,  by  supplying  the  deficiency,  or  correcting  the 
redundancy  of  the  former.  Theoretical  notions,  founded  on  this  basis, 
have  always  had,  and  continue  to  have  more  or  less  influence  upon  ther- 
apeutics. It  has  been  supposed  that  nervous  action  in  excess  might  be 
controlled  by  the  use  of  negative,  and  when  deficient  might  be  replaced 
by  that  of  positive  electricity.  It  has  been  considered  important, 
through  the  direction  of  the  electrical  current,  to  imitate  the  natural  pre- 
sumed nervous  currents ;  for  one  purpose  to  send  the  influence  in  one 
direction,  for  another  in  another  direction ;  to  procure  in  certain  cases  its 
transmission  by  one  set  of  nerves  rather  than  another;  in  short,  to 


524  GENERAL    STIMULANTS.  [PART  II. 

make  use  of  electricity  as  if  it  were  really  the  true  nervous  fluid,  and 
wield  it,  as  that  instrument  is  wielded  under  the  powers  of  life,  for  the 
maintenance  of  all  the  functions  in  their  due  action  and  subordination. 
It  is  true  that  this  supposition  of  the  identity  of  the  two  agents  has  been 
quite  abandoned,  under  the  irresistible  contradiction  of  experiment;* 
but  there  still  remains  the  undoubted  and  extraordinary  analogy  between 
them,  to  sustain  the  conjecture  that  the}-  might  operate  under  similar 
laws  upon  the  system,  and  that  consequently  electricity  might,  in  many 
instances,  be  substituted  for  the  nervous  influence,  if  brought  to  bear  on 
the  system  in  a  similar  manner.  I  fear,  however,  that  it  will  be  neces- 
sary to  abandon  this  view  of  the  powers  and  uses  of  electricity. 

With  the  facts  at  present  known  in  relation  to  its  effects  on  the  sys- 
tem, it  is  best  to  consider  it  simply  as  a  universal  excitant,  capable  of 
stimulating  any  function  or  organ  upon  which  it  can  be  brought  to  bear 
directly  into  increased  activity,  and  having  this  special  advantage  over 
every  other  remedial  agent,  that,  by  its  peculiar  nature,  it  is  capable  of 
being  directed  to,  and  in  a  great  degree  limited  in,  any  part  which  it 
may  be  desirable  to  operate  upon  exclusively.  It  must  be  borne  in  mind 
that  it  is  not  by  its  accumulation  that  it  is  capable  of  fulfilling  any  thera- 
peutic purpose,  but  only  by  movement;  and  hence  it  cannot  be  brought 
to  exert  a  direct  simultaneous  influence  upon  the  whole  system ;  for  it  is 
scarcely  possible  so  to  direct  its  current,  that  it  should  pass  at  the  same 
time  through  all  parts  of  the  body.  It  is,  therefore,  though  a  universal 
stimulant,  necessarily  more  or  less  local  in  its  therapeutic  action  at  any 
one  time. 

With  its  universal  stimulant  power,  it  exercises  a  special  excitant 
influence  upon  the  properties  of  sensation  and  muscular  contraction ; 
and  upon  this  influence  its  most  important  remedial  applications  are 
based. 

Through  the  quick  and  powerful  impression  it  makes  upon  the  nerv- 
ous centres,  commonly  designated  as  the  shock,  it  is  capable,  if  not  car- 
ried too  far,  of  arousing  the  whole  system,  and  thus  fulfilling  another 
important  indication. 

By  this  same  shock,  in  its  more  forcible  application,  it  overwhelms, 
and  for  a  time  depresses  or  suspends  function;  and  by  a  continued  exci- 
tant influence,  it  exhausts  excitability,  and  thus  may  induce  secondary 
depression.  It  may  consequently  be  made  use  of  occasionally  as  a  sed- 
ative agent.  In  the  depressing  influence  of  the  shock,  it  has,  if  prop- 

*  This  was  demonstrated  by  the  experiments  of  Matteucci  and  others;  but  an 
observation  of  M.  Duchenne  shows,  in  a  striking  point  of  view,  the  distinction  of 
the  two  actions,  the  nervous,  namely,  and  electric.  According  to  that  author,  the 
muscles  may  be  wholly  insensible  to  electrical  influence,  and  yet  capable  of  acting 
under  the  influence  of  the  will.  (Electrisation  Lucalisee,  etc.,  p.  402.) 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. — ELECTRICITY.  525 

erly  managed,  this  great  advantage,  that,  as  it  acts  mainly  on  the 
nervous  system,  the  reaction  which  follows  is  also  mainly  nervous,  and, 
therefore,  not  disposed  to  lead  to  fever  or  inflammation. 

Again,  it  may,  in  certain  forms,  be  made  to  produce  inflammation,  and 
thus  act  revulsively. 

The  influences  hitherto  mentioned  have  been  vital.  But  it  also  pro- 
duces chemical  effects,  of  which  we  may  sometimes  avail  ourselves  ther- 
apeutically. 

From  what  has  been  just  stated,  the  following  practical  indications 
for  the  use  of  electricity  may  be  deduced:  1.  to  excite  any  particular 
function  or  organ  which  may  be  inactive  or  torpid,  and  which  may  stand 
in  need  of  stimulation ;  2.  especially  to  stimulate  parts  in  which  sensa- 
tion or  the  normal  power  of  motion  may  be  defective  or  wanting,  as  in 
paralytic  conditions  of  the  muscular  power  or  general  sensibility,  or  of 
the  special  senses;  3.  to  awaken  the  system  generally  from  a  state  of  tor- 
por, as  in  asphyxia,  syncope,  and  the  poisonous  effects  of  the  narcotics; 
4.  to  benumb  deranged  sensation,  or  suppress  excessive  muscular  con- 
traction, as  in  neuralgia,  some  forms  of  rheumatism,  and  tetanus;  5.  to 
operate  revulsively  by  inflaming  or  irritating  the  skin,  as  in  various  in- 
ternal and  subcutaneous  affections,  including  chronic  inflammations, 
rheumatism,  etc.;  6.  to  alter  morbid  nutrition  by  stimulating  the  disinte- 
grating process,  and  thus  promoting  the  absorption  of  indolent  tumours; 
and  7.  through  its  chemical  agency  to  effect  various  objects,  as  the  coag- 
ulation of  the  blood  in  aneurisms,  the  solution  of  stone  in  the  bladder, 
and  the  extraction  of  poisonous  metals  from  the  system,  for  all  which 
purposes  it  has  been  recommended  and  employed.  It  is,  I  believe,  in 
some  one  of  the  above  methods,  or  some  combination  of  them,  that  it 
operates  as  a  remedial  agent.  But  to  render  it  practically  useful,  we 
must  be  more  precise,  and  consider  severally  the  various  diseases  in 
which  it  may  be  used;  pointing  out  in  each  the  particular  circum- 
stances which  may  indicate  or  contraindicate  it,  and  the  particular  modes 
of  application  most  appropriate. 

1.  Paralytic  Affections. 

It  is  only  by  stimulating  the  paralyzed  part,  or  the  nervous  centre  or 
nervous  trunk  supplying  it,  that  electricity  operates  in  the  cure  of  palsy. 
It  is  obvious,  therefore,  that  it  is  wholly  inapplicable  to  cases  in  which 
the  affection  depends  upon  high  vascular  congestion,  inflammation,  or 
other  organic  disease  of  the  nervous  centres.  It  is  not  less  obvious  that 
it  can  be  of  no  use,  when  similar  disease  in  the  connecting  nerves  pre- 
vents the  transmission  of  influence  from  the  centres,  even  though  these 
may  be  in  a  healthy  state.  Under  these  circumstances,  so  far  from 
being  serviceable,  it  may  do  serious  harm,  not  only  when  applied  directly 


GENERAL    STIMULANTS.  [PART  II. 

to  the  diseased  centres  or  nerves,  but  even  when  limited  to  the  panv- 
ly/.eil  part ;  for  any  excitement  in  this  part  reacts  upon  the  nervous  cen- 
tres, and  of  course  upon  the  nerves  which  convey  impressions  to  them 
But,  when  all  excitement  in  nervous  centres  or  trunks  has  subsided, 
when  the  organic  injury  has  been  repaired,  and  the  continuance  of  the 
palsy  is  owing  simply  to  debility  in  the  centres,  or  the  habit  of  inertia. 
or  defective  nutrition  in  the  paraly/ed  part,  the  electric  influence  is 
strongly  indicated,  and  often  doe-  great  service. 

The  same  remark  is  applicable  to  cases  of  palsy  from  wounds  or  other 
mechanical  injuries  of  the  nervous  centres  or  trunks.  It  is  vain  to  stim- 
ulate the  palsied  part  until  the  wound  has  healed,  or  the  injury  been 
repaired.  But  after  this  event,  it  not  unfrequently  happens  that  the 
palsy  persists,  and  sometimes  seems  as  if  it  would  persist  indefinitely, 
unless  the  sluggish  centre  be  stimulated,  or  the  paralyzed  part  restored, 
by  suitable  excitation,  to  its  proper  organic  condition  and  due  sensibility. 
Perhaps,  under  these  circumstances,  no  one  agent  is  so  efficient  as  elec- 
tricity, because  no  one  can  be  brought  to  bear  so  accurately  upon  the 
seat  of  the  disease. 

It  must  be  observed  that,  in  thus  limiting  the  power  of  electricity  in 
paralytic  affections,  I  have  reference  to  the  excitant  power  of  the  remedy 
over  the  muscle.  But,  as  will  be  shown  directly,  electricity  may  some- 
times be  used  with  great  effect  in  the  cure  of  certain  chronic  cases  of  in- 
flammation ;  and  thus,  in  cases  of  palsy  dependent  on  chronic  inflam- 
matory thickening  of  the  supplying  nerve,  a  cure  may  be  hoped  for  h\ 
the  antiphlogistic  power  of  the  agent  directed  to  the  diseased  part  of  Un- 
nerve. 

In  all  cases  of  palsy  arising  from  simple  debility  or  depression  of  the 
centres,  and  all  those  of  local  origin,  not  dependent  on  irreparable  los.- 
of  parts,  or  other  organic  injury,  much  good  may  be  hoped  for  from 
electricity. 

In  relation  to  the  precise  circumstances  under  which,  in  the  ra-rs 
above  mentioned  as  indicating  this  agent,  it  may  be  used  with  the 
greatest  benefit,  to  the  precise  modes,  moreover,  in  which  it  may  be 
most  effectually  employed,  and  the  probable  results  in  each  case,  nothing 
has  appeared  which,  so  far  as  I  am  able  to  judge,  approaches  in  value 
the  recent  contributions  of  M.  Duchenne  to  this  branch  of  therapeutics. 
In  the  following  remarks  on  the  use  of  the  remedy  in  palsy,  the  reader 
will  please  to  ascribe  to  that  author  most  of  the  credit  of  what  he  mav 
find  in  them  that  is  meritorious. 

In  the  first  place,  it  may  be  stated,  as  a  general  rule,  that  application 
directly  to  the  palsied  part  is  much  more  efficacious  than  when  made 
through  the  medium  of  the  nerve  supplying  the  part. 

In  palsy,  the  sensibility  and  power  of  motion  may  both  be  lost,  or 
either,  without  the  other. 


CHAP.   I.]  DIFFUSIBLE    STIMULANTS. ELECTRICITY.  527 

In  reference  to  the  condition  of  the  muscles,  palsies  may  be  classified 
according  to  the  mode  in  which  the  part  affected  is  influenced  by  the 
electric  current;  and,  by  attention  to  these  differences,  great  assistance  is 
gained,  not  only  in  diagnosis,  but  in  the  proper  application  of  the  rem- 
edy. There  are  two  classes  of  the  affection;  one  in  which  the  muscle 
does  not  contract,  or  contracts  but.  slightly  and  inefficiently,  under  the 
electric  stimulus,  and  the  other  in  which  it  responds  readily  to  the 
stimulus,  and  contracts  whenever  it  is  applied.  In  one  case  the  electro- 
contractility  is  lost  or  impaired,  in  the  other  it  remains  untouched. 
To  the  former  class  belong  palsies  depending  on  lesions,  traumatic  or 
otherwise,  of  the  spinal  marrow  or  nervous  trunks  proceeding  from  it, 
and  the  palsy  of  lead;  to  the  latter  all  the  purely  cerebral  palsies, 
whether  proceeding  from  hemorrhage,  inflammation,  or  other  lesion,  the 
palsies  denominated  rheumatic  and  hysterical,  and  those  dependent  on 
atrophy  or  fatly  degeneration  of  the  muscle  itself,  which  exhibits  this 
property  so  long  as  any  of  the  muscular  fibre  is  left.  The  electro-sensi- 
bility, or  susceptibility  to  painful  impression  from  electricity,  is  some- 
what differently  modified.  Generally  speaking,  a  loss  or  diminution  of 
electro-contractility  is  accompanied  with  the  same  condition  of  electro- 
sensibility  ;  but  with  integrity  of  the  electro-contractility,  the  sensibility 
may  be  normal,  increased,  diminished,  or  quite  lost.  Having  made  these 
preliminary  observations,  we  will  proceed  to  the  consideration  of  the 
special  palsies.  The  reader  will  remember  that  it  is  the  electricity  of  in- 
duction, the  form,  namely,  developed  by  the  magneto-galvanic  or  magneto- 
electric  machines,  that  is  employed,  unless  the  fact  is  otherwise  specially 
stated.  We  may  sometimes  use  M.  Duchenne's  term  of  faradisation,  to 
signify  this  mode  of  applying  electricity. 

1.  Palsy  from  Cerebral  Hemorrhage.  This  generally  assumes  the 
form  of  hemiplegia;  but  it  may  also  be  paraplegic  or  local.  The 
reader  will  bear  in  mind  the  observations  above  made,  in  relation  to  the 
circumstances  under  which  electricity  becomes  applicable  in  this  affec- 
tion. No  attempt  should  be  made  to  employ  this  agent,  until  there  is 
reason  to  think  that  the  effused  blood  has  been  absorbed,  and  a  cyst  or 
cicatrix  only  remains,  without  inflammatory  action.  It  will  seldom  be 
proper  to  begin  with  the  use  of  it  until  six  or  seven  months  after  the 
commencement  of  the  disease.  If  employed  too  early,  there  will  be 
great  danger  of  producing  hazardous  congestion  or  inflammation  of  the 
brain,  through  the  reaction  upon  it  of  the  local  disturbance.  To  obviate 
this  as  far  as  possible,  the  exciters  should  be  placed  as  near  each  other 
as  may  consist  with  the  object  of  sending  the  current  into  the  muscle, 
so  as  to  confine  the  disturbance  within  the  narrowest  limits.  If,  in  cases 
of  cerebral  hemorrhage,  after  from  five  to  eight  months,  the  palsy  per- 
sists without  any  contraction  of  the  muscles,  a  cure  may  be  expected 
with  considerable  certainty  under  faradisation ;  if  there  be  permanent 


528  GENERAL    STIMULANTS.  [PART  II. 

contraction,  little  hope  of  a  cure  need  be  indulged;  as  this  condition 
indicates  a  persistent  state  of  cerebral  inflammation  or  softening-,  which 
is  not  likely  to  cease.*  If  there  be  only  temporary,  or  irregular  con- 


*  Dr.  Robert  Remak,  of  Berlin,  asserts,  as  the  result  of  numerous  trials,  that  the 
application  of  the  continued  current,  as  produced  by  the  elements  of  Daniel!,  Grove, 
and  Bunsen,  has  the  effect  of  immediately  relaxing  the  tonic  spasms  of  the  muscles 
attending  hemiplfgia  from  cerebral  hemorrhage,  and  rendering  them  amenable  to 
the  action  of  the  will.  He  affirms,  too,  that  by  the  continued  application  of  the 
constant  current  to  the  nerves  and  muscles,  he  has  obtained  curative  effects  greater 
than  he  had  been  able  to  obtain  by  any  other  mode  of  applying  electricity,  in  acute 
and  chronic  rheumatism,  cerebral  hemiplegia,  paraplegia,  muscular  atrophy,  chorea, 
stammering,  trembling  of  the  limbs,  and  cramps.  ( Med.  Times  and  Gaz.,  May,  1858, 
p.  479.) — Note  to  the  second  edition. 

The  late  Berlin  Professor,  Dr.  Robert  Remak,  referred  to  in  the  preceding  note, 
was  one  of  the  highest  German  authorities  on  the  subject  of  medical  electricity,  and 
the  great  advocate  for  galvanization,  or  the  use  of  the  constant  current  as  :\  therapeu- 
tic agent,  in  contradistinction  to  the  induced  or  interrupted  current,  the  faradisation 
of  M.  Duchennc.  Shortly  before  his  decease,  he  delivered  a  course  of  lectures  at 
the  Hospital  "//a  Charite","  of  Paris,  setting  forth  his  peculiar  views,  a  translation 
of  which  is  published  in  the  New  York  Medical  Journal  for  June,  July,  and  August, 
1866  (pp.  185,  279,  and  357).  The  following  are  some  of  the  more  interesting 
points,  which  I  have  thought  it  due  to  the  subject  of  electrical  therapeutics  to  place 
before  the  readers  of  this  work.  The  constant  galvanic  current  is,  according  to 
Prof.  Remak,  incomparably  superior,  in  the  treatment  of  diseases,  to  all  other  elec- 
trical currents;  and,  in  the  majority  of  instances  where  this  is  useful,  the  induction 
currents  are  rather  injurious  than  otherwise.  He  appears  to  prefer,  for  the  de- 
velopment of  galvanism,  the  battery  of  Daniell,  which  affords  a  more  constant  cur- 
rent than  that  either  of  Grove  or  of  Bunsen,  and  the  objection  to  which,  of  re- 
quiring daily  cleansing,  has  been  obviated  by  recent  improvements.  He  applies 
the  current  to  the  surface  by  means  of  metallic  electrodes  covered  with  muslin  or 
wool,  moistened  with  water,  which  communicate  with  the  conducting  rods  by  a 
bundle  of  silver  wires,  with  gutta  percha  or  caoutchouc  envelopes  (p.  188).  He 
prefers  the  surface  of  application  of  those  instruments  to  be  as  broad  as  circum- 
stances will  admit;  but  it  of  course  must  vary  in  size  according  to  the  part  to  which 
it  is  applied. 

The  general  effect  of  a  prolonged  application  of  the  constant  current  is  increase 
of  the  temperature  of  the  body,  followed  by  perspiration,  and  often  a  long  sleep 
and  subsequent  general  feeling  of  repose.  Of  the  local  effects  the  most  curious 
are  those  upon  the  special  senses,  which  are  not  produced  by  the  induction  cur- 
rent. Thus,  a  very  feeble  current  applied  to  the  face  occasions  flashes  of  light,  and 
a  peculiar  modification  of  taste.  Though,  in  a  healthy  state  of  the  organ  of  hear- 
ing,'little  effect  is  produced;  yet,  in  nervous  deafness,  the  gentlest  application  of 
the  current  to  the  petrous  bone  causes  sounds.  The  retina  is  most  sensitive  to  the 
positive  pole,  the  gustatory  nerves  to  the  negative ;  and  the  auditory  nerve  is 
more  sensitive  at  the  opening  of  the  circuit  than  at  its  close.  Another  effect  of  the 
constant  current  is  a  species  of  vertigo,  which  is  apt  to  happen  when  the  applica- 
tion is  made  to  a  certain  limited  space,  as  in  the  auriculo-maxillary  fossa.  A  de- 
scending current  acts  more  energetically  on  the  nerves  of  sensation,  an  ascending 
on  those  of  motion;  the  former  at  the  point  of  exit,  the  latter  at  that  of  entrance. 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. — ELECTRICITY.  529 

tractions,  the  prognosis  is  less  favourable  than  with  none,  but  not  alto- 
gether unfavourable ;  as  this  condition  may  be  owing  to  an  unhealthy 
excitability  of  the  spinal  centres,  consequent  on  a  diminution  of  cerebral 
power.  Nor  must  the  mere  stiffening  of  a  muscle,  arising  from  its 

The  two  electrodes  act  differently  on  the  blood-vessels;  the  positive  dilating  them 
and  reddening  (he  skin,  the  negative  producing  a  contrary  effect,  after  continuing 
from  five  to  ten  minutes  in  action. 

Dr  Remak  makes  a  distinction  between  the  con.<lant  and  the  continuous  currents. 
The  voltaic  pile  may  give  a  continuous  current,  but  it  is  not  stead}',  and  gradually 
weakens  until  it  ceases  at  last;  the  constant  current  continues  long  without  losing 
its  intensity.  The  constant  current  does  not  require  that  the  electrodes  should  be 
in  immovable  contact  with  the  skin;  but  is  developed  equally  by  passing  the  elec- 
trodes over  the  surface  from  point  to  point,  without  separating  them  from  the  body. 
These  currents  are  distinguished  as  the  current  in  repose  and  the  current  in  motion, 
the  former  proceeding  from  the  unmoved  electrode,  the  latter  from  the  one  chang- 
ing its  position.  As  to  the  visible  effects  of  the  electrodes  on  the  skin,  the  negative 
pole  rather  than  the  positive,  produces  a  papillary  and  urticarious  eruption,  often 
extremely  sensitive,  and,  after  prolonged  application,  becoming  filled  with  fluid,  and 
ending  at  length  in  a  brown  crust. 

In  general  the  current  in  repose  is  calming,  and  the  current  in  motion  excit- 
ing: yet,  in  severe  paralysis,  the  former,  when  not  too  much  prolonged,  is  more 
energetic  in  restoring  power  than  the  latter.  Generally,  interruptions  in  the 
constant  current  weaken  it,  and  are  useful  only  in  the  treatment  of  contracted 
muscles.  The  soothing  influence  of  the  constant  current  is  exerted  by  very  feeble 
galvanic  action,  insufficient  even  to  disturb  the  skin.  It  differs  from  the  sedative 
influence  of  the  narcotics,  as  opium,  belladonna,  etc.,  and  should  not  supersede 
them ;  but  when  these  fail  to  yield  prompt  relief,  and  in  cases  requiring  their  long- 
continued  use,  galvanization  should  be  resorted  to,  which  both  soothes  and  stimu- 
lates. The  soothing  influence  may  be  employed  to  relieve  exaggerated  sensibility 
in  a  part,  the  result  of  inflammation.  Under  such  circumstances,  the  positive  elec- 
trode may  be  applied  over  the  painful  part,  the  negative  at  a  distance.  A  battery 
of  from  15  to  25  elements  will  generally  give  relief  in  from  5  to  20  minutes.  But 
the  most  effective  plan,  which  relieves  the  severest  inflammation  and  most  ex- 
quisite sensitiveness,  is  to  place  the  positive  electrode  on  some  point  of  the  nerve- 
trunk  which  is  distributed  to  the  diseased  part,  and  the  negative  anywhere  else. 

Ur.  Rcmak  mentions  as  a  curious  fact,  that,  in  the  treatment  of  neuralgia,  the 
direct  application  of  the  constant  current  to  certain  points  of  the  nerve-centres 
having  no  relation  with  the  limb  or  part  affected,  is  often  very  effectual.  This, 
however,  may  be  considered  as  an  example  of  revulsion,  analogous  to  the  power- 
ful influence  of  mental  emotion  in  relieving  neuralgia. 

The  constant  current  is  radically  curative  only  where  it  reaches  the  source  of 
the  disease;  for  example,  when  it  acts  on  and  removes  the  inflammatory  swelling 
of  the  nervous  sheath,  on  which  neuralgia  may  depend. 

In  the  treatment  of  paralysis,  whether  of  motion  or  sensation,  the  galvanic  cur- 
rent will  exhibit  its  anti-paralytic  power  only  when  any  disease  in  the  nervous 
centres  or  trunks  in  which  the  paralysis  originated  has  ceased.  Then  the  constant 
current,  sent  through  the  negative  electrode,  to  the  nervous  filaments  supplying 
the  paralyzed  muscle,  will  instantly  render  the  muscle  subservient  to  the  will. 
But  to  effect  a  perfect  cure,  it  will  be  necessary  to  apply  the  current  several  times, 
VOL.  I. — 34 


530  GENERAL    STIMULANTS.    '  [PART  II. 

shortening  by  position,  be  confounded  with  tonic  spasm  or  rigidity.  M. 
Duchennc  effect  rd  radical  cures  in  one-twentieth  only  of  the  cases,  and 
amelioration  in  about  one-quarter.  The  probability,  I  think,  is  that  the 
electricity  does  not  operate  altogether  locally,  in  these  cases,  in  restoring 
voluntary  contractility;  but  that  the  excitement  produced  in  the  muscle, 
also  reacts  usefully  as  a  stimulant  upon  the  cerebral  centres. 

It  may  sometimes  be  very  important,  in  deciding  as  to  the  proper 
period  for  commencing  with  the  electric  treatment,  to  know  certainly 
whether  the  affection  is  really  cerebral.  The  complete  integrity  of  the 
electro-muscular  contractility  in  the  paralyzed  muscle,  which  charac- 
terizes the  cerebral  cases,  might  be  sufficient  sometimes  to  determine  the 
question. 

When  palsy  of  the  face  and  tongue  only  is  left  after  the  absorption  of 
the  effused  blood,  it  will  in  general  readily  yield  to  this  remedy;  but  it 
should  be  employed,  at  first,  with  much  caution,  for  fear  of  involving 
the  brain,  from  its  vicinity. 

Indeed,  it  would  be  a  good  rule,  in  reference  to  cerebral  palsy  in 
general,  to  commence  cautiously,  with  short  sittings  of  not  more  than 
five  minutes,  and  not  repeated  oftener  than  every  second  or  third  day, 
until  the  state  of  the  brain  shall  have  been  sufficiently  tested.  The 
intermissions,  too,  should  be  distant,  as  exciting  less  disturbance  of  sen- 
sation, which  is  most  to  be  apprehended;  while  the  contraction  produced 
is  energetic.  The  influence  should  be  directed  to  every  paralyzed 
muscle ;  and  those  most  deeply  affected  should  be  longest  and  most 
strongly  excited. 

2.  Palsy  of  the  Insane.  This  form  of  palsy  is  scarcely  a  proper  sub- 
ject, under  any  circumstances,  for  the  application  of  electricity,  which  is 

80  as  to  reach  all  the  fibres,  of  which  some  may  have  at  first  escaped  its  influence. 
Whenever  the  palsy  depends  on  tumefaction  of  the  nerve  sheaths,  whether  pro- 
ceeding from  inflammation  of  the  bones,  joints,  or  viscera,  or  from  injury  to  the 
nerve  itself,  as  by  cold,  violent  stretching,  etc.,  the  indication  is  to  bring  the  con- 
stant current  to  bear  on  the  swollen  nerve;  and  the  lost  contractility  will  in  time 
be  restored,  even  in  the  most  inveterate  cases.  Not  only  paralysis  from  this  source, 
but  morbid  contractions  of  the  muscles,  and  even  hyperissthesia,  which  may  have 
a  similar  origin,  will  yield  to  the  same  measure.  These  affections  are  very  apt  to 
occur  in  the  lower  extremities,  and  especially  in  the  regions  of  the  crural  and 
sciatic  nerves;  and  the  most  obstinate  forms  of  sciatica  sometimes  have  their  origin 
in  this  cause. 

I  have  not  space  for  the  further  observations  of  Dr.  Remak;  and  this  is  of  the 
less  importance,  as  they  are  so  mingled  with  hypothetical  views,  and  presented  in 
so  fragmentary  a  form,  as  very  much  to  lessen  their  value;  but  in  what  precedes  I 
have  endeavoured  to  do  justice  to  the  claims  he  puts  forth  for  galvanization  as  dis- 
tinguished from  faradisation  as  a  therapeutic  agent,  which,  in  the  statements  made 
in  the  text,  might  perhaps  be  considered  as  somewhat  undervalued.  (Note  to  the 
third  edition.) 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. ELECTRICITY.  531 

contraindicated  by  the  existing-  and  increasing  cerebral  lesion.  It  may. 
however,  sometimes  be  important  not  to  mistake  for  it  some  other  form 
of  palsy  which  may  be  benefited  by  this  agent.  The  fact  that  this  va- 
riety is  always  attended  with  unimpaired  electro-muscular  contractility 
may  sometimes  serve  to  distinguish  it  from  cases  of  general  palsy,  of 
another  origin,  in  which  this  property  may  be  wanting,  and  which  may 
be  amenable  in  some  degree  to  the  remedy. 

3.  Spinal  Palsy.   This  has  most  frequently  the  form  of  paraplegia. 
When  dependent  on  active  congestion,  inflammation,  or  even  pressure 
from  moderate  hemorrhage  or  effusion,  it  often,  I  believe,  ends  favour- 
ably with  the  removal  of  the  disease  in  the  spinal  column  ;  and,  in  such 
cases,  there  is  no  indication  whatever  for  electricity,  which  could  be  pro- 
ductive only  of  mischief.     When  the  palsy,  having  originated  in  an  in- 
jury or  wound  of  the  spine,  persists  after  time  has  been  allowed  for  the 
repair  of  the  injury,  the  remedy  may  be  used  with  hope  of  benefit.    But 
as  this  case  falls  under  the  category  of  traumatic  paralysis,  of  which  I 
shall  treat  separately,  it  is  unnecessary  to  say  more  of  it  at  present. 
When  the  palsy  continues  in  consequence  of  previous  hemorrhage,  the 
same  prognosis  and  indications  exist  as  in  cerebral  hemorrhage.     But, 
unhappily,  most  cases  of  obstinate  spinal  paraplegia  depend  on  spon- 
taneous organic  lesion  of  the  medulla,  generally  of  inflammatory  origin  ; 
and  little  is  to  be  expected  from  any  remedy.     Electricity  should  be 
used  only  when  the  palsy  has  survived  all  traces  of  spinal  inflammation, 
under  which  circumstances  it  is  indicated,  and  will  no  doubt  often  do 
good.     I  presume  that  most  of  the  cases  of  paraplegia,  not  hysterical, 
which  end  in  recovery  under  the  use  of  electricity  and  nux  vornica,  av( 
of  this  character.     In  spinal  paralysis,  according  to  M.  Duchenne,  there 
is  a  complete  absence  of  electro-muscular  contractility  and  sensibility. 
I  should  siiv  that  there  might  be  good  reason  to  refer  the  disease  to  the 
spine  when  this  condition  is  presented  ;  but  it  does  not  necessarily  follow, 
because  sensation  and  voluntary  motion  are  lost  in  the  lower  extremities, 
in  consequence  of  disease  in  the  spinal  marrow,  that  therefore  reflex  ac- 
tion should  cease;  for  the  lesion  may  be  seated  only  in  the  conducting 
fibres  by  which  the  brain  communicates  with  the  limbs,  and  the  spinal 
centres  themselves  may  be  untouched.     Such,  I  believe,  are  the  many 
cases  of  paraplegia  which  M.  Duchenne  is  indisposed  to  consider  spinal, 
because  wanting  in  what  he  deems  to  be  the  characteristic  relation  to 
electric  influence,  and  which  are  benefited  by  faradisation. 

4.  Traumatic  Palty.   This  is  one  of  the  forms  of  palsy  in  which  elec- 
tricity exercises  the  most  extraordinary  powers.      It  is  applicable,  of 
course,  only  after  the  wound  or  injury  of  the  nerve  has  healed,  or  been 
repaired  ;  but,  after  this  event,  there  is  occasionally  left  behind  a  very 
paralytic  condition,  which  shows  no  disposition  to  recovery,  and  may  go 
on  indefinitely,  unless  relieved.     Scarcely  any  length  of  time  offers  an 


532  GENERAL    STIMULANTS.  [PART  II. 

obstacle,  in  these  cases,  to  the  beneficial  effects  of  electricity,  unless  the 
injury  has  been  such  as  in  its  nature  to  be  irremediable,  or  the  muscle 
has  undergone  complete  degeneration  from  want  of  use.  Cases  have 
been  cured  after  a  duration  of  four  years.  The  application  should  be 
made  every  other  day,  and  eight  or  ten  minutes  at  a  time.  The  muscles 
are  often  much  atrophied,  and,  as  before  stated,  electro-muscular  con- 
tractility and  sensibility  have  been  lost.  The  first  step  towards  recovery 
is  usually  the  excitation  of  painful  sensation,  with  heat  in  the  part.  After 
this  follows  an  obvious  improvement  in  the  nutrition  of  the  muscle;  the 
power  of  voluntary  movement  next  returns ;  and  all  this  may  occur  be- 
fore the  electro-muscular  contractility  has  been  restored.  At  length, 
however,  the  muscle  contracts  under  the  electric  excitement,  and  the  cure 
is  completed.  If  electric  contractility  should  not  have  been  wholly  abol- 
ished, it  is  unnecessary  to  delay  the  use  of  the  remedy;  but  otherwise 
it  would  be  best  to  wait  for  the  complete  repair  of  the  injury,  even  so 
long  as  from  four  to  ten  months.  Each  muscle  should  be  treated  accord- 
ing to  its  condition.  The  more  it  is  atrophied,  and  the  less  is  its  con- 
tractility,, the  more  intense  should  be  the  current,  and  the  more  rapid  'the 
intermissions.  The  duration  of  each  sitting  should  be  ten  or  fifteen  min- 
utes at  furthest;  and  rarely  more  than  one  minute  should  be  given  to 
each  muscle.  The  operation  should  also  pass  rapidly  from  muscle  to 
muscle,  returning  several  times  to  each,  in  order  to  prevent  too  great 
fatigue  to  any  one.  Cures  may  be  effected  in  the  majority  of  cases. 
The  mean  duration  of  treatment  is  two  or  three  months;  but  sometimes 
years  are  required  before  a  complete  cure  can  be  effected. 

5.  Rheumatic  Palsy.  This  name  has  been  given  to  a  variety  of  palsy 
which  comes  on  after  exposure  to  cold.  It  is  sometimes  preceded  by 
pain,  which  disappears,  leaving  the  palsy  behind;  sometimes  is  wholly 
unattended  with  pain.  It  may  occur  in  any  part  of  the  body,  but  is 
most  common  in  the  forearm  and  shoulder.  Sometimes  it  affects  the 
face  through  the  seventh  pair  of  nerves,  and  sometimes  also  probably 
appears  in  the  form  of  paraplegia;  in  which  case  I  have  no  doubt  the 
seat  of  the  rheumatic  disease  is  in  the  spine.  It  is  often  a  serious  affec- 
tion; the  muscles  becoming  atrophied,  and  sometimes  contracted  so  as 
to  produce  a  good  deal  of  deformity.  It  is  distinguished  from  lr:ul-pulsv 
by  the  unimpaired  electro-muscular  contractility  and  sensibility.  In  the 
face,  it  may  sometimes  be  difficult  to  determine  between  it  and  cerebral 
palsy;  but  independently  of  the  facts  that,  in  the  latter  case,  there  are 
generally  obvious  head  symptoms,  and  palsy  elsewhere,  there  is  one 
diagnostic  character  worthy  of  attention.  In  hemiplegia  we  seldom 
meet  with  palsy  of  the  orbicular  muscle  of  the  eyelid,  and  the  inference 
is  probable  that,  when  cerebral  palsy  is  confined  to  the  face,  this  phe- 
nomenon will  be  wanting.  When  it  occurs,  therefore,  in  facial  paralysis, 
the  affection  may  be  considered  as  probably  seated  in  the  seventh  pair. 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. ELECTRICITY.  533 

Correct  diagnosis  is  here  very  important ;  as,  if  the  affection  be  cerebral, 
electricity  is  contra! ml icatod  for  a  long  time  after  the  attack;  whereas, 
if  it  be  mere  rheumatic  palsy  of  the  seventh  pair,  the  remedy  may  be 
applied  speedily.  Rheumatic  palsy  may  almost  always  be  cured  by 
faradisation.  The  natural  tonic  contractility  is  often  restored,  thereby 
removing  deformity,  before  the  muscles  come  under  the  control  of  the 
will.  The  muscles  sometimes  assume  their  proper  symmetry  three  or 
four  weeks  before  a  single  voluntar}-  movement  has  been  made  by  them. 
In  the  affection  of  the  seventh  pair,  which  is  not  unfrcquently  attended 
with  an  unsightly  distortion  of  the  features,  it  is  important  to  examine 
each  muscle  carefully,  and  give  it  the  due  share  of  electrical  excitation. 

6.  Hysterical  Palvy.  When  palsy  attacks  hysterical  women,  and  can 
be  referred  to  no  precise  origin,  it  is  considered  usually  as  entitled  to 
this  designation.     It  is  characterized  by  retaining  the  electro-muscular 
contractility,  but  is  generally  attended  with  diminished  sensibility  of  the 
muscle.     It  will  generally  yield  to  electricity ;  though,  in  some  rare  in- 
stances, it  ivsists  this,  as  all  other  remedies.    Under  such  circumstances 
however,  it  is  probably  something  more  than  merely  hysterical.     The 
faradisation  should  be  applied  to  ever}r  organ  affected,  and  the  applica- 
tion continued  for  some  time  after  recovery.     In  consequence  of  the 
great  nervous  excitability  of  the  patient,  it  is  best  to  commence  very 
lightly,  spending  the  first  sitting  in  doing  little  more  than  accustoming 
the  patient   to  the  manipulations;  and  gradually  increasing  as  she  is 
found  to  tolerate  the  remedy.  The  diminished  sensibility  of  the  muscles 
renders  rapid  intermissions  of  the  current  necessary;  but  watchfulness 
must  be  observed,  lest  a  little  too  mu,ch  local  disturbance  should  bring 
on  an  attack  of  hysteria.     The  remedy  should  be  directed  as  well  to  the 
nervous  trunk  as  to  the  parts  affected.     Sometimes  it  may  be  sufficient 
to  stimulate  the  cutaneous  sensibility;  but  this  is  more  painful,  and  will 
not  often  be  submitted  to. 

7.  Diphtheric  Pahtj.    For  a  minute  description  of  the  palsy  so  apt  to 
follow  attacks  of  diphtheria,  to  which  the  attention  of  the  profession  has 
been  especially  called  only  of  late,  the  reader  is  referred  to  my  Treatise 
on  the  Practice,  of  Medicine  (6th  ed.,  ii.  514).     In  mentioning  it  here, 
my  object  is  to  state  that,  in  the  cases  which  have  been  examined  in 
reference  to  the  electric  condition  of  the  muscles,  they  were  found  to  pos- 
sess sensibility  to  the  galvanic  influence  :  and  that  electricity  is  one  of 
the  remedies  to  which,  with  suitable  adjuvant  measures,  the  disease  has 
yielded  most  readily.     It  is  probable  that  faradisation  in  this,  as  in  the 
rheumatie  variety  of  the  disease,  is  the  form  in  which  the  remedy  will 
prove  most  effective. 

8.  Lead  Palxy.  If  the  muscles  retain  only  a  small  portion  of  their 
electric  contractility,  it  may  be  considered  certain  that  the  disease  will 
recover  easily  and  rapidly ;  and  even  with  a  complete  loss  of  that  prop- 


534  GENERAL    STIMULANTS.  [PART  II. 

erty,  a  favourable  result  may  be  expected,  though  it  will  be  longer  post- 
poned. When,  with  the  loss  of  the  contractility,  there  is  at  the  same 
time  a  great  diminution  of  sensibility,  with  atrophy  conjoined,  the  cure 
is  still  more  difficult  and  protracted.  But  the  remedy  will  almost  always 
succeed  in  the  end.  From  thirty  to  one  hundred  sittings  may  be  re- 
quired, at  the  rate  of  three  weekly;  but,  by  operating  at  shorter  inter- 
vals, the  length  of  time  required  may  be  diminished.  An  intense  current 
with  rapid  intermissions  should  be  used.  It  is  desirable  to  excite  painful 
sensations;  and,  as  these  are  attended  sometimes  with  considerable 
constitutional  disturbance,  it  is  impossible,  in  many  instances,  to  have 
quickly  repeated  sittings.  Hence  the  length  of  time  often  required  for 
the  cure. 

9.  Progressive  Fatty  Muscular  Atrophy.  Under  this  name  M.  Du- 
chenne  refers  to  a  disease  long  known  as  a  variety  of  general  palsy,  but 
which  has  only  recently  become  well  understood.  It  consists  essentially 
in  a  gradually  progressive  atrophy  of  the  muscles,  with  fatty  degenera- 
tion of  the  fibres ;  and  the  paralytic  phenomena  are  ascribable  to  the 
organic  change  in  the  muscle.  The  credit  of  first  ascertaining  its  true 
nature  appears  to  be  due  to  M.  Cruveilhier,  who  demonstrated  the  exist- 
ence of  fatty  degeneration  of  the  affected  tissue.  It  is  distinguished  from 
all  other  forms  of  palsy,  by  the  irregular  and  apparently  capricious 
method  in  which  the  muscles  are  struck  with  the  disease  ;  so  that  in  the 
vicinity  of  a  round  plump  muscle,  is  a  cavity  consequent  upon  the 
atrophy  of  another,  thus  giving  a  quite  characteristic  aspect  to  the  com- 
plaint. The  only  other  pathological  lesion  found,  is  a  wasting  or  atrophy 
of  the  anterior  roots  of  the  corresponding  spinal  nerves,  which  has  been 
noticed  in  one  or  more  cases.  The  spinal  marrow  is  quite  sound  ;  and  it 
is  uncertain  whether  the  nervous  atrophy  noticed  was  a  result  or  cause 
of  the  affection.  A  singular  fact  in  relation  to  the  disease  is,  that  the 
muscles  retain  their  electric  contractility,  or  contract  under  electric  excite- 
ment, as  long  as  any  of  the  fibres  remain  undestroyed.  It  was  generally 
considered  quite  incurable ;  but  M.  Duchenne  has  demonstrated  that  it 
may  at  least  be  arrested  in  its  course  by  means  of  faradisation ;  and  has 
even  rendered  it  probable  that  the  muscle  may  recover  its  normal  struc- 
ture, if  it  shall  not  have  been  so  far  destroyed,  before  the  commencement 
>f  treatment,  as  to  give  no  sign  of  contraction  when  electrically  excited. 
At  least  muscles  which  have  been  apparently  wasted  away  almost  to 
nothing  recover  their  healthful  size,  and  their  power  of  action.  It  is  said 
that  the  atrophy  precedes  the  fatty  degeneration ;  and  it  may  be  sup- 
posed that  the  shrinking  is  only  in  consequence  of  tin-  absorption  of  the 
inter-fibrous  matter ;  but  M.  Duchenne  thinks  that  new  fibres  are  cre- 
ated ;  and,  if  so,  there  is  no  reason  why  the  muscle  might  not  grow  after 
partial  destruction  from  fatty  degeneration,  as  well  as  from  any  other 
cause.  The  treatment  of  the  affection  generally  requires  an  apparatus  of 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. — ELECTRICITY.  535 

great  force  and  rapid  intermissions ;  and  a  feeble  instrument  may  fail 
altogether.  Each  application,  however,  should  not  continue  longer  than 
eight  or  ten  minutes,  for  fear  of  exhausting  the  muscle,  and  thus  hasten- 
ing its  destruction.  The  sensibility  of  the  muscles,  which  is  at  first 
blunted,  in  general  rapidly  increases,  and  it  is  necessary  gradually  to 
diminish  the  energy  of  the  treatment ;  but  it  should  be  sustained  at  the 
highest  point  possible. 

A  similar  affection  is  sometimes  met  with  in  infancy,  and  may  be 
treated  in  the  same  way. 

10.  Paralysis  of  the  ft  I  adder. — Dysury. — Incontinence.  Difficulty  in 
evacuating  the  bladder  sometimes  proceeds  from  palsy  or  debility  of  the 
abdominal  muscles;  the  urine  being  forcibly  expelled  if  a  catheter  is  in- 
troduced.    In  such  cases,  the  affection  will  generally  yield  promptly  to 
faradisation  of  those  muscles.     In  proper  palsy  of  the  muscular  coat 
of  the  bladder,  the  electricity  may  be  applied  in  the  manner  already 
described  (see  page  518),  either  by  exciters  introduced  into  the  rectum 
and  bladder,  or  into  the  bladder  alone,  or  one  into  the  bladder,  and  the 
other  moistened  and   moved  over  the  hypogastric  region  externally. 
Sometimes  there  is  loss  of  sensibility  in  the  mucous  coat  of  the  bladder; 
so  that  the  urine  accumulates  because  the  patient  is  unconscious  of  its 
presence.     All  that  is  requisite  for  its  evacuation  is  the  exercise  of  the 
will.    Here  -it  is  advisable  to  make  the  application  directly  to  the  in- 
ternal coat. 

In  incontinence  depending  on  paralysis  of  the  sphincter  or  neck  of  the 
bladder,  one  excitor  should  be  introduced  into  the  rectum,  and  moved 
over  the  parts  corresponding  with  the  levator  ani,  while  the  metallic  ex- 
tremity of  the  other  is  brought,  through  the  urethra,  into  apposition  with 
the  neck  of  the  bladder. 

11.  Impotence  may  sometimes  be  usefully  treated  with  electricity  in 
this  manner,  applied  to  the  organs  of  generation  externally,  and  to  the 
vesiculae  seminales  through  the  rectum  or  urethra. 

12.  Paralysis  of  the  Rectum,  and  of  the  Sphincter  Ani.  Palsy  of  the 
rectum,  which  is  indicated  sometimes  by  an  obstinate  constipation,  may 
often  be  relieved  by  faradising  the  rectum  directly,  in  the  manner  before 
described.  (See  page  518.) 

In  prolapsus  ani,  which  is  generally,  when  considerable,  connected 
with  relaxation  of  the  sphincters  of  the  anus,  and  in  incontinence  of  the 
feces  dependent  on  the  same  cause,  one  excitor  may  be  introduced  into 
the  anus,  and  the  other,  in  the  form  of  a  wet  sponge,  applied  externally 
to  the  perinffium.  The  operation  may  be  continued  eight  or  ten  minutes. 
Obstinate  cases  of  prolapsus  in  children  have  been  promptly  cured  by 
this  treatment. 

13.  Palsy  of  the  Larynx. — Aphonia.  When  not  dependent  on  organic 
lesion,  or  symptomatic  of  some  other  disease,  this  will  sometimes  yield 


536  GENERAL    STIMULANTS.  [PART  II. 

to  local  faradisation  applied  to  the  muscles  from  without,  and  the  skin 
also,  or  l)v  operating  through  the  pharynx.  (See  page  519.)  The  loss  of 
the  strength  and  character  of  the  voice,  often  incurred  by  those  who 
speak  much  in  public,  may  be  relieved  by  the  same  measure.  Other 
modes  of  applying  the  remedy,  as  by  successive  discharges  through  the 
organ  from  a  powerful  battery,  by  a  galvanic  current  introduced  by 
means  of  acupuncture,  and  by  the  simple  apparatus  of  a  small  zinc  and 
silver  plate  (see  page  504),  one  on  one  side,  the  other  on  the  other  of 
the  larynx,  have  also  proved  successful.  But  in  these  cases  electricity, 
like  all  other  measures,  not  unfrequently  fails  without  any  assignable 
cause. 

14.  Cutaneous  Anaesthesia,  or  Loss  of  Sensibility  in  the  Skin.  The 
loss  of  sensibility  in  paralytic  muscles  is  generally  remedied  at  the  same 
time  with  loss  of  motion.    But  sometimes  the  two  conditions  exist  sepa- 
rately; and  insensibility  of" the  skin  is  not  a  very  uncommon  affection. 
In  this  isolated  state,  when  not  dependent  on  organic  lesion  of  the  nerves, 
it  is  generally  an  hysterical  affection,  and  yields  readily  to  the  electrical 
influence.     When  it  affects  the  face,  the  best  method  of  applying  the 
remedy  is  by  the  hand,  which  usually  proves  sufficient  for  the  cure. 
If  not,  the  blunt  excitors  may  be  applied,  and  these  will  often  answer 
for  other  parts  of  the  body.    But  sometimes  a  more  energetic  impression 
is  required  for  the  general  surface,  which  may  be  obtained  by  means  of 
"fustigation"  with  the  brush  of  wires.  (See  page  508.)    The  excitors 
should  generally  be  carried  from  one  point  to  another  of  the  surface, 
until  the  whole  affected  part  has  been  electrified.    Sometimes,  however. 
the  insensibility  is  so  great  that  it  is  necessary  to  leave  the  bunch  of 
wires  for  some  time  in  contact,  until  sensation  is  produced.      First  a 
tingling  is  felt,  then  a  burning  sensation,  and  this  soon  increases  so  thai 
it  can  be  borne  no  longer.     As  the  skin  becomes  more  sensitive,  it  i> 
necessary  to  return  to  the  blunt  excitors  again      In  a  few  instances  tin- 
return  of  sensibility,  in  a  small  space,  is  followed,  without  further  appli- 
cation, by  its  extension  over  the  whole  part  atl'ected;  but  much  more 
frequently  it  is  necessary  that  every  part  should  be  subjected  to  the  con- 
tact of  the  instruments.     Sometimes  the  affection  returns  after  having 
yielded,  but  may  be  cured  by  repetitions  of  the  application.    It  is  in  the 
hands  and  soles  of  the  feet,  that  the  inconvenience  of  this  paralytic  con- 
dition is  greatest,  and  the  cure  of  it  most  important. 

15.  Amaurosis.  Electricity  should  never  be  employed  in  this  affection, 
if  there  be  any  reason  to  suppose  that  it  depends  on  active  congestion. 
inflammation,  or  other  organic  disease  in  the  nervous  (-(Mitre  of  vision, 
the  nerve  itself,  or  its  expansion  on  the  retina.     In  purely  functional 
cases,  it  may  sometimes  be  used  with  benefit;  but  galvanism  is  here 
more  effective  than  the  induced  electricity.    In  doubtful  cases,  it  may  l» 
applied  over  the  face  and  about  the  orbit  in  the  first  place,  in  order  to 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. ELECTRICITY.  537 

excite  the  eye  through  the  ramifications  of  the  fifth  pair,  which  have  a 
peculiar  influence  over  vision  when  galvanically  excited;  and,  if  this 
measure  is  unsuccessful,  the  application  may  be  made  to  the  ball  of  the 
eye,  in  order  directly  to  excite  the  optic  nerve ;  one  pole  being  placed  in 
the  orbit,  and  the  other  at  the  back  of  the  neck.  Acupuncture  of  the 
parts  about  the  eye  has  been  brought  to  the  aid  of  galvanism ;  and  many 
cures  of  incomplete,  and  some  of  complete  amaurosj.s  have  been  reported, 
supposed  to  have  been  obtained  in  this  way.  (See  Channing,  Medical 
Application  of  Electricity,  Boston,  1852,  p.  87.)  The  electro-magnetic 
instrument  with  two  wires  may  also  be  used  for  this  purpose,  though 
less  effective  than  the  battery. 

16.  Deafness.   In  nervous  deafness,  faradisation  of  the  chorda  tym- 
pani  has  been  followed  by  happy  results.     Great  care  must  be  exer- 
cised in  conducting  this  operation.     While  the  patient  lies  on  his  side, 
the  meatus  auditorius  should  be  half  filled  with  water;  a  wire  connected 
with  one  of  the  poles  should  then  be  introduced  so  as  to  touch  neither 
the  tympanum  nor  the  walls  of  the  passage;  and  the  wet  sponge  excitor, 
connected  with  the  other  pole,  should  then  be  applied  to  the  nape  of  the 
neck.     The  slightest  power  of  the  instrument  should  be  first  exerted  ; 
not  greater  than  may  be  sufficient  to  cause  the  least  possible  sensation 
when  the  excitors  are  applied  to  the  end  of  the  tongue ;  and  then  in- 
creased as  may  be  found  necessary.     A  slight  buzzing  sound  is  first  pro- 
duced by  this  operation  in  the  ear  when  healthful,  followed  by  tingling, 
and  then,  with  the  increase  of  the  force  of  the  current,  by  severe  pain  ; 
the  tingling,  with  a  sense  of  numbness,  extending  to  the  side  and  ante- 
rior part  of  the  tongue.     There  is  also  a  peculiar  taste  produced.     M. 
Duchenne  has  seen  this  process  cure,  in  a  short  time,  cases  of  deafness 
which  had  long  resisted  energetic  measures,  under  the  most  competent 
practitioners.     It  is  not  impossible  that  the  same  measure  might  be  use- 
ful in  deafness  of  organic  origin,  provided  all  acuteness  of  symptoms  had 
passed.     The  functional  disorders  of  hearing  which  are  so  common,  and 
so  frequently  alluded  to  by  writers  under  the  name  of  tinnitus  aurium, 
often  yield  with  the  utmost  facility  to  the  remedy.     It  is  asserted  that 
galvanism  has  proved  useful  by  promoting  the  absorption  of  pus  and 
coagulable  lymph  in  the  cavity  of  the  tympanum,  and  in  exciting  the 
secretion  of  wax  when  deficient. 

17.  Smell  and  Taste.  In  paralytic  conditions  of  these  functions,  as  well 
as  in  palsy  of  the  muscles  of  the  tongue,  the  application  of  electricity 
may  be  made  in  the  manner  statdil  in  page  520. 

Stammering,  which  may  possibly  sometimes  be  connected  with  de- 
bility of  the  muscles  of  the  tongue,  and  other  parts  concerned  in  articu- 
lation, is  said  to  have  been  benefited  by  a  galvanic  current  directed  from 
the  tongue  to  the  surface  of  the  throat. 


538  GENERAL   STIMULANTS.  [PART  II. 

2.  General  and  Local  Relaxation,  Debility,  or  Torpor. 

Under  this  head  may  be  enumerated  a  considerable  number  of  affec- 
tions in  which  electricity  has  been  found  more  or  less  useful. 

In  asphyxia  and  syncope  it  may  be  resorted  to  in  reference  to  the 
shock  upon  the  system,  and,  in  the  former,  to  promote  contraction  of  the 
diaphragm.  In  asphyxia,  or  a  state  approaching  it,  arising  from  nar- 
cotic poisoning,  especially  that  from  opium,  it  has  been  employed,  with 
striking  success,  in  several  cases,  among  which  may  be  mentioned  one 
recorded  by  Dr.  Page,  of  Valparaiso,  and  a  second  by  Dr.  James  Russel, 
of  London.  Electro-magnetism  was  used  in  both  these  cases,  the  direc- 
tion being,  in  one  case,  from  one  side  to  the  other  through  the  heart;  in 
the  other,  from  the  back  of  the  neck  to  the  sternum,  by  which  respiration 
was  restored.  In  asphyxia  from  drowning,  a  current  of  galvanism  has 
been  passed  into  the  diaphragm,  by  cutting  down  to  the  muscle  below 
the  seventh  rib,  with  the  apparent  effect  of  saving  life.  Acupuncture 
would  probably  have  answered  the  same  purpose.  In  these  cases  of 
asphyxia  and  syncope,  it  is  probable  that  the  mere  shock  upon  the  ner- 
vous centres,  occasioned  by  pain,  has  great  influence  in  rousing  the  pa- 
tient; and,  for  the  production  of  this  effect,  nothing  is  more  powerful, 
prompt,  and  safe  than  the  electro-magnetic  current  with  rapid  intermis- 
sions.* 

Artificial  respiration,  when  desirable,  may  be  most  conveniently  pro- 
duced, according  to  M.  Duchenne,  by  calling  the  diaphragm  into  action, 
through  a  vigorous  impression  on  the  phrenic  nerve,  where  it  passes  the 
anterior  scalcnus  muscle.  This  nerve,  after  the  union  of  its  three  roots, 
descends  from  without  inwardly  before  the  anterior  surface  of  the  scale- 
nus.  It  is  at  this  point  that  it  is  necessary  to  make  the  requisite  appli- 
cation. Some  difficulty  is  thrown  in  the  way  by  the  sterno-mastoid  and 
platysma-myoid  muscles,  which  cover  the  scalenus.  But  by  depressing 
the  skin  from  without  inwards,  with  two  fingers  placed  along  the  outer 
border  of  the  clavicular  fasciculus  of  the  sterno-mastoid,  then  separating 
the  fingers,  and  maintaining  the  pressure,  access  may  be  obtained  to  the 
anterior  surface  of  the  scalenus,  without  the  interposition  of  the  other 
muscles.  One  of  the  excitors  is  to  be  placed  between  the  fingers,  in  such 
a  manner  as  to  cross  the  direction  of  the  phrenic  nerve.  While  an  as- 
sistant holds  the  instrument  in  this  position,  the  second  excitor  is  to  be 
similarly  applied  on  the  opposite  side.  Then  the  operator  takes  hold  of 
both  by  their  isolated  handles,  and  the  machine  is  set  in  motion.  Any 

*  A  remarkable  case  of  resuscitation  after  drowning,  by  means  of  the  induction 
apparatus,  and  electro-ncupuncture,  by  Dr.  A.  C.  Garratt,  of  Boston,  is  recorded  in 
i lie  JJoston  Med.  and  Snry.  Journ.  (Sept.  6,  1801.  p.  89).  It  is  well  worth  perusal, 
ns  an  example  of  success  rewarding  faithful  and  long-continued  effort,  under  ap- 
parently the  most  discouraging  circumstances.  (A'ole  to  the  third  edition.) 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. — ELECTRICITY.  539 

of  the  inductive  machines  will  answer  the  purpose,  if  properly  graduated, 
and  of  very  rapid  intermissions.  The  exciters  should  end  in  a  small 
metallic  cone,  which  should  be  covered  with  moist  leather.  The  instant 
that  the  current  is  passed,  the  lower  ribs  expand,  the  abdominal  walls 
rise,  and  air  rushes  with  sound  into  the  lungs.  After  a  second  or  two, 
the  current  is  broken,  the  walls  of  the  chest  subside,  and  expiration 
takes  place.  To  complete  the  expiration,  an  assistant  presses  upon  the 
chest  and  abdomen.  In  another  second,  the  operation  is  resumed ;  and 
this  artificial  respiration,  perfectly  imitating  the  natural,  may  be  kept 
up  as  long  as  maybe  necessary.  (Electrisation  Localise,  pp.  485-6  ) 

In  poisoning  from  opium  and  other  narcotics,  even  when  threatening 
symptoms  of  asphyxia  have  not  yet  appeared,  the  painful  excitation  of 
the  electro-magnetic  machine  is  useful,  independently  of  its  influence  on 
respiration,  by  stimulating  the  nervous  centres,  and  sustaining  life  until 
the  action  of  the  poison  has  passed.  A  case  of  this  kind  has  been  re- 
ported by  Dr.  Bullock,  of  Wilmington,  Delaware.  (Am.  Journ.  of  Med. 
Set.,  N.  S.,  xxviii.  5750 

In  general  muscular  relaxation,  the  excitant  influence  of  electricity 
may  perhaps  sometimes  be  usefully  employed,  by  rapidly  faradising  the 
different  muscles  successively. 

In  debility  of  various  functions  it  has  been  used  with  supposed,  and 
no  doubt  often  with  real  benefit. 

In  dyspepsia,  a  current  of  galvanism  may  be  passed  from  the  nape  of 
the  neck  to  the  epigastrium,  or  immediately  through  the  stomach,  from 
before  backward. 

Torpid  liver  may  be  treated  in  the  same  way,  the  current  being  sent 
in  various  directions  through  the  organ,  so  as  to  traverse  the  whole  of 
it  as  far  as  possible. 

Suppression  of  the  secretion  of  milk  is  said  to  yield  frequently  to  fara- 
disation of  the  mamma,  sometimes  after  three  or  four  daily  applications 
of  the  remedy.  It  should  not  be  carried  so  far  as  to  occasion  contrac- 
tion of  the  pectoral  muscles,  or  severe  pain.  Each  operation  may  con- 
tinue fifteen  or  twenty  minutes.  The  induced  current  is  here  the  most 
effective. 

Constipation  dependent  on  inertia  of  the  bowels  has  «>ften  been 
treated  advantageously  with  electricity.  Allusion  has  already  been 
made,  under  palsy  of  the  rectum,  to  the  mode  of  treating  it  when 
arising  from  that  cause.  In  other  cases,  the  current  may  be  made  to 
pass  from  the  fundament,  or  from  an  excitor  introduced  into  the  rectum, 
to  the  pit  of  the  stomach,  or  to  various  points  over  the  surface  of  the 
abdomen  ;  or  it  may  be  directed  through  the  bowels  from  before  back- 
ward, or  from  side  to  side. 

Ameaorrhcea  has  been  treated  by  electricity  with  great  success.  Dr. 
Golding  Bird  states  that  he  has  never  known  it  to  fail  in  exciting  men- 


540  GENERAL    STIMULANTS.  [PART  II. 

struation,  when  the  uterus  was  capable  of  performing  that  function. 
(Lond.  Med.  Gaz.,  June,  1847.)  After  proper  attention  to  the  general 
health,  a  dozen  shocks  of  the  Leyden  jar  were  passed  through  the  organ. 
from  the  sacrum  to  the  pubes,  and  the  measure  was  repeated  daily,  if 
necessary. 

Flooding  after  delivery  is  said  to  have  been  effectually  controlled  by 
galvanism,  which  produces  contraction  of  the  uterus.  Dr.  Radford,  who 
has  employed  the  remedy  for  this  purpose,  states  that  it  may  be  so  ap- 
plied as  to  excite  not  only  tonic,  but  alsg  intermittent  contraction,  and 
suggests  it  as  a  means  of  hastening  tedious  labours.  He  used  a  coil 
machine,  applying  one  pole  to  the  os  uteri,  and  the  other  to  the  walls  of 
the  abdomen  over  the  fundus.  The  conductor  introduced  into  the  vagina 
must  be  covered  with  a  non-conducting  material,  except  at  its  extremity. 
(Prov.  Med.  Journ.,  Dec.  1844.)  Dr.  F.  W.  Mackenzie  has  found  a 
tained  galvanic  current,  sent  through  the  uterus  longitudinally  from  the 
upper  portion  of  the  spinal  cord,  to  be  very  useful  in  promoting  contrac- 
tion of  the  uterus  in  hemorrhage  with  threatened  abortion,  and.  in  < 
of  placenta  praevia,  in  facilitating  delivery  and  preventing  hemorrhage. 
(Med.  Times  and  Gaz  ,  March,  1858,  p.  271  ) 

In  a  cool,  dry,  inactive  state  of  the  skin,  especially  when  connected 
with  interior  disease,  much  benefit  may  be  expected  from  electric  stimu- 
lation of  the  surface,  which  is  accomplished,  in  the  mildest  method,  by 
withdrawing  sparks  from  the  body  in  the  electrical  bath  ;  in  the  severest. 
through  the  agency  of  the  electro-magnetic  machine,  and  M.  Duchenne's 
wire  excitor;  and,  in  intermediate  grades,  by  the  different  arrangements 
at  command.  Indeed,  electricity,  in  its  various  forms  and  modes  of  ap- 
plication, affords  to  a  practitioner,  suitably  provided  with  apparatus,  a 
powerful  method  of  revulsion  to  the  surface,  of  which  he  may  avail  him- 
self in  a  great  number  of  diseased  conditions. 

Indolent  ulcers  may  be  stimulated  into  a  healing  condition  by  making 
their  surfaces  the  recipient  of  the  galvanic  current,  either  through  the 
moist  sponge  excitor,  or  their  own  wet  div.-sings  connected  with  one  of 
the  poles,  or  by  covering  them  with  a  plate  of  silver  or  copper  forming 
one  of  the  constituents  of  a  galvanic  arrangement,  of  which  a  zinc  plate. 
applied  tofauother  portion  of  the  surface,  and  connected  with  it  by  a 
wire,  may  form  another. 

Opacity  of  the  cornea  may,  according  to  Dr.  Althaus.  1><  generally 
cured  by  faradisation,  which  is  greatly  preferable  to  ordinary  galvanism 
for  this-  purpose,  because  so  much  less  likely  to  disturb  the  retina.  The 
negative  pole  should  be  applied  over  the  closed  eye,  and  the  positive 
held  in  the  hand  of  the  patient.  The  application  may  continue  fit 
minutes,  and  be  repeated  every  other  day.  A  cure  may  be  expected  in 
from  one  to  three  months.  (Med.  T.  and  Gaz.,  Sept.  l.si;->.  p.  271.) 

In  the  photophobia  of  scrofulous  ophthalmia  in  children,  extraordi- 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. —  ELECTRICITY.  541 

nary  s1*ecess  has  been  obtained  by  Dr.  Addinell  Hcwson,  of  Philadel- 
phia, from  the  ordinary  galvanic  current,  applied  over  the  supra-orbital 
branch  of  the  fifth  nerve.  He  made  use  of  Pulvermacher's  chain  bat- 
tery of  sixty  links,  using  vinegar  as  the  exciting  agent.  The  applica- 
tions were  usually  made  every  throe  or  four  days,  and  for  a  minute  or 
two  each  time  ;  but  they  might  be  repeated  daily  without  disadvantage. 
Great  relief  followed  the  first  application,  and  a  cure  was  in  general 
effected.  (Am.  J.  of  Ned.  Sci.,  Jan.  1860,  p.  114.) 

3.  Neuralgic  and  Rheumatic  Affections. 

Neuralgia.  Electricity  has  been  found  curative  in  many  cases  of  this 
affection,  operating,  it  would  seem,  sometimes  directly  by  the  benumb- 
ing influence  of  its  excessive  power,  sometimes  revulsively.  These  two 
methods  require  different  applications  of  the  electric  influence.  If  the 
object  be  to  operate  revulsively,  the  plan  of  Duchenne  may  be  followed 
of  confining  the  action  to  the  skin  (see  page  517);  if  to  benumb  the 
nerve,  a  moistened  extremity  of  one  conductor  should  be  applied  over 
the  nervous  trunk  as  far  up  as  may  be,  the  other  over  one  or  more  of  its 
branches  in  which  the  pain  may  be  felt. 

Excessive  cutaneous  sensibility,  which  is  a  frequent  attendant  upon 
hysteria,  yields  1n  general  readily  to  faradisation.  The  treatment  is  ap- 
plicable only  to  purely  functional  cases,  and  not  to  those  dependent  on 
lesions  of  the  nerves  or  their  centres.  In  the  application  of  the  remedy, 
the  skin  should  be  kept  perfectly  dry.  Sometimes  fustigation  may  be 
used ;  in  other  cases,  the  blunt  exciters,  carried  from  point  to  point  over 
the  sensitive  part,  will  be  sufficient.  The  instrument  should  work  with 
rapid  intermissions,  and  with  an  intensity  as  great  as  the  patient  can 
well  bear;  and  the  operation  may  be  continued  from  two  to  five  minutes. 
A  feeling  of  numbness  follows  the  first  pain,  with  an  agreeable  sense  of 
relief.  Sometimes  a  single  sitting  is  sufficient;  but  more  frequently  the 
complaint  returns  after  some  hours,  though  with  diminished  intensity; 
and  several  applications  are  required  before  the  cure  is  effected.  In  many 
cases,  however,  only  temporary  relief  is  obtained. 

A  similar  excessive  sensibility  of  the  muscles  sometimes  occurs, 
which  may  cither  be  conjoined  with  the  cutaneous  affection,*  or  may  co- 
exist with  insensibility  of  the  skin.  Though  usually  more  resistant  than 
the  pure  cutaneous  affection,  it  often  yields  promptly  to  a  similar  excita- 
tion of  the  surface. 

In  neuralgia  of  the  face,  tongue,  etc.,  galvanism  and  electro-magnet- 
ism have  both  been  used  with  occasional  success;  the  former  being 
sometimes  aided  by  acupuncture ;  but  the  general  result  has  not  been 
very  encouraging. 

Sciatica  is  an  extremely  obstinate  form  of  disease,  sometimes  appar- 
ently purely  neuralgic,  sometimes  rheumatic,  and  in  other  cases  attended 


542  GENERAL    STIMULANTS.  [PART  IT. 

with  inflammation  of  the  neurilemma.  When  purely  functional,  it  will 
sometimes  yield  to  faradisation,  after  vain  Attempts  to  cure  it  by  other 
means.  Occasionally  it  will  give  way,  fur  a  time,  to  a  sudden  and  violent 
pain  excited  by  fust igat ion,  or  the  contact  of  the  wires,  in  any  part  of  the 
surface.  The  measure,  however,  is  more  effectual  when  put  in  opera- 
tion in  the  vicinity  of  the  part.  The  skin  must  be  thoroughly  dried,  so 
as  to  prevent  the  current  from  penetrating  to  the  nerve,  in  which  case 
the  pain  is  aggravated.  The  relief  at  first  procured  is  temporary ;  but. 
by  repeating  the  fustigation  upon  each  return,  or  at  relatively  short  in- 
tervals, for  six  or  eight  times,  the  disease  will  often  yield  entirely.  The 
most  obstinate  cases  in  the  hospitals  have  recovered  under  the  remedy. 
Electro-puncture  is  asserted  also  to  have  been  used  with  advantage;  but 
the  cutaneous  excitation  is  preferable. 

Angina  pecioris,  in  one  striking  instance  under  the  care  of  M.  Du- 
chenne,  yielded  speedily  to  electro-cutaneous  excitation  applied  to  the 
mammary  region.  At  the  moment  of  the  application  of  the  two  metallic 
excitors,  which  proceeded  from  a  powerful  machine  graduated  to  the 
maximum,  and  working-  with  rapid  intermissions,  the  patient  uttered  a 
loud  cry,  so  as  to  render  it  necessary  to  interrupt  the  operation ;  but  the 
pain  of  the  angina,  which  had  been  excessive,  ceased  at  once.  By 
repeating  the  operation  at  each  return,  the  disease  appeared  to  yield 
entirely. 

In  other  neuralgic  cases,  whether  external  or  in  the  viscera,  the  rem- 
edy has  operated  with  equal  success.  It  should  be  recollected  that  it  is 
the  cutaneous  excitement  that  is  produced  here;  the  current  being  pre- 
vented from  penetrating  beneath  the  skin  by  drying  it  thoroughly  with 
some  absorbent  powder. 

In  colica  pictonum,  M.  Briquet  effects  prompt  relief  by  faradisation 
of  the  surface  of  the  abdomen.  For  an  account  of  his  mode  of  apply- 
ing the  remedy  see  my  Treatise  on  the  Practice  of  Medicine  (<>th  ed.. 
vol.  i.  p.  748). 

Rheumatism.  In  the  neuralgic  form,  this  complaint  will  often  yield 
with  great  facility  to  the  electric  influence  ;  and  it  is  probable  that  many 
of  the  cases  treated  successfully  under  the  names  of  neuralgia,  sciatica, 
angina  pectoris,  etc.,  have  been  either  of  this  character,  or  gouty.  Bui 
ordinary  muscular  subacute  rheumatism,  such  as  lumbago,  pleurodynia. 
torticollis,  etc.,  will  also  frequently  yield  to  the  remedy  as  to  a  charm. 
Sometimes  a  single  faradisation  of  the  skin,  is  sufficient  to  effect  a  cure  : 
but  more  frequently  the  pain  returns,  and  five  or  six  applications  may 
be  necessary  for  the  purpose.  It  should  not  be  abandoned  until  the  last 
vestige  of  pain  has  been  removed.  Rheumatic  arlhralgia  will  also 
often  yield  happily  to  the  remedy.  To  acute  inflammatory  rheuma- 
tism it  is  wholly  inapplicable.  In  chronic  rheumatism  of  the  joints,  gal- 
vanism, with  the  aid  of  acupuncture,  has  sometimes  proved  efficient;  but 


CHAP.  I.]  DIFFUSIBLE    STIMULANTS. — ELECTRICITY.  543 

electro-magnetism  would  probably  be  safer,  as  less  likely  to  excite  inflam- 
mation, with  an  equal  degree  of  power. 

Rheumatic  contraction  of  the  muscles,  which  not  urtfrequently  affects 
the  face,  neck,  shoulder,  and  parts  of  the  chest,  and  which  has  a  very 
disagreeable  distorting  effect,  will  generally  yield  to  this  remedy  applied 
to  the  skin.  M.  Duchenne  also  cures  the  affection  by  bringing  the  an- 
tagonistic muscles  into  play  through  the  electric  current,  and  thus  estab- 
lishing an  equilibrium  between  them. 

4.  Spasmodic  Affection*. 

Many  of  these  complaints  have  been  treated  by  electricity,  with  varia- 
ble success,  as  hysteria,  epilepsy,  chorea,  etc.,  and  Matteucci  even  ven- 
tured to  recommend  it  in  tetanus,  on  the  ground  that  a  continuance  of 
the  electric  current  exhausts  after  a  time  the  excitability  of  the  muscles  ; 
but  experience  has  not  yet  pronounced  in  its  favour.  In  spasmodic 
asthma  great  relief  is  said  to  have  been  sometimes  obtained  by  passing 
a  current  of  galvanism  from  the  nape  of  the  neck  to  the  pit  of  the 
stomach.  Hiccough  has  been  treated  effectually,  it  is  said,  in  the  same 
way. 

5.  Indolent  Swellings. 

Various  tumefactions,  hypertrophic,  rheumatic,  and  scrofulous,  the 
result  of  simple  chronic  inflammation,  or  left  behind  after  sprains  or 
other  injuries,  have  from  time  to  time  been  treated  by  electricity  in  its 
different  forms,  and  with  more  or  less  success.*  The  remedy  probably 
operates  as  a  simple  excitant,  hastening  suppuration  when  the  tendency 
is  to  that  result,  promoting  the  absorption  of  exuded  fibrin  and  other 
secretions  or  depositions,  and  stimulating  the  disintegrating  process,  so 
as  to  favour  resolution.  Dr.  Remak,  of  Berlin,  states  that  he  has  found 
the  constant  current,  produced  by  the  arrangements  of  Daniell,  Grove, 
and  Bunsen,  to  have  a  powerful  effect  in  resolving  inflammatory  tumours, 
by  dilating  the  blood-vessels  and  promoting  absorption.  (Med.  Times  and 
Gaz.,  May,  1858,  p.  479.)  It  is  highly  probable  that  cases  of  palsy,  de- 
pendent on  chronic  inflammatory  thickening  of  the  spinal  membranes  or 
ligaments,  or  similar  thickening  from  exudation  in  the  theca  of  nervous 

*  Serous  effurions  may  ba  removed  in  the  same  way  by  the  promotion  of  absorp- 
tion;  ami  cases  of  hydrocele  have  been  treated  effectually  by  both  galvanisation 
and  faradisation,  after  failure  with  iodine  injections  and  the  seton.  The  method 
of  proceeding  is  to  introduce  two  acupuncture  needles  into  the  fluid,  one  at  one  end 
of  the  sac,  the  other  at  the  other,  and  then  connecting  these  with  the  poles  of  the 
induction  machine  or  galvanic  battery.  A  mild  current  should  be  used  at  first,  to 
be  gradually  increased  until  the  patient  complains.  The  operation  should  continue 
for  about  twenty  minutes.  Sometimes  the  swelling  disappears  within  twenty-four 
hours;  sometimes  three  or  four  operations  are  necessary.  (Althaus,  Med.  T. and 
Gaz.,  Sept.  1862,  p.  27l.j— .Vote  to  the  third  edition. 


544  GENERAL   STIMULANTS.  [PART  II. 

trunks,  or  the  passages  which  they  traverse,  might  often  be  relieved  by 
the  galvanic  influence  brought  to  bear  on  these  conditions,  could  their 
seat  be  precisely  ascertained.  Even  strictures  of  the  urethra  are  said  to 
haye  been  cured  by  the  same  means. 

6.  Extra-uterine  Pregnancy. 

Electricity  is  said  to  have  been  successfully  resorted  to  by  Professor 
Burci,  of  Pisa,  in  an  extra-uterine  pregnancy,  in  order  to  prevent  the 
further  development  of  the  foetus,  and  favour  its  absorption.  Two  needles 
connected  with  an  electro-magnetic  instrument  were  introduced  into  the 
tumour.  Much  pain  was  produced  by  the  successive  shocks ;  but  only 
one  application  was  necessary.  The  tumour  ceased  to  grow,  and  grad- 
ually shrivelled.  (Med.  and  Surg.  Reporter,  xi.  112.) 

7.    Therapeutic  Application  of  Chemical  Influence. 

Electricity  has  been  employed  for  three  distinct  purposes,  in  reference 
to  its  chemical  reagency :  1.  for  the  cure  of  aneurisms,  through  its  coag- 
ulating influence  upon  the  blood;  2.  for  the  solution  of  calculi  in  the  blad- 
der; and  3.  for  the  abstraction  of  metallic  substances  from  the  system. 

1.  Cure  of  Aneurisms.  It  has  been  experimentally  proved  that  a 
current  of  galvanism,  sent  through  the  blood  in  the  vessels,  has  the  effect 
of  coagulating  it.  By  some,  this  effect  is  ascribed  to  a  chemical,  by 
others,  to  a  vital  influence.  It  was  supposed  that,  directed  through  the 
blood  of  an  aneurismal  tumour,  it  might  have  the  same  effect,  and  that 
it  might  thus  be  employed  with  some  hope  of  success  in  the  treatment 
of  these  tumours.  The  experiment  has  been  tried,  and  some  cases  of 
apparent  cure,  with  others  of  failure,  have  been  reported.  The  needles 
for  this  purpose  should  be  made  of  gold  or  platinum ;  because,  if  of  steel, 
they  might  undergo  chemical  change,  and  thus  become  irritant  in  their 
course.  They  should  be  introduced  so  that  their  points  may  enter  the 
blood,  and  there  should  be  no  contact  between  them.  A  battery  of  ten 
or  fifteen  pairs  may  be  used,  and  the  operation  continued  fifteen  or  twenty 
minutes,  or  longer.  One  of  the  risks  incurred  is  of  irritating  the  sides 
of  the  opening  into  the  tumour,  so  as  to  form  an  eschar,  which,  on  sep- 
arating, may  give  exit  to  the  blood.  To  avoid  this,  it  has  been  proposed 
to  coat  the  needles  with  shellac,  except  at  the  points ;  but  this  docs  not 
seem  to  have  answered.* 

*  The  following  observations,  in  relation  to  this  subject,  are  derived  from  a 
paper  by  Dr.  Althaus,  published  in  the  Medical  Times  and  Gazette  (Aug.  1862, 
p.  219).  Clots  are  produced  only  at  the  positive  pole,  where  acids  are  liber- 
ated from  the  decomposition  of  the  salts  of  the  blood;  while  at  the  negative 
pole,  where  alkalies  are  set  free,  the  blood  is  rendered  more  fluid.  Consequently 
to  succeed  in  the  treatment  of  aneurisms,  it  is  necessary  that  only  the  positive 
pole  should  be  made  to  act  directly  on  the  blood.  Another  cause  of  failure  is 


CHAP.  I.]  DIFFUSIBLE   STIMULANTS. — ELECTRICITY.  545 

The  same  measure  has  been  employed  for  the  obliteration  of  varicose 
veins,  with  apparent  success,  in  several  instances. 

2.  Solution  of  Calculi  in  the  Bladder.  The  idea  of  destroying  calculi 
in  the  bladder  by  means  of  the  decomposing  power  of  galvanism  having 
been  suggested,  MM.  Prevost  and  Dumas  performed  some  experiments 
on  a  phosphatic  calculus  out  of  the  body,  by  which  they  succeeded  in 
partially  dissolving  and  utterly  breaking  up  the  stone  through  this  influ- 
ence.    They  afterwards  proved,  by  introducing  a  calculus  into  the  blad- 
der of  a  dog,  and,  by  means  of  two  insulated  conductors  passed  through 
the  urethra,  bringing  to  bear  upon  it  a  powerful  battery,  that  the  opera- 
tion might  be  performed  with  safety,  and  with  some  chances  of  success 
within  the  body.    But  I  am  not  awara  that  any  useful  results  have  been 
obtained  by  the  process;  the  prominent  objection  to  it  being  the  insol- 
uble character  of  the  urinary  calculi,  which  prevents  a  vigorous  decom- 
posing influence  from  being  exerted  upon  them. 

3.  Elimination  of  Metallic  Substances  from  the  System.  In  the  first 
edition  of  this  work,  an  account  was  given  of  a  plan  of  withdrawing 
metallic  substances  from  the  system,  by  the  agency  of  galvanism.     The 
patient,  seated  on  a  wooden  bench  in  an  isolated  metallic  bathing  tub, 
containing  water  slightly  acidulated  with  nitric,  muriatic,  or  sulphuric 
acid,  held  in  his  hand  a  conductor  from  the  positive  pole  of  a  galvanic 
buttery,  the  tub  being  connected  with  the  negative  pole.     It  was  thought 
that,  through  the  agency   jf  the  current,  the  metallic  salt  in  the  system 
was  decomposed,  and  the  metal,  being  withdrawn,  attached  itself  in 
patches  to  the  sides  of  the  tub.     Reflection  has  convinced  me,  what  I 
was  at  first  disposed  to  believe,  that  such  a  result  in  the  human  system 
is  quite  impossible;  and  Prof.  E.  H.  Clarke,  of  Boston,  states  that  he 
has  satisfied  himself  of  its  impracticability  by  numerous  experiments. 
(Am.  Journ.  of  Med.  Sci.,  N.  S.,  xxxiii.  T4.) 


Some  years  since,  much  attention  wTas  paid  to  the  asserted  advant- 
ages of  electro-magnetism  as  an  anaesthetic  agent  in  the  extraction  of 
teeth.  Dr.  J.  B.  Francis,  claiming  to  be  the  discoverer  of  the  principle, 
secured  his  right  under  our  patent  laws  to  its  exclusive  application.  The 
subject  was  examined  by  a  committee  of  the  Franklin  Institute  of  Phil- 

the  use  of  faradisation  instead  of  galvanization;  the  former  Laving  little  influence 
in  promoting  coagulation.  The  character  of  the  needle  used  is  also  of  some  im- 
portance, the  most  oxidizable  metal  being  preferable.  Therefore,  in  the  treatment 
of  aneurisms,  ''a  steel  needle  covered  with  zinc,  and  connected  with  the  positive 
pole  of  a  pile  of  twenty  pairs  of  Bunsen's,  Grove's,  or  Daniell's  battery,  feebly 
charged,  should  be  inserted  in  the  centre  of  the  sac,  and  the  circuit  closed  by  placing 
a  metallic  plate,  connected  with  the  negative  pole,  on  the  surface  of  the  tumour." 
Coagulation  is  produced  in  fifteen  or  twenty  minutes.  (Note  to  the  third  edition.) 

VOL.  i. — 35 


546  GENERAL    STIMULANTS.  [PART  II. 

adelphia,  who,  after  a  careful  investigation,  reported  in  favour  of  the 
efficiency  of  the  process  employed.  This  consisted  simply  in  passing 
the  current  from  a  magneto-galvanic  machine  through  the  tooth  at  the 
moment  of  extraction.  A  conductor  from  one  pole  was  placed  in  the 
hand  of  the  patient,  and  a  wire  from  the  other  was  attached  to  the 
forceps,  by  the  contact  of  which  with  the  tooth  the  circuit  was  com- 
pleted. In  numerous  instances,  the  operation,  according  to  the  state- 
ment of  the  patients,  was  without  pain;  and  the  electric  current,  if 
care  was  taken  to  avoid  the  soft  parts,  occasioned  little  or  no  inconven- 
ience. It  was  supposed  that  the  nerve  of  the  tooth,  becoming  benumbed 
by  the  electric  influence,  was  rendered  insusceptible  to  painful  impres- 
sion. The  statements  on  the  subject  were  received  with  incredulity  by 
many  scientific  men,  who  did  not  think  it  possible  that  so  powerful  and 
speedy  a  benumbing  effect  should  be  produced  by  any  amount  of  electric 
influence  insufficient  to  occasion  suffering  to  the  patient ;  and  many 
experiments  afterwards  made  either  proved  less  successful  or  failed 
entirely.  The  fact  seems  to  be  that,  under  the  influence  of  a  new  sen- 
sation, and  of  new  and  strange  manipulations,  the  attention  of  the 
patient  was  excited,  and  the  cerebral  centres  so  occupied  as,  in  many 
instances,  to  be  for  the  moment  partially  at  least  insensible  to  impres- 
sions usually  productive  of  pain;  on  the  same  principle,  probably,  as  that 
which  operates  when  the  pain  of  a  violently  aching  tooth  ceases  entirely 
upon  a  mere  visit  to  the  dentist.  It  is  certainly  not  impossible  to  pro- 
duce a  local  benumbing  effect  by  electric  influence;  but  to  do  so  the 
impression  must  be  very  powerful ;  so  much  so  as  to  overwhelm  nervous 
function  by  excess  of  excitement,  and  beyond  anything  that  it  would  be 
prudent  to  employ  for  the  mere  purpose  of  saving  pain  in  the  extraction 
of  a  tooth. 


CHAP.  I.]  ARTERIAL    STIMULANTS.  547 


OL.A.SS    I. 
ARTERIAL  STIMULANTS. 

THESE  are  diffusible  stimulants  operating  especially  on  the  circulatory 
function,  with  little  comparative  influence  on  the  nervous  system.  They 
have  sometimes  been  called  Incitants  or  Simple  Stimulants;  but  it  has 
seemed  to  me  that  the  name  here  given  best  expresses  their  peculiar 
character.  Of  course,  they  in  some  degree  affect  the  nervous  system ; 
for  one  great  general  function  can  scarcely  be  considerably  excited  with- 
out more  or  less  involving  the  others ;  but  their  primary  and  prominent 
action  is  upon  the  heart  and  arteries. 

The  obvious  effects  produced  by  the  arterial  stimulants,  as  a  class,  are 
a  sensation  of  warmth  or  heat  in  the  stomach,  increased  frequency  and 
force  of  pulse,  and  augmented  temperature  of  the  surface.  They,  in 
general,  also  act  as  powerful  irritants  to  the  skin  when  directly  applied 
to  it,  and  indeed  to  any  sensitive  part  with  which  they  may  come  into 
contact.  Each  one,  however,  has  characteristic  properties,  distinct  from 
that  of  simple  diffusible  stimulation. 

They  may  be  employed  in  all  cases  calling  for  stimulation,  when  the 
action  of  the  heart  is  depressed,  and  are  frequently  thus  used  both  ex- 
ternally and  internally.  They  are  specially  applicable,  and  preferably 
to  the  other  classes  of  diffusible  stimulants,  in  those  cases,  enumerated 
in  the  general  observations  made  upon  diffusible  stimulation,  in  which 
reaction  must  follow  the  state  of  prostration.  In  the  collapse  attendant 
upon  severe  injuries,  and  that  which  occurs  at  the  commencement  of 
febrile  diseases,  they  are  peculiarly  indicated;  because  they  have  no 
special  influence  on  the  brain,  and  are  not  likely,  therefore,  as  alcohol 
and  some  other  cerebral  stimulants,  to  affect  that  organ  injuriously,  when 
reaction  takes  place. 

They  are,  in  general,  contraindicated  by  gastric  inflammation,  because 
brought  into  immediate  contadPwith  the  inflamed  part,  and  acting  upon 
it  with  their  whole  stimulant  power. 

A  great  number  of  medicinal  substances  have  the  property  of  stimu- 
lating the  circulation.  Not  to  mention  the  nervous  and  cerebral  stimu- 
lants, which,  in  accordance  with  their ,very  definition,  have  this  power, 
and,  in  some  instances,  in  a  very  high  degree,  there  are  many  others  dis- 
tributed among  the  various  classes.  But  all  of  these  have  other  prop- 
erties which  serve  to  place  them  elsewhere,  and  for  which  they  are  chiefly 
employed  as  medicines;  and,  though  their  action  upon  the  heart  and 


548  GENERAL   STIMULANTS.  [PART  II. 

arteries  may  sometimes  be  incidentally  useful,  they  are  seldom  or  never 
employed  with  an  exclusive  view  to  this  effect.  The  aromatics  approach 
nearest  in  their  properties  to  this  class ;  but  they  are  much  more  power- 
ful as  local  than  as  general  stimulants;  and  their  application,  as  internal 
remedies,  is  almost  restricted  to  affections  of  the  alimentary  canal. 
Mustard,  copaiba,  guaiac,  mezereon,  cantharides,  savine,  and  many 
others,  more  or  less  excite  the  circulation ;  but  each  one  of  them  be- 
longs to  some  other  class,  as  the  emetics,  diuretics,  diaphoretics,  em- 
menagogues,  or  alteratives ;  and  they  are  almost  never  given  as  arterial 
stimulants  simply. 

The  medicines  strictly  belonging  to  this  class  are  very  few,  and  might, 
perhaps,  be  still  further  limited;  for  carbonate  of  ammonia,  which  I  at- 
tach to  it,  has,  in  addition  to  its  influence  over  the  heart  and  arteries,  an 
action  upon  the  nervous  system,  which  would  almost  entitle  it  to  a  place 
among  the  nervous  stimulants. 


I.  CAYENNE  PEPPER. 

CAPSICUM.  U.  S.,  Br. 

Syn.  Eed  Pepper. 

Origin.  Cayenne  pepper  is  the  fruit  of  Capsicum  annuum,  an  annual 
plant  from  one  to  three  feet  high,  inhabiting  mtertropical  America,  and 
supposed  by  some  to  be  a  native  of  the  East  Indies.  It  is  cultivated  in 
most  civilized  countries,  and  abundantly  in  the  United  States.  Other 
species  contribute  to  the  Cayenne  pepper  of  commerce.  The  fruit  as 
grown  in  Cayenne,  in  South  America,  from  which  the  medicine  derived 
its  common  name,  is  said  to  be  the  product  of  Capsicum  frutescens,  and 
perhaps  also  of  G.  baccatum.  Much  of  the  powdered  Cayenne  pepper 
used  in  this  country  is  brought  from  the  W.  Indies.  Under  the  name 
of  Liberia  pepper,  considerable  quantities  of  a  small  fruit,  about  an  inch 
in  length,  are  imported  from  the  coast  of  Africa.  It  is  probably  identical 
with  that  known  in  England  as  Guinea  pepper,  which  Dr.  Pereira  ascer- 
tained to  be  the  product  of  C.  frutescens. 

Properties.  This  fruit  is  a  light  shimig  berry,  of  various  size  and 
shape,  and  usually  of  a  red  or  orange-red  colour.  The  variety  n 
employed  in  medicine  is  of  a  conical  form,  about  as  long  as  the  finger, 
rounded  at  the  base,  and  somewhat  curved  towards  the  smaller  end. 
When  cut  open,  it  is  seen  to  have  two  or  three  cells,  containing  Hat 
whitish  seeds,  and  a  very  loose  medulla.  When  dried,  it  shrinks,  be- 
comes wrinkled,  and  assumes  a  darker  colour. 

As  employed  in  medicine,  capsicum  is  in  the  form  of  a  powder,  which 
is  bright-red  when  fresh,  but  gradually  fades,  and  in  time  loses  almost 


CHAP.  I.]         ARTERIAL   STIMULANTS. — CAYENNE    PEPPER.  549 

all  its  colour.  That  imported  is  usually  lighter  coloured  than  our  own, 
being  brownish-yellow  rather  than  red.  It  has  a  slight,  peculiar,  some- 
what aromatic  odour,  and  a  bitterish,  extremely  pungent,  burning,  almost 
fiery  taste,  remaining  long  upon  the  tongue.  It  imparts  its  virtues  to 
water,  but  more  freely  and  largely  to  alcohol. 

Active  Principle.  The  virtues  of  capsicum  probably  reside  in  a  pecu- 
liar resinoid  matter,  and,  in  a  less  degree,  in  a  volatile  principle  on  which 
its  odour  depends,  but  which  does  not  appear  to  have  been  yet  isolated. 
The  capsicin  of  Braconnot  contains  the  active  matter  of  the  fruit,  but 
has  been  ascertained  by  Prof.  Procter  to  be  complex.  The  crystals,  in 
which,  as  stated  in  the  preceding  edition  of  this  work,  the  active  principle 
was  supposed  to  have  been  obtained,  have  proved,  on  further  examina- 
tion, to  have  been  a  salt  of  lead,  from  the  acetate  of  that  metal  used  in 
the  process.  From  the  most  recent  experiments  it  would  appear  that 
the  activity  of  capsicum  resides  in  a  peculiar  oleaginous  liquid  substance, 
which,  however,  is  itself  complex,  consisting  probably,  of  a  bland  fixed 
oil,  and  an  acrid  resinoid  principle,  which  has  not  yet  been  procured  in  a 
pure  state.  For  this  principle  when  obtained  uncombined,  the  name  of 
capsicin  should  be  reserved.* 

Effects  on  the  System.  Cayenne  pepper  produces  a  sensation  of  heat  in 
the  stomach,  diffuses  a  general  glow  over  the  system,  and  somewhat  ex- 
cites the  pulse.  In  ordinary  doses,  it  has  no  observable  effect  whatever 
on  the  brain,  or  general  nervous  system.  Locally  it  is  powerfully  stimu- 
lating, more  so  proportionably  than  in  its  operation  upon  the  circulation, 
and  in  this  respect  approaches  the  aromatics.  On  the  skin  it  acts  as  a 
rubcfacient.  When  taken  into  the  stomach  in  excessive  doses,  it  is  ca- 
pable of  producing  gastro-intestinal  inflammation,  with  violent  burning 
pain,  vomiting,  and  purging;  and  is  said  to  have  caused  vertigo  and  a 
sort  of  intoxication,  but  on  insufficient  authority.  Any  cerebral  symp- 
toms it  produces  are  probably  secondary  and  sympathetic.  Used  too 
largely  and  too  long  as  a  condiment,  it  may  give  rise  to  chronic  irritation 
or  secondary  debility  of  stomach,  and,  by  an  over-stimulation  of  the 
blood-making  functions,  may  favour  the  development  of  gout. 

Therapeutic  Application.  The  medicine  may  be  used  for  the  general 
purposes  of  the  arterial  stimulants,  though  less  excitant  to  the  circulation 
than  others  of  the  class.  It  has  been  employed  as  a  safe  stimulant  in 
the  cold  stage  of  pernicious  fever,  and  occasionally,  as  an  adjuvant  to 
other  stimulants,  in  low  typhoid  fevers,  when  the  stomach  has  been  tor- 
pid, and  the  patient  troubled  with  flatulence.  In  the  low  and  malignant 
forms  of  scarlet  fever,  it  has  been  much  and  advantageously  employed ; 
and  it  may  be  considered  as  among  the  best  stimulants  in  that  affection. 

*  See  U.  S.  Dispensatory  (12th  ed  ,  p.  208) ;  and  a  paper  by  Mr.  David  Preston,  in 

the  American  Journal  of  Pharmacy  (May,  1865,  p.  161). 


550  GENERAL    STIMULANTS.  [PART  II. 

I  have  myself  given  it  frequently,  and  been  satisfied  of  its  beneficial 
effects.  It  is  used  both  internally,  and  as  a  gargle.  In  the  latter  mode 
of  application,  I  know  nothing  better  adapted  to  that  condition  of  the 
fauces,  in  which  the  mucous  membrane  has  assumed  a  dark-red  colour, 
and  has  begun  to  slough,  or  appears  to  be  on  the  point  of  doing  so.  But 
it  has  also  seemed  to  me  useful  in  almost  all  varieties  of  the  sore-throat 
of  scarlatina,  in  which,  so  far  from  irritating,  it  often  soothes ;  at  least 
patients  have  frequently  assured  me  that,  though  it  burned  their  mouth 
in  its  passage,  it  had  quite  a  contrary  effect  upon  the  fauces,  which  it 
greatly  relieved. 

In  the  early  stage  of  scarlet  fever,  there  is  sometimes  great  backward- 
ness in  the  appearance  of  the  eruption.  A  few  purplish  points  may 
serve  to  indicate  the  nature  of  the  case,  and  the  vain  struggle  of  the  sys- 
tem to  throw  out  the  irritation  upon  the  surface.  Along  with  this  con- 
dition there  may  be  coma,  or  a  disposition  to  it,  with  an  appearance  of 
general  prostration.  In  such  cases,  Cayenne  pepper  may  be  freely  used, 
both  internally,  in  connection  with  other  stimulants,  and  outwardly  as 
a  rubefacient. 

It  has  been  used,  as  a  pervading  stimulant  of  the  capillaries,  in  old 
cases  of  palsy;  and  has  been  highly  recommended  in  uterine  hemorrhage, 
in  doses  of  from  five  to  ten  grains,  repeated  every  ten  minutes  until  the 
hemorrhage  ceases.  (Brock,  Assoc.  Med.  Journ.,  June,  1854,  p.  582.) 

In  the  Dublin  Medical  Press,  Dr.  Lyons  recommends  capsicum  very 
highly  in  the  early  or  forming  stage  of  delirium  tremens,  stating  that  a 
single  dose  of  twenty  grains  will  usually  cut  short  the  disease;  though, 
in  persons  of  extremely  intemperate  habits,  it  may  be  necessary  to  repeat 
the  dose  three  or  four  times.  (Med.  Record,  Aug.  1,  1866,  p.  260.) 

As  a  local  stimulant,  it  has  been  much  employed  in  atonic  states  of 
the  stomach,  usually  in  connection  with  other  medicines,  to  the  action 
of  which  it  is  supposed  to  render  that  organ  more  sensible.  The  same 
influence  is  also  extended  to  the  bowels.  It  has  been  thought  to  be 
specially  useful,  in  this  way,  in  drunkards,  whose  stomachs  have  lost 
their  excitability  under  the  influence  of  strong  drink.  It  has  been  given, 
with  this  object,  along  with  sulphate  of  quinia  in  intermittents,  with  the 
simple  bitters  in  dyspepsia,  and  with  the  cathartics  in  flatulence  and  con- 
stipation. It  has  also  been  specially  recommended  in  the  dyspepsia  of 
gouty  persons,  and  in  convalescence  from  delirium  tremens.  Taken  in 
the  dose  of  a  teaspoonful,  at  the  very  commencement  of  sea-sickness,  it 
is  said  sometimes  to  set  aside  that  affection.  Much  efficiency  has  also 
been  recently  claimed  for  it  in  hemorrhoidal  tumours,  given  to  an  amount 
of  from  ten  grains  to  two  scruples  in  the  course  of  the  day.  (Ann.  de 
Therap.,  1858,  p.  90.) 

Topically,  it  is  occasionally  employed  as  a  gargle  at  the  commence- 
ment of  ordinary  angina,  as  a  direct  application  in  relaxation  and  elon- 
gation of  the  uvula,  and  externally  as  an  active  rubefacicut. 


CHAP.  I.]      ARTERIAL   STIMULANTS. — OIL   OF   TURPENTINE.  551 

Administration.  The  dose  of  the  powder  is  from  five  to  ten  grains,  to 
be  repeated,  in  acute  cases,  every  hour  or  two,  in  chronic  cases,  three  or 
four  times  a  day.  The  powder  may  also  be  used  locally  as  a  cataplasm, 
or  as  an  application  to  the  fauces.  In  young  children,  who  cannot 
gargle,  I  have  found  much  advantage,  when  the  use  of  capsicum  in  this 
way  was  indicated,  as  in  the  gangrenous  condition  of  the  fauces  in 
scarlet  fever  or  malignant  sore-throat,  from  mixing  the  powder  with 
water  into  a  sort  of  semifluid  paste,  and  diffusing  this  over  the  fauces, 
several  times  a  day,  by  means  of  a  camel's-hair  brush,  or  some  similar 
implement.  Should  the  child  swallow  a  portion,  it  will  be  all  the  better. 
In  the  same  way,  it  may  be  applied  to  the  elongated  uvula. 

The  medicine  is  sometimes  used  also  in  the  form  of  infusion  (!NFU- 
SUM  CAPSICI,  U.  &),  which  is  made  in  the  proportion  of  two  drachms  to 
eight  fluidounces  of  boiling  water,  and  given  in  the  dose  of  half  a  fluid- 
ounce.  In  the  same  form,  it  may  be  employed  as  a  gargle;  but,  for  ordi- 
nary cases  of  sore-throat,  it  should  be  diluted  with  from  four  to  eight 
parts  of  water. 

The  formula  for  the  infusion  of  Dr.  Stephens,  which  has  been  much 
used  in  scarlet  fever,  both  internally  and  as  a  gargle,  directs  that  two 
tablespoonfuls  of  the  powder,  and  a  tablespoonful  of  common  salt,  should 
be  macerated  for  an  hour  in  a  pint  of  liquid  consisting  of  equal  parts  of 
boiling-hot  water  and  vinegar.  This  is  to  be  strained,  and  given  in  the 
dose  of  a  tablespoonful  every  half  hour. 

The  officinal  Tincture  (TINCTURA  CAPSICI,  U.  S.)  may  be  used  inter- 
nally in  the  dose  of  one  or  two  fluidracbms;  as  a  gargle,  mixed  with 
water  or  rose-water  in  the  proportion  of  half  a  fluidounce  to  eight  fluid- 
ounces;  and  externally,  hot  and  undiluted,  as  a  rubefacient.  It  may  also 
be  applied  of  full  strength,  by  means  of  a  camel's-hair  pencil,  to  the 
relaxed  uvula, 


II.  OIL  OF  TURPENTINE. 
OLEUM  TEREBINTHIN^E.  U.S.,  Br. 

Origin.  As  used  in  this  country,  oil  of  turpentine  is  obtained  exclu- 
sively from  our  common  or  white  turpentine,  by  distillation. 

Properties.  It  is  a  limpid,  colourless  liquid,  of  a  strong,  peculiar 
odour,  and  a  warm,  pungent,  bitterish,  and  very  characteristic  taste. 
This  odour  and  taste  have  been  assumed  as  a  standard  of  comparison ; 
and,  when  similar  properties  are  observed  in  other  bodies,  they  are  said 
to  be  terebinthinate.  The  oil  is  lighter  than  water,  volatilizable,  highly 
imflammable,  very  slightly  soluble  in  water,  scarcely  soluble,  when  quite 
pure,  in  cold  officinal  alcohol,  and  readily  dissolved  by  ether.  On  expo- 


552  GENERAL   STIMULANTS.  [PART  II. 

sure  to  the  air,  it  absorbs  oxygen,  and  becomes  yellowish  and  thicker, 
in  consequence  of  the  formation  of  resinous  matter,  which  is  held  in  so- 
lution in  the  oil.  In  time,  it  is  in  this  way  rendered  very  impure.  But, 
as  the  resin  formed  is  readily  soluble  in  alcohol,  the  oil  may  be  purified 
by  agitation  with  that  fluid,  which  dissolves  the  impurity,  and  leaves 
the  oil  fit  for  use.  When  quite  pure,  it  is  composed  of  hydrogen  and 
carbon  exclusively;  but,  as  found  in  the  shops,  it  almost  always  contains 
oxygen  absorbed  from  the  air. 

EFFECTS  ON  THE  SYSTEM.  The  first  effect  of  oil  of  turpentine,  when 
given  to  a  healthy  person  in  moderate  doses,  is  usually  a  feeling  of 
warmth  in  the  stomach,  which  is  followed  by  a  glow  over  the  system, 
and,  after  a  short  time,  by  increased  frequency  of  the  pulse.  There  is 
also  generally  an  increased  secretion  of  urine,  which  has  a  violet  odour; 
and,  after  the  oil  has  been  taken  for  some  time,  a  tcrebinthinate  smell  is 
perceptible  in  the  breath,  and  the  exhalations  from  the  skin.  The  oil  is 
said,  moreover,  to  be  diaphoretic.  This  effect  I  have  not  noticed  as  a 
common  event ;  though,  in  certain  conditions  of  low  fever  in  which  it  is 
given,  I  have  often  observed  a  soft  and  natural  state  of  the  skin  follow- 
ing a  dry  and  hot  condition ;  but  this  change  I  have  ascribed  rather  to 
the  effect  of  the  medicine  in  relieving  the  disease,  and  removing  a  source 
of  irritation  to  the  surface,  than  to  its  direct  action  on  the  perspiratory 
function.  The  kidneys  and  urinary  passages  are  the  parts  in  which  the 
operation  of  the  oil,  after  entering  the  circulation,  is  most  obvious. 
Though,  as  stated  above,  the  urinary  secretion  is  usually  increased  under 
the  stimulation  of  the  medicine,  yet,  after  some  days,  irritation  is  often 
produced,  amounting  even  to  strangury,  and  attended  occasionally  with 
bloody  urine;  and  the  secretion  is  now  diminished,  instead  of  being  aug- 
mented. With  these  phenomena,  there  is  an  entire  absence  of  any  evi- 
dence of  special  action  on  the  brain  or  nervous  system  generally. 

From  larger  quantities,  if  within  the  limits  of  two  fluidrachms,  no 
other  observable  effects  ordinarily  result  than  perhaps  some  increase  of 
the  phenomena  mentioned,  and  a  disposition  to  disturb  the  bowels,  \\  Inch 
is  sometimes  also  evinced  even  by  the  common  medicinal  doses. 

If  the  quantity  be  increased  beyond  half  a  fluidounce,  up  to  one,  two, 
or  three  fluidounces,  a  greater  degree  of  general  excitement  is  produced, 
in  which  the  brain  now  participates;  feelings  of  fulness  of  the  head,  and 
slight  vertigo,  being  experienced,  and  sometimes,  it  is  said,  drowsin  <•-.-. 
or  a  confusion  of  mind  bordering  upon  intoxication.  A  condition  resem- 
bling trance  is  said  to  have  been  experienced  in  one  instance.  In  the 
doses  mentioned,  the  oil  not  unfrequcntly  occasions  nausea,  and  some- 
times vomiting;  and  in  a  short  time,  usually  within  an  hour  or  two, 
purges  actively;  after  which  the  cerebral  symptoms  subside.  These 
symptoms  may  possibly  bo  the  result  of  a  sympathetic  impression  upon 
the  brain,  extended  from  the  irritated  stomach,  as  might  be  inferred 


CHAP.  I.]        ARTERIAL   STIMULANTS. — OIL   OF   TURPENTINE.  553 

from  their  quick  occurrence,  and  their  rapid  disappearance  upon  the  dis- 
charge of  the  oil  by  the  bowels.  Another  evidence,  to  the  same  effect, 
is  that  large  doses  of  the  oil  are  less  apt  to  produce  irritation  of  the 
urinary  passages  than  the  smaller  doses  frequently  repeated;  showing 
that  an  equal  amount  of  absorption  has  not  taken  place.  The  severer 
head  symptoms  are  most  apt  to  occur  when  the  medicine  does  not,  as 
sometimes  happens,  operate  on  the  bowels.  In  this  case,  too,  the  exha- 
lations from  the  skin  and  lungs  are  highly  terebiuthinate,  and  the  urine 
has  the  violet  odour  strongly. 

Like  most  other  stimulants,  the  oil  sometimes  appears  to  act  as  an 
emmenagogue. 

It  can  scarcely  be  considered  poisonous ;  as  not  less  than  four  fluid- 
ounces  are  asserted  to  have  been  taken  without  serious  consequences. 
On  the  lower  animals,  however,  it  would  seem  to  act  deleteriously;  for 
two  drachms,  given  to  a  dog,  are  said  to  have  proved  fatal  in  three  min- 
utes, with  symptoms  of  tetanus,  and  great  prostration.  (Pereira,  Mat. 
Mat.,  3d  ed.,  p.  1193.)  A  case,  moreover,  has  been  recently  recorded, 
in  which  death  was  supposed  to  have  been  occasioned  in  a  woman  by 
six  fluidounces  of  the  oil ;  but  the  circumstances  of  the  case  are  so  ob- 
scure, as  to  leave  the  real  cause  of  the  fatal  result  uncertain.  (See  Am. 
Journ.  of  Med.  Sci.,  X.  8.,  xxxvi.  5G2.)  As  to  the  alleged  poisonous 
effects  resembling  those  of  lead,  said  to  have  been  produced  by  exposure 
to  the  exhalations  from  a  newly -painted  room  (Gaz.  Med.  de  Paris,  1855, 
No.  52),  and  which  were  ascribed  to  the  oil  of  turpentine  used  in  the 
paint,  there  cannot  be  the  least  doubt  that  they  were  really  owing  to  the 
lead  which  must  have  risen  with  the  vapours ;  for  long  exposure  to  the 
pure  vapours  of  the  oil,  which  is  not  uncommon  in  this  country,  never 
occasions  such  effects;  while,  as  before  stated  in  this  work,  it  is  well 
known  that  painters  who  use  this  oil  in  mixing  their  paints  are  pecu- 
liarly liable  to  lead-poison. 

The  oil  is  undoubtedly  absorbed.  Ticdemann  and  Gnaelin  detected  it 
in  the  chyle  of  animals  to  whom  it  had  been  given.  The  odour  of  the 
urine,  and  that  exhaled  from  the  lungs  and  skin,  are  of  themselves  suffi- 
cient proof.  It  may  be  absorbed  into  the  system  when  inhaled  in  the 
form  of  vapour.  I  have  had  under  my  care  a  young-  man,  attacked 
with  strangury  and  bloody  urine,  from  being  confined  on  board  of  a 
vessel  loaded  with  turpentine,  during  a  voyage  from  North  Carolina  to 
New  York;  and  he  informed  me  that  another  of  the  crew  was  affected 
in  the  same  manner. 

When  applied  to  the  skin,  the  oil  acts  usually  as  a  powerful  rube- 
facient. 

THERAPEUTIC  APPLICATION.  From  the  variety  and  importance  of  its 
therapeutic  effects,  oil  of  turpentine  deserves  to  rank  among  the  most 
valuable  medicines.  In  regard  to  some  of  these  effects,  the  anthelmintic, 


554  GENERAL   STIMULANTS.  [PART  II. 

namely,  the  rubefacient,  and  those  exerted  on  the  urinary  organs,  it  will 
be  considered  elsewhere.  In  this  place,  it  is  to  be  treated  of  mainly  as  a 
stimulant,  either  generally  to  the  system,  or  locally  to  the  alimentary 
mucous  membrane. 

Cold  Stage  of  Fevers.  In  consequence  of  the  absence  of  any  direct 
effect  on  the  brain,  at  least  in  ordinary  stimulant  doses,  the  oil  may  be 
given  in  all  instances  of  depression  or  collapse,  occurring  in  the  cold  stage 
of  febrile  diseases,  when  internal  stimulation  is  required.  In  some  cases 
of  this  kind,  I  have  known  it  to  be  very  useful;  and  it  may  be  given 
with  great  freedom. 

Low  Fevers  generally.  It  has  also  been  considerably  used  as  a  stimu- 
lant in  low  states  of  fever,  especially  when  the  existence  of  disorder  of 
the  brain  may  be  supposed  to  contraindicate  the  alcoholic  liquors,  and 
other  cerebral  stimulants.  In  typhus  and  typhoid  fevers  it  has  long 
been  employed  with  this  view;  and  I  found  it  in  use  upon  entering  into 
the  practice  of  medicine,  nearly  fifty  years  ago.  But  it  was  given  only 
as  a  stimulant,  and,  though  successful  in  some  instances,  appeared  in 
others  to  display  little  remedial  power.  I  claim  to  have  discovered  the 
principle  upon  which  its  special  success  in  these  cases  depended,  or  at 
least  the  precise  circumstances  under  which  it  proved  successful ;  so 
that  its  employment  may  now  be  regulated  with  considerable  confidence 
of  gaining  the  results  aimed  at.  As  a  mere  stimulant,  it  may  be  em- 
ployed in  most  instances  of  low  fever,  but  must  take  rank  with  others 
of  the  class,  and  indeed  below  several  of  them.  In  regard  to  the  special 
object  which  I  now  have  in  view,  it  can  be  replaced,  so  far  as  I  know, 
with  equal  benefit,  by  no  other  medicine. 

The  advanced  stage  of  the  fever  named  specifically  typhoid  fever, 
but  for  which  I  have  ventured  to  propose  the  name  of  enteric  fever, 
affords  the  condition  here  referred  to.  I  may,  perhaps,  be  excused  if  I 
relate  the  circumstances  which  led  me  to  this  discovery;  as  I  shall  thus 
be  able  to  produce  a  stronger  impression  on  the  reader  than  by  a  mere 
abstract  statement  of  results.  In  the  year  1823,  I  had  under  my  care  a 
case  of  fever  of  the  kind  then  known  as  nervous  fever,  or  slow  remittent, 
or  typhus  mitior,  by  which  titles  it  was  variably  and  somewhat  indefi- 
nitely called,  in  the  advanced  stage  of  which,  violent  peritoneal  inflam- 
mation came  on,  ending  speedily  in  death.  On  examination,  I  found  a 
number  of  ulcerated  surfaces  in  the  mucous  membrane  of  the  ileum,  in 
one  of  which,  near  the  cfficum,  a  large  perforation  existed,  through  which 
a  portion  of  the  contents  of  the  bowels  had  passed  into  the  peritoneal 
cavity.  In  this  case  there  had  been  tympanitic  abdomen,  and  the  tongue, 
after  having  parted  with  apportion  of  the  fur  in  the  centre,  leaving  a 
smooth  moist  red  surface,  had  suddenly  ceased  to  advance  in  the  clean- 
ing process,  and  become  quite  dry  before  the  occurrence  of  the  perfora- 
tion. Not  long  previously  to  this,  I  had  witnessed  a  fatal  case  in  the 


CHAP.   I.]        ARTERIAL    STIMULANTS. OIL    OP    TURPENTINE.  555 

practice  of  a  friend,  which,  after  an  abortive  attempt  to  clear  the  tongue 
in  a  similar  manner,  with  a  similar  dry  ness  afterwards,  had  become  ag- 
gravated, and  ended  fatally.  Comparing  these  cases,  I  was  induced  to 
think  that  the  peculiar  condition  of  the  tongue  referred  to,  with  the 
tympanitic  abdomen,  might  be  the  result  of  the  ulceration  of  the  ileum, 
and  that,  if  I  could  find  a  medicine  which  would  correct  this  ulcerative 
condition,  I  might  possibly  in  future  save  my  patients  under  similar  cir- 
cumstances. Not  long  afterwards  another  case  presented  itself,  having 
the  same  distinctive  characters.  Terebinthinate  remedies  having  been 
found  useful  in  ulcerative  affections  of  the  bowels,  it  occurred  to  me  that 
the  oil  of  turpentine  might  possibly  answer  my  purpose  in  this  instance. 
I  gave  it  accordingly.  In  twenty-four  hours,  the  tongue  showed  a  dis- 
position again  to  become  moist,  a  little  white  fur  began  to  appear  on  the 
part  before  denuded,  there  was  an  amelioration  of  the  other  symptoms, 
and  from  that  time  the  march  towards  health  was  uninterrupted  under 
the  continued  use  of  the  remedy,  though  I  had  in  the  beginning  almost 
despaired  df  my  patient.  Other  cases  occurred  afterwards,  of  the  same 
character,  and  with  the  same  results;  and  from  that  time  to  the  present, 
though  I  have  seen  great  numbers  in  my  private  practice,  in  consulta- 
tion, and  in  the  Pennsylvania  Hospital,  I  have  lost  only  two,  presenting 
thr  phenomena  mentioned.  Of  these  two,  one  exhibited,  on  examination 
after  death,  such  an  amount  of  disease  in  the  ileum  as  to  have  rendered 
a  fatal  issue  unavoidable;  and  in  the  other,  a  small  ulcerated  opening 
was  found  at  the  bottom  of  an  offset  of  the  bowel,  or  cul-de-sac,  about 
an  inch  and  a  half  in  depth,  into  which,  as  it  was  filled  with  mucus, 
the  oil  had  been  unable  to  penetrate,  so  as  to  come  into  contact  with  the 
surface  of  the  ulcer;  while  several  large  ulcerated  patches  in  the  ileum 
were  rapidly  cicatrizing,  showing  the  probably  beneficial  influence  of  the 
remedy  on  them.  A  brief  account  of  the  use  of  the  oil  in  this  condition 
of  febril'  and  of  the  circumstances  which  led  to  it,  was  pub- 

lished in  the  North  American  Medical  and  Surgical  Journal  for  April, 
1826  (page  272).  When  the  admirable  work  of  Louis  on  typhoid  fever 
appeared.  I  at  once  recognized,  in  his  description,  the  disease  which  had 
exhibited  the  phenomena  above  mentioned.  The  ulcerative  condition 
referred  to,  I  had  previously  considered  as  liable  to  occur  in  any  pro- 
tracted fever.  I  now  learned  that  it  was  the  characteristic  lesion  of  a 
special  disease.  My  therapeutic  views,  therefore,  were  immediately 
transtWivd  to  the  typhoid  fever,  which  Louis  had  enabled  us  accu- 
rately to  diagnosticate,  and.  having  tried  the  remedy  in  this  affection,  I 
found  my  best  hopes  fulfilled.  Ever  since  that  time,  I  have  been  in  the 
habit,  in  my  lectures  in  the  University  of  Pennsylvania,  of  strenuously 
recommending  the  oil  of  turpentine  in  the  treatment  of  enteric  or  typhoid 
fever,  and  have  done  the  same  in  my  work  on  the  Practice  of  Medicine, 
always  restricting  its  use  to  the  period  of  probable  softening  and  ulcera- 


556  GENERAL   STIMULANTS.  [PART  II. 

tion  in  the  diseased  glandular  patches,  and  expressing  my  belief  that  it 
was  no  specific  in  that  disease,  but  might  be  confidently  relied  on  as 
having  a  favourable  influence  over  this  peculiar  morbid  affection  of  the 
bowel,  and  vastly  diminishing  the  danger  from  that  source.  Abundant 
testimony  has  been  given  to  me,  by  practitioners  from  various  parts  of 
the  Union,  of  very  favourable  changes  having  taken  place  in  the  mor- 
tality of  the  disease,  after  they  had  adopted  the  practice  here  recom- 
mended. It  will  be  best,  probably,  after  this  brief  history,  that  I  should 
state  distinctly,  the  condition  under  which,  in  enteric  fever,  the  oil  may 
be  beneficially  employed,  and  the  principles  upon  which  I  believe  it 
to  act. 

Enteric  or  Typhoid  Fever.  Though  the  oil  may  be  of  some  use  as  a 
mere  stimulant  in  this  disease,  it  is,  in  that  respect,  of  but  comparatively 
little  value,  and  cannot  be  depended  on  to  the  exclusion  of  wine-whey, 
carbonate  of  ammonia,  and  nutritious  aliment,  in  low  conditions  of  the 
fever.  But  the  oil  will  accomplish  what  these  cannot.  It  acts  most  hap- 
pily in  stimulating  the  diseased  patches  of  Peyers  glands,  and  the  iso- 
lated glands  of  the  same  kind,  whereby  the  softened  and  disorganized 
matter  is  more  readily  thrown  off,  and  the  ulcerated  surfaces  disposed  to 
heal,  when  they  might  otherwise  be  unable  to  do  so.  The  remedy, 
therefore,  is  to  be  given  at  the  period' during  which  the  discharge  of  the 
softened  matter  is  going  on,  and  ulcers  are  forming,  or  in  existence.  This 
is  usually,  I  believe,  about  the  middle,  or  towards  the  close  of  the  second 
\veek.  Before  this  time  I  count  upon  no  material  service  from  the  oil. 
It  is  now  that  the  tongue  becomes  dry;  and  the  occurrence  of  this  dry 
state,  of  the  tongue,  in  a  decided  degree,  is  the  signal  for  commencing 
with  the  use  of  the  remedy.  I  give  it  usually  in  doses  of  ten  drops 
every  two  hours,  but  sometimes  increase  to  fifteen  or  twenty  drops.  At 
the  end  of  twenty-four,  or  at  the  furthest  of  forty-eight  hours,  there  may 
very  generally  be  seen  a  return  of  moisture  with  a  white  fur  on  the 
.surface  of  the  tongue  at  the  sides,  for  its  whole  length,  leaving  the 
surface  in  the  middle  still  dry  and  often  cracked.  With  this  amendment 
there  is  often  also  a  diminution  of  the  tympanites,  a  cooler  and  moister 
skin,  and  a  less  frequent  pulse.  The  same  change  goes  on  till  the  whole 
tongue  becomes  moist,  and  covered  usually  with  a  whitish  fur,  which  then 
gradually  disappears,  commencing  from  the  tip  and  edges.  Sometimes, 
even  when  there  has  been  no  dryness  of  the  tongue  in  the  ease,  I  have 
found  the  oil  to  act  favourably  in  ameliorating  the  symptoms;  and  1're- 
quently,  when  the  disease  has  appeared  to  linger  in  its  advanced  stages, 
and,  though  not  severe,  to  show  a  perverse  disposition  to  hang  on  to  the 
patient,  I  have  seen  it  almost  immediately  enter  into  convalescence  under 
the  use  of  the  remedy.  Again,  when  the  case  is  marked  in  its  pro"! 
by  the  cleaning  of  the  tongue  by  flakes  or  in  patches,  leaving  a  red  and 
smooth  surface,  as  if  deprived  of  the  outer  layer  of  the  epithelium  and 


CHAP.  I.]        ARTERIAL   STIMULANTS. — OIL   OF   TURPENTINE.  557 

papillag,  and  when  the  surface  of  the  tongue,  whether  completely  or  only 
partially  cleared,  instead  of  remaining  moist,  as  it  does  in  favourable 
cases,  becomes  very  dry,  with  an  aggravation  of  the  general  symptoms, 
I  take  it  for  granted  that  there  has  been  a  corresponding  unfavourable 
change  in  the  intestinal  ulceration,  indicating  the  use  of  the  oil.  It  is 
precisely  under  these  circumstances  that,  previously  to  my  original  use 
of  the  oil,  I  had  seen  a  majority  of  the  cases  that  came  under  my  notice 
prove  fatal ;  and,  since  the  use  of  it,  only  two.  I  do  not  claim  for  the 
oil  any  specific  power  over  typhoid  fever.  It  will  not  prevent  death 
from  iutercurrent  pneumonia,  or  meningitis,  or  various  other  sources  of 
mischief;  but  I  do  think,  as  the  result,  too,  of  great  experience  in 
the  disease,  that  so  far  as  the  mere  affection  of  the  intestinal  glands  and 
its  direct  consequences  are  concerned,  it  will  vastly  diminish  the  chances 
of  a  fatal  issue.  The  reason  why,  in  the  special  condition  of  the  tongue 
last  described,  the  favourable  effects  of  the  remedy  may  be  almost  cer- 
tainly calculated  on,  is  that,  at  the  commencement  of  the  cleaning  pro- 
cess, the  proper  idiopathic  disease  has  about  run  its  course,  and  would 
almost  certainly  end  well,  but  for  an  unfavourable  change  in  the  condi- 
tion of  the  ulcerated  surfaces ;  and  whatever,  therefore,  will  favour  the 
healing  of  these,  will  in  all  probability  secure  a  favourable  termination. 
I  have  been  more  particular  in  this  account  of  the  use  of  oil  of  turpen- 
tine in  enteric  fever,  because  I  have  great  confidence  in  the  efficiency  of 
the  remedy  myself,  and  wish  to  prevail  on  others  to  use  it  by  showing 
the  grounds  of  this  confidence,  and  pointing  out  the  precise  circumstances 
under  which,  according  to  my  experience,  it  should  be  employed. 

Scarlet  Fever.  In  the  advanced  stage  of  this  complaint,  a  troublesome 
diarrhoea  not  unfrequently  supervenes,  which  is  sometimes,  I  believe, 
sustained  by  ulcers  in  the  small  intestines.  It  is  not  uncommon  for  this 
condition  to  be  attended  by  a  dry  tongue,  as  in  enteric  or  typhoid  fever. 
Under  these  circumstances,  I  have  prescribed  the  oil  of  turpentine  with 
apparent  benefit. 

Dysentery  and  Diarrhoea.  Whenever,  in  the  course  of  these  com- 
plaints, whether  acute  or  chronic,  the  tongue  exhibits  a  smooth  surface, 
as  if  deprived  of  its  papillary  structure,  and  at  the  same  time  becomes 
perfectly  dry,  I  always  unhesitatingly  employ  the  oil  of  turpentine,  be- 
lieving that  this  aridity  indicates  a  deficiency  of  the  vital  forces,  which 
calls  for  the  stimulating  property  of  the  oil,  while  the  probable  existence 
of  ulcers  in  the  bowels  requires  its  alterative  action.  In  chronic  dysen- 
tery, particularly,  I  have  repeatedly  seen  the  happiest  changes  effected 
by  the  remedy,  under  the  precise  circumstances  mentioned,  and  would 
strongly  urge  upon  the  reader  a  trial  of  it.  One  instance  occurs  to  me, 
in  which  the  patient  had  been  very  long  ill,  and  was  reduced  to  the  lowest 
condition  compatible  with  life.  No  one  who  saw  the  case  had  any  hope 
of  a  cure.  But  the  same  favourable  change  took  place,  under  the  use  of 


558  GENERAL   STIMULANTS.  [PART  II. 

the  oil,  as  in  the  analogous  condition  in  enteric  fever,  and  the  patient 
recovered.  I  seldom  fail,  in  such  cases,  in  restoring  moisture,  and  an 
otherwise  favourable  condition  to  the  tongue,  even  though  the  disease 
may  prove  ultimately  fatal.  The  oil  should  be  combined  with  a  little 
laudanum  in  these  cases. 

Gastritis  and  Yellow  Fever.  In  the  last  stage  of  inflammation  of  the 
gastric  mucous  membrane,  when  the  skin  has  become  damp  with  cool 
sweats,  hiccough  has  set  in,  and  the  patient  vomits  dark  matter;  in  short, 
when  symptoms  of  threatened  gangrene  appear,  the  oil  of  turpentine 
with  laudanum  sometimes  offers  a  last  chance  for  safety.  It  acts  as  a 
stimulant  and  alterative  to  the  diseased  surface,  while  it  somewhat  stim- 
ulates the  system.  I  have  seen  at  least  one  apparently  desperate  case 
recover  from  such  a. condition  under  the  use  of  it.  Now  this  condition 
is  very  frequently  presented  in  the  second  stage  of  yellow  fever,  antici- 
patory or  attendant  on  black  vomit.  The  oil  has  been  highly  recom- 
mended under  these  circumstances,  being  commenced  with  after  the  sub- 
sidence of  the  primary  fever.  Some  have  even  employed  it  throughout 
the  disease;  but  in  the  early  stage,  when  the  gastritis  is  yet  active,  the 
use  of  a  powerful  local  stimulant  like  this  would  not  correspond  with 
my  views  of  sound  therapeutics. 

Puerperal  Fece.r.  Dr.  Brenan,  of  Dublin,  has  spoken  in  the  strongest 
terms  of  the  usefulness  of  this  remedy  in  puerperal  fever.  He  gave  it 
in  doses  of  one  or  two  tablespoonfuls  every  three  or  four  hours,  and  at 
the  same  time  covered  the  abdomen  with  flannels  saturated  with  the  oil. 
There  is  no  doubt  that  benefit  may  accrue  from  the  external  use  of  the 
remedy  in  the  way  mentioned ;  and,  in  the  malignant  forms  of  the  dis- 
ease, when  the  blood  is  impaired,  and  the  inflammation  partakes  of  the 
same  depraved  character,  it  is  not  impossible  that  the  powerful  revulsion 
towards  the  inner  from  the  outer  surface  of  the  bowels  may  have  proved 
useful.  The  recommendation  of  Dr.  Brenan  has  not  been  without  the 
support  of  other  highly  respectable  practitioners;  but  the  remedy  has 
not  been  adopted  by  the  profession  generally;  and  it  certainly  appears 
to  be  contraindicatcd  in  all  cases  of  genuine-  vigorous  inflammation,  in 
which  it  might  be  proper  to  employ  the  lancet.  I  cannot,  however, 
speak  of  it  from  experience. 

Chronic  Rheumatism  and  Gout.  Oil  of  turpentine  has  considerable 
reputation  in  these  affections,  more  especially  the  former,  in  which  it  is 
said  to  have  sometimes  proved  very  efficacious.  It  lias  been  more  par- 
ticularly recommended  in  this  disease,  in  the  forms  of  lumbago  and 
sciatica.  The  oil  is  undoubtedly  a  penetrating  remedy,  reaching  the 
minutest  capillaries,  and  apparently  acting  on  them  with  considerable 
energy.  It  may  thus  prove  alterative  in  some  of  those  obstinate  rheu- 
matic cases,  which  have  taken  so  deep  a  hold  of  the  tissues,  as  to  be  in- 
capable of  being  unseated  by  anything  which  cannot  be  brought  to  bear 


CHAP.  I.]        ARTERIAL   STIMULANTS. — OIL   OF   TURPENTINE.  559 

with  considerable  force  immediately  upon  the  molecules  of  the  tissue 
affected.  I  have  no  faith  whatever  in  the  diaphoretic  action  of  the  oil, 
to  which  some  have  been  disposed  to  ascribe,  in  part  at  least,  its  effi- 
ciency in  rheumatism.  The  medicine  has  not  only  been  used  internally, 
but  has  also  been  applied  in  the  form  of  a  bath  of  the  vapour,  at  a  tem- 
perature of  from  140°  Fahr.  to  160°,  which  is  said  to  be  well  borne.  In 
this  case  it  is  probable  that  the  diaphoretic  effect  of  the  heat  may  add  to 
the  efficiency  of  the  oil.  (Arch.  Gen.,  4e  ser.,  xxviii.  80.)* 

Nervous  Diseases.  Cures  are  stated  to  have  been  effected  by  the  oil 
of  turpentine  in  neuralgia,  chorea,  epilepsy,  and  tetanus;  and  it  is 
probable  that,  largely  employed,  it  may  sometimes  cure  these  affections, 
when  purely  functional,  by  its  strong  influence  upon  the  ultimate  con- 
stituents of  the  tissues  through  the  capillaries,  and  its  revulsive  action 
towards  the  alimentary  canal;  but  I  cannot  recommend  it  on  the  ground 
of  my  own  experience.  A  case  of  recovery  from  trismus  nascentium, 
under  its  use,  is  reported  by  Prof.  H.  L.  Byrd,  of  the  Oglethorpe  Medi- 
cal College  in  Georgia.  (Chariest.  Mud.  Journ.  and  Rev.,  xii.  474.) 

Hemorrhages.  Oil  of  turpentine -is  among  our  best  haemostatics. 
Some  have  supposed  that  it  operates  in  the  hemorrhages  by  an  astrin- 
gent property.  But  I  have  not  been  able  to  discover  that  it  has  this 
property  in  the  slightest  degree.  On  the  contrary,  its  tendency  is  to 
expand  the  capillaries  of  the  part  with  which  it  is  brought  into  contact. 

*  For  a  particular  account  of  the  origin,  construction,  application,  and  uses  of 
these  terebinthinate  vapour-baths,  the  reader  is  referred  to  an  article  by  Dr.  M. 
Macario,  in  the  numbers  of  the  Archives  Generates  for  April  and  May,  1859,  pages 
385  and  533.  By  this  writer  it  is  stated  that  cures  are  sometimes  obtained  in  chronic 
polity,  rheumatic,  neuralgic,  and  catarrhal  affections,  which  have  resisted  all  other 
remedies.  He  does  not  think  the  temperature  should  be  higher  than  between  110° 
and  140°  Fahr.,  which  is  sufficient  for  all  the  objects  aimed  at.  The  patient 
is  placed  wholly  within  the  balh,  the  vapours  of  which,  therefore,  act  as  well 
through  the  respiratory  organs  as  upon  the  surface  of  the  body.  When  there  is  no 
great  occasion  for  haste,  it  is  sufficient  to  administer  the  bath  every  other  day. 
Under  the  influence  of  the  bath,  the  pulse  generally  becomes  more  frequent,  some- 
times beating  130  in  the  minute,  while  the  respiration  remains  normal ;  the  whole 
surface  is  reddened;  and  a  profuse  perspiration  breaks  forth,  which,  however,  does 
not  have  the  effect  of  weakening  the  patient.  Very  seldom  is  headache  or  other 
evidence  of  congestion  of  the  brain  experienced.  As  effects  of  the  bathing,  more- 
over, the  appetite  and  thirst  are  increased,  and  digestion  accelerated;  the  urine, 
though  remaining  about  normal  in  quantity,  acquires  a  strong  violet  odour;  and 
occasionally,  especially  in  nervous  subjects,  the  nervous  system  is  considerably  dis- 
turbed, as  shown  by  restlessness,  irritability,  and  want  of  sleep.  The  skin  is  some- 
times covered  with  a  miliary  eruption,  and  sometimes  affected  with  furuncles  in  vari- 
able numbers  and  size.  M.  Macario  considers  the  baths  applicable  not  only  to  the 
affections  mentioned,  but  also  to  chronic  affections  of  debility,  as  scrofula,  stiffness 
and  contraction  of  the  limbs,  and  palsies  of  a  rheumatic  character.  They  ore  contra- 
indicated  in  acute  diseases  generally,  attended  with  phenomena  of  excitation.  (Note 
to  the  second  edition.)  9 


560  GENERAL    STIMULANTS.  [PART  II. 

But  we  do  not  know  the  precise  condition  of  the  minute  vessels  in  hem- 
orrhage; and  it  may  well  be,  that  the  stimulant  and  alterative  influence 
of  the  oil  upon  them  may  check  the  hemorrhagic  tendency  without  dimin- 
ishing their  volume.  The  conditions  which  I  have  considered  as  pre- 
requisite to  the  use  of  the  oil,  are  the  absence  of  general  febrile  excite- 
ment, and  of  active  congestion  in  the  part  affected.  Under  these  cir- 
cumstances, it  may  be  tried  in  any  of  the  hemorrhages;  but  that  in 
which,  according  to  my  own  observation,  it  has  proved  most  efficient,  is 
the  haemoptysis  of  consumptive  patients,  or  of  persons  supposed  to  be 
consumptively  inclined.  In  this  affection,  it  has  proved  in  my  hands 
more  effectual  than  any  other  remedy,  or  combination  of  remedies.  I 
was  first  induced  to  employ  it,  from  having  noticed  its  great  efficiency  in 
a  medical  student  more  than  thirty  years  ago,  who  had  employed  it  in 
his  own  case,  in  a  very  severe  attack.  This  student  is  now  Dr.  James 
L.  Pierce,  of  Philadelphia.  Since  that  time,  I  have  used  it  very  success- 
fully, and  sometimes  when  all  other  remedies  had  been  without  effect. 
Should  evidences  of  active  congestion  be  present,  they  should  be  re- 
moved by  cups  or  leeches  before  the  use  of  the  oil ;  at  least  this  is  the 
method  which  I  have  generally  followed. 

Chronic  Bronchitis.  This  affection,  when  attended  with  copious  ex- 
pectoration, is  said  to  have  been  advantageously  treated  with  the  oil ; 
as  have  other  excessive  mucous  discharges. 

Dr.  D.  S.  Brandon,  of  Georgia,  speaks  favourably  of  its  use  in  stoma- 
titis materna,  having  found  it  very  efficient  in  the  dose  of  twelve  drops 
three  or  four  times  a  day.  (Am.  J.  of  Med.  Sci.,  April,  I860,  p.  576.) 

Affections  of  the  Stomach  and  Bowels.  In  gouty  spasm  of  the  stom- 
ach, flatulent  colic,  excessive  flatulence  without  xpasm,  and  a  tympanitic 
slate  of  the  abdomen,  the  oil  is  often  beneficial  through  its  direct  stimu- 
lant influence.  In  tympanites,  given  both  by  the  mouth,  and  in  the  form 
of  enema,  it  is  one  of  the  most  effectual  remedies.  It  may  be  employed 
also  in  hiccough,  and  has  been  recommended,  in  combination  with  ether, 
as  one  of  the  best  remedies  in  biliary  calculi.  But  experience  has  not 
proved  its  efficiency  in  the  latter  affection;  and  it  is  difficult  to  imagine 
in  what  way  it  could  prove  serviceable,  unless  possibly  sometimes  by 
relaxing  the  spasm  attending  the  passage  of  these  calculi  through  the 
ducts. 

The  external  use  of  the  oil  will  be  treated  of  under  the  rubefacients ; 
its  employment  in  affections  of  the  urinary  passages,  under  that  of  diu- 
retics; and  its  application  as  a  vermifuge,  under  the  anthelmintics. 

ADMINISTRATION.  The  dose  of  the  oil  for  the  purpose  of  a  general 
stimulant  is  five  to  twenty  drops,  repeated  every  half  hour,  hour,  or  two 
hours,  in  acute  cases,  and  three  or  four  times  a  day  in  chronic.  But  the 
dose  may  be  much  increased  if  thought  advisable.  Should  it  occasion 
strangury  or  bloody  urine,  it  should  be  suspended.  It  may  be  admin- 


CHAP.  I.]      ARTERIAL  STIMULANTS. — CARBONATE  OF  AMMONIA.        561 

istered  dropped  on  sugar,  or  in  the  form  of  emulsion,  made  by  suspend- 
ing it  in  water  by  means  of  gum  arabic  and  loaf  sugar;  each  tablespoonful 
of  the  emulsion  containing  a  dose  of  the  oil.  Laudanum  may  often  be 
usefully  added,  either  when  the  oil  is  disposed  to  purge,  or  when  there 
is  an  indication  for  the  checking  of  diarrhoea  at  the  time  of  its  admin- 
istration. 

Its  use  in  the  form  of  enema  will  be  treated  of  under  the  head  of  the 
cathartics. 

It  has  been  recommended  in  the  form  of  bath,  for  its  constitutional  im- 
pression, by  Dr.  T.  Smith  of  Cheltenham,  England,  who  employs  in  each 
bath  from  five  to  ten  fluidounces  of  the  oil,  a  fluidounce  of  the  oil  of  rose- 
mary, and  two  pounds  of  carbonate  of  soda. 

Its  external  use  in  the  form  of  a  vapour-bath  in  chronic  rheumatism 
has  already  been  noticed.  In  scabies  it  is  said  to  effect  an  immediate 
cure,  if  the  patient  sprinkle  about  a  fluidounce  of  it,  before  going  to  bed, 
upon  the  sheets  and  the  clothing  in  which  he  is  to  sleep.  (Am.  Journ. 
of  Med  Sci.,  N.  S.,  xxxiv.  232.) 

Skoda  recommends  the  inhalation  of  its  vapour  in  gangrene  of  the 
lungs. 


III.  CARBONATE  OF  AMMONIA. 
AMMONITE  CARBON  AS.  U.S.,Br. 

Preparation.  Carbonate  of  ammonia  is  prepared  by  subliming  a  mix- 
ture of  carbonate  of  lime  and  muriate  of  ammonia.  The  muriatic  acid 
and  lime,  reacting  upon  each  other,  produce  chloride  of  calcium  and 
water;  and  the  water  thus  formed  unites  with  the  carbonic  acid  and  am- 
monia to  generate  the  compound  under  consideration,  which  rises  in 
vapour,  and  is  condensed  in  a  proper  recipient.  During  the  process  a 
portion  of  ammonia  is  liberated.  The  cake  formed  by  the  condensation 
of  the  vapour  is  broken  into  lumps,  which  should  be  kept  in  a  well-stopped 
bottle. 

Composition.  This  is  not  a  neutral  carbonate,  as  its  officinal  name 
implies,  but  either  a  sesquicarbonate,  consisting  of  three  equivalents  of 
carbonic  acid,  two  of  ammonia,  and  two  of  water,  or,  as  some  chemists 
prefer  to  consider  it,  a  compound  of  one  equivalent  of  the  proper  car- 
bonate of  ammonia  and  one  of  the  bicarbonate.  When  purified  by  a 
second  sublimation,  it  is  said  to  lose  a  portion  of  carbonic  acid,  and  to 
become  the  4-5  carbonate  of  ammonia,  thus  acquiring  more  stimulating 
properties. 

Properties.  The  salt,  as  kept  in  the  shops,  is  usually  in  whitish  lumps, 
more  or  less  rectangular,  hard,  fibrous,  translucent,  of  a  characteristic 
VOL.  i. — 36  • 


562  GENERAL   STIMULANTS.  [PART  II. 

very  pungent  odour,  and  an  acrid,  alkaline,  yet  somewhat  cooling  taste, 
with  a  burning  sensation  in  the  throat,  which  renders  it  difficult  of  admin- 
istration to  persons  of  very  sensitive  fauces.  It  is  very  soluble  in  cold 
water,  and  freely  dissolved  by  proof  spirit ;  but  is  scarcely  soluble  in 
pure  alcohol.  By  heat  it  is  wholly  volatiliaed.  Exposed  to  the  air,  it 
gradually  parts  with  the  proper  carbonate  of  ammonia,  and  is  ulti- 
mately converted  into  the  bicarbonate,  becoming  at  the  same  time  quite 
white,  opaque,  and  disposed  to  crumble.  I  have  noticed  that,  after  long 
exposure,  the  resulting  substance  deliquesces,  and  ultimately  assumes 
the  liquid  form. 

The  lumps  should  always  be  translucent  when  held  up  to  the  light ; 
otherwise  they  have  undergone  more  or  less  completely  the  change  just 
referred  to.  which  is  a  deterioration,  as  the  bicarbonate  is  much  It •<- 
stimulating  than  the  officinal  salt.  A  loss  of  odour,  and  of  the  property 
of  changing  to  brown  the  yellow  colour  of  turmeric  paper  held  over  it. 
are  also  signs  of  deterioration. 

Incompatible^.  A  solution  of  carbonate  of  ammonia  is  decomposed  by 
most  acids;  by  potassa,  soda,  and  their  carbonates;  by  lime-water  and 
magnesia ;  alum  and  corrosive  sublimate ;  by  the  soluble  salts  of  lime, 
lead,  zinc,  and  iron,  excepting  the  tartrate  of  iron  and  potassa  and  tin- 
analogous  ferruginous  compounds;  and  by  most  salts  with  excess  of 
acid,  as  the  bitartrate  and  bisulphate  of  potassa. 

Effects  on  the  System.  Carbonate  of  ammonia  is  irritant  in  its  local 
action,  and  an  energetic  stimulant  to  the  system.  Taken  internally,  it 
occasions  a  sense  of  heat  in  the  stomach,  increases  the  frequency  and 
force  of  the  pulse,  and  produces  a  general  glow  through  the  system. 
Though  sometimes  causing  a  sensation  of  fulness  in  the  head,  it  has  no 
conspicuous  influence  over  the  special  cerebral  functions;  and  there  are 
few  substances  so  actively  stimulant  to  the  circulation,  with  so  little 
obvious  effect  on  the  brain.  It  appears  to  excite  more  or  less  the  gen- 
eral organic  nervous  system,  and  might  even  rank  with  the  nervous 
stimulants:  but  its  influence  on  the  circulatory  system  is  so  much  more 
decided,  and  its  best  therapeutic  uses  are  so  closely  dependent  on  this 
action,  that  I  have  concluded  to  rank  it  in  the  present  class,  with  this 
explanation  as  a  caution  to  the  learner.  Asa  diffusible  stimulant,  it  is 
remarkably  characterized  by  the  brevity  of  its  action. 

With  its  general  stimulant  influence  on  the  circulation  and  organic- 
nervous  system,  it  has  a  tendency  to  increase  the  secretions.  It  often 
produces  more  or  less  diaphoresis,  sometimes  operates  as  a  diuretic,  and 
appears  to  act  on  the  pulmonary  organs,  if  not  as  an  expectorant,  cer- 
tainly as  a  special  stimulant  of  the  respiratory  function. 

In  over-doses  it  irritates  the  stomach,  and,  if  not  discharged  by  vomit- 
ing, which  generally  happens  when  it  is  given  very  largely,  may  produce 
dangerous  inflammation  of  the  mucous  membrane,  with  severe  burning 


CHAP.  I.]     ARTERIAL   STIMULANTS. —  CARBONATE    OF    AMMONIA.       563 

pain.  It  is  probably  only  in  this  way  that  it  is  capable  of  acting  as  an 
acute  poison  in  the  human  subject;  but  Huxham  relates  a  case  in  which 
its  long-continued  use  was  followed  by  a  cachectic  state  of  system  and 
depraved  state  of  the  blood,  as  indicated  by  hemorrhage  from  the  nose, 
gums,  and  intestines,  pustular  eruptions  on  the  surface,  dropping  out  of 
the  teeth,  and  a  general  wasting  of  the  body,  with  hectic  symptoms. 
The  patient  ultimately  died  from  the  effects  of  the  poison.  These  prob- 
ably depended  mainly  upon  a  constantly  sustained  excess  of  alkalinity  of 
the  blood.  Two  drachms  and  a  half  given  to  a  dog  were  found  by  Or- 
fila  to  produce  gastric  inflammation  with  tetanic  spasms.  The  obvious 
antidote,  should  an  over-dose  be  taken,  would  be  one  of  the  mild  vegeta- 
ble acids,  as  the  acetic  in  the  form  of  vinegar,  the  citric  in  that  of  lemon 
or  lime  juice,  or  the  tartaric. 

Therapeutic  Application.  In  an  impure  form  this  salt  has  long  been 
used  in  medicine,  under  the  names  of  sal  volatile,  salt  of  hartshorn,  etc. 
It  may  often  be  very  usefully  employed.  In  consequence  of  the  energy 
and,  at  the  same  time,  brevity  of  its  stimulant  action,  it  is  admirably 
adapted  to  all  those  cases  of  sudden  depression  or  collapse,  which,  if  the 
patient  survive,  must  be  followed  by  febrile  reaction,  if  not  acute  inflamma- 
tion. The  want  of  any  special  influence  on  the  brain  adapts  it  peculiarly 
to  those  in  which  the  reaction  will  be  likely  to  be  attended  with  inflam- 
mation or  great  vascular  excitement  of  that  organ.  Instances  of  the 
kind  are  not  unfrequently  presented  in  the  cold  stage  of  febrile  diseases, 
the  collapse  of  concussion  of  the  brain,  and  the  prostration  of  any  sud- 
den shock.  Under  these  circumstances,  it  is  an  admirable  adjuvant  of 
the  hot  bath. 

In  all  fevers,  assuming  in  (heir  progress  a  low  form,  requiring  stim- 
ulation, this  is  one  of  the  first  of  the  diffusible  stimulants  which  may  be 
had  recourse  to.  In  typhus  and  enteric  fevers,  in  the  various  exanthe- 
mata assuming  a  typhoid  condition,  especially  scarlatina,  smallpox,  and 
malignant  erysipelas,  and  even  in  the  phlegmasiae  when  attended  with 
the  same  state  of  system,  it  may  often  be  used  very  advantageously,  as- 
sociated with  other  stimulants,  especially  with  wine-whey,  and  the  pre- 
parations of  Peruvian  bark.  Its  tendency  to  produce  softness  or  moist- 
ure of  the  skin,  'adds  to  its  usefulness ;  and  sometimes,  when  the  breath 
and  exhalations  from  the  patients  have  a  sour  smell,  as  they  are  apt  to 
have  in  low  fevers,  its  property  of  neutralizing  acid,  may  be  considered 
a  peculiar  recommendation. 

In  the  malignant  pustule,  carbuncle,  glanders,  metastatic  abscess,  and 
all  cases  of  purulent  infection  of  the  blood,  and  other  affections  of  a 
similar  kind,  accompanied  with  a  depressed  condition  of  the  system,  it 
may  be  used,  conjointly  with  other  stimulants,  with  hope  of  benefit. 

There  are  few  conditions  in  which  it  acts  more  happily  than  in  the 
advanced  stages  of  the  different  pectoral  inflammations,  when  the  oc- 


564  GENERAL    STIMULANTS.  [PART  II. 

currence  of  suppuration  with  a  tendency  to  prostration  calls  for  the  use 
of  stimulants.  I  have  frequently  seen  it  of  the  greatest  possible  service 
in  pneumonia  under  these  circumstances,  when  the  severe  oppression  of 
breathing,  the  cool  skin,  the  feeble  pulse,  and  the  sweats  at  night,  have 
indicated  the  probable  approach  if  not  occurrence  of  the  third  stage  of 
the  disease,  and  the  absolute  necessity  of  supporting  treatment.  I  do 
not  think  it  is  going  too  far  to  say  that  I  have  repeatedly,  in  this  con- 
dition, known  it  to  be  the  main  agent  of  safety  to  the  patient.  It  prob- 
ably operates,  under  such  circumstances,  not  only  by  a  general  stimu- 
lation of  the  circulatory  and  nervous  systems,  but  also  by  a  special 
excitation  of  the  ultimate  tissue  of  the  lungs,  concerned  in  the  respiratory 
function.  In  a  somewhat  less  degree,  it  often  proves  serviceable  in  pro- 
tracted acute  bronchitis,  with  a  suppurative  condition  of  the  mucous 
membrane.  In  chronic  bronchitis  also,  and  in  phthisis,  when  the  lungs 
are  loaded  with  pus,  and  too  feeble  to  discharge  it  effectually,  the  car- 
bonate of  ammonia  yields  much  relief  by  stimulating  the  expulsive  power. 

It  has  been  recommended  both  in  chronic  and  acute  rheumatism. 
There  is  a  condition  of  the  latter  affection  in  which  it  may  be  very  ap- 
propriately employed.  This  condition  consists  in  an  asthenic  state  of 
system,  probably  dependent  on  impoverished  blood,  in  which,  though 
there  may  be  considerable  inflammation,  it  is  apt  to  be  movable,  changing 
its  seat  from  place  to  place,  and  a  good  deal  of  nervous  irritation  mingles 
with  it,  along  with  a  frequent  but  feeble  pulse,  a  tendency  to  paleness, 
and,  perhaps,  coolness  of  the  surface,  and  sweats  during  sleep.  This  is 
altogether  different  from  the  typhoid  state  of  the  system,  with  depraved 
blood,  and  yields  more  happily  and  speedily  to  a  well-directed  stimula- 
tion. Perhaps  the  use  of  the  medicine  may  be  ascribed  in  part  to  its 
alkalinity,  which  is  indicated  sometimes  in  these  cases  by  an  excess  of 
acid  in  the  system.  In  chronic  rheumatism  the  medicine  is  usually  given 
in  connection  with  guaiacum,  in  the  form  of  tiie  ammoniated  tincture  of 
that  resin;  and  probably  acts  by  stimulating,  in  a  manner  similar  to  that 
of  oil  of  turpentine,  the  ultimate  structure  of  the  inflamed  tissue  into  a 
new  action,  which  may  supersede  the  old. 

The  medicine  has  been  recommended  in  scrofula;  but  it  exercises  no 
special  influence  over  the  diathesis,  and  only  proves  beneficial  sometimes 
in  states  of  depression  attendant  on  this  disease,  as  in  a  similar  .state  in 
any  other. 

As  an  antispasmodic  in  the  nervous  affections  it  has  received  high 
commendation.  Hysteria  and  epilepsy  are  the  particular  complaints  in 
which  it  has  been  most  praised.  In  the  former  affection  it  will  no  doubt 
often  prove  beneficial,  partly,  in  all  probability,  by  a  direct  stimulation 
of  the  nervous  centres,  but  much  more,  I  believe,  by  obviating  the  flat- 
ulence, spasmodic  pains,  and  other  disordered  sensations  in  the  stomach 
and  bowels  which  so  often  attend  and  aggravate  the  disorder.  In  epi- 


CHAP.  I.]     ARTERIAL    STIMULANTS. CARBONATE    OF    AMMONIA.       565 

lepsy,  when  entire!}'  functional,  it  may  sometimes  prove  beneficial.  Dr. 
Pereira  thought  he  had  derived  much  advantage  from  it  both  in  epilepsy 
and  hysteria,  given  in  doses  of  fifteen  or  twenty  grains  three  times  a 
day,  and  continued  steadily  for  two  or  three  weeks. 

Dr.  Barlow  recommends  carbonate  of  ammonia  in  diabetes,  in  con- 
junction with  a  diet  of  animal  food  and  the  cruciferae,  exercise,  the  warm 
bath,  and  opiates ;  but  experience  has  not  proved  it  to  possess  any  special 
influence  over  that  complaint.  (Brit,  and  For.  Med.  Rev.,  Oct.  1841.) 

Cazenave  has  found  it  useful  in  scaly  affections  of  the  skin ;  but  a 
much  more  effectual  remedy,  in  these  complaints,  is  arsenic  in  some  one 
of  its  medicinal  forms;  and  it  is  scarcely  advisable  to  postpone  the  cure 
by  using  substitutes  which  exercise  a  comparatively  feeble,  and  at  best 
uncertain  influence  over  the  disease. 

Carbonate  of  ammonia  has  been  much  commended  for  the  possession 
of  certain  antidotal  virtues.  In  the  depressed  state  of  system  resulting 
from  sedative  poisons,  such  as  tobacco,  digitalis,  and  hydrocyanic  acid, 
it  is  obviously  indicated  as  a  rapid  and  active  stimulant;  but,  in  regard 
to  hydrocyanic  acid,  it  has  been  supposed  to  have  special  powers  as  an 
antidote.  Whether  it  can  be  of  any  service  chemically  by  neutralizing 
the  poison,  is  a  matter  of  some  doubt;  but  it  should  at  least  be  employed 
as  one  of  the  most  efficient  agents,  if  not  the  most  efficient,  in  counter- 
acting its  effects. 

Either  in  this  form,  or  that  of  solution  or  spirit  of  ammonia,  the  vola- 
tile alkali  has  obtained  great  credit,  as  an  antidote  to  the  bites  of  poison- 
ous animals.  Numerous  cases  are  on  record  in  which,  applied  locally 
and  taken  internally,  it  has  been  supposed  to  prevent  the  poisonous 
effects  of  the  bites  of  serpents.  But  as  these  bites  often  produce  no  fatal 
effects  if  left  alone,  it  is  extremely  difficult  to  decide  upon  the  amount  of 
credit  which  the  supposed  antidote  may  really  merit.  The  reputation  of 
the  medicine  was  mainly  based  on  the  apparent  success  of  the  eau  de 
luce,  a  liquid  containing  ammonia  as  its  chief  ingredient,  which  was 
<ri  vcn  by  Bernard  de  Jussieu  to  a  servant  bitten  by  a  viper.  But  Fontana 
proved  that  the  lute  of  the  viper  rarely  causes  death,  and  that  its  effects 
are  in  no  degree  diminished  by  the  use  of  ammonia;  and  the  same  ob- 
servation was  extended  to  the  bites  of  venomous  insects.  Trousseau  and 
Pidoux  state  that  they  have  never  seen  the  external  or  internal  use  of 
ammonia  modify,  in  the  least  degree,  the  symptoms  of  poisoning  by  the 
bites  of  venomous  animals.  (Traite  de  Therap.,  4e  ed.,  i.  336.)  I  have 
never  had  the  opportunity  of  trying  the  remedy  in  any  serious  case  of 
.the  kind. 

Another  antidotal  application  of  ammonia  has  been  to  the  relief  of  the 
intoxicating  effects  of  alcoholic  drinks.  Over  absolute  drunkenness  it 
has  no  control  whatever;  but,  in  slight  disorder  from  this  cause,  either 
the  carbonate  of  ammonia,  or  the  alkali  itself  in  aqueous  or  spirituous 
solution,  occasionally  gives  relief. 


566  GENERAL   STIMULANTS.  [PART  II. 

The  local  effects  of  carbonate  of  ammonia  on  the  stomach  and  bowels 
are  often  advantageous.  In  excess  of  acid  with  a  languid  state  of  the 
stomach,  such  as  not  unfrequently  exists  in  dyspepsia,  in  sick-headache 
with  the  same  complication,  and  in  the  spasmodic  pain  or  other  uneasi- 
ness of  flatulence  and  atonic  gout,  it  may  be  prescribed  alone,  or  in  connec- 
tion with  tonics  and  purgatives ;  but  the  aromatic  spirit  is  usually  pre- 
ferred, under  these  circumstances,  to  the  carbonate  in  its  ordinary  form. 

The  main  contraindication  to  the  use  of  carbonate  of  ammonia,  in 
cases  which  may  seem  to  call  for  it,  is  the  existence  of  inflammation  of 
the  stomach. 

Administration.  The  dose  of  the  medicine  is  from  two  or  three  to 
twenty  grains,  repeated  every  half  hour,  hour,  or  two  hours.  From  five 
to  ten  grains  every  hour  or  two  is  the  ordinary  dose  in  low  fevers. 
Thirty  grains  or  more  will  generally  vomit.  The  medicine  may  be  given 
in  pill  or  solution;  but  the  latter  is  the  better  form;  because,  should  the 
pill  come  in  contact  with  the  mucous  coat  of  the  stomach,  it  would  be 
more  apt  to  excite  irritation.  But  the  acrimony  of  the  salt  should  be 
covered  by  mixing  it,  in  solution,  with  gum  arabic  and  loaf  sugar,  and 
the  taste  corrected  by  using  one  of  the  aromatic  waters  as  the  vehicle. 

Carbonate  of  ammonia,  broken  into  minute  fragments,  and  mingled 
with  the  volatile  oil  of  bergamot,  lavender,  or  other  aromatic,  is  put  into 
small  bottles,  and  used  as  smelling  salts.  The  ammoniacal  odour,  which 
is  rendered  agreeable  by  that  of  the  volatile  oils,  is  pungent  and  exciting ; 
and  the  preparation  is  frequently  used  by  delicate  persons  to  obviate 
unpleasant  nervousness,  and  to  relieve  faintness.  Indeed,  the  applica- 
tion of  ammoniacal  vapour  to  the  nostrils  is  one  of  the  most  efficient  of 
the  milder  methods  of  preventing  or  remedying  syncope.  For  this  pur- 
pose, either  the  carbonate  may  be  used,  or  one  of  the  liquid  preparations 
of  ammonia  to  be  mentioned  directly.  They  are  simply  held  to  the 
nostrils,  so  that  the  patient,  if  still  breathing,  may  inhale  the  vapour 
with  the  air;  and  even  without  inhalation,  a  portion  of  the  vapour  will 
enter  the  nostrils  on  the  principle  of  the  diffusion  of  gaseous  bodies ;  but 
caution  is  necessary,  especially  when  the  patient  is  insensible,  that  the 
vapour  should  not  be  too  concentrated,  nor  too  copiously  applied ;  as 
there  is  risk  of  producing  severe  inflammation  of  the  nostrils,  of  the 
larynx,  and  even  of  the  bronchial  tubes,  when  it  is  carried  into  the  lungs 
with  the  inhaled  air. 

The  salt  is  sometimes  used  externally,  mixed  with  olive  oil,  as  a  mild 
rubefacient  liniment.  A  liniment  was  directed  by  the  London  Coll- 
though  discarded  in  the  British  Pharmacopoeia,  made  l>y  mixing  a  fluid- 
ounce  of  a  saturated  solution  of  the  salt  with  three  fluidounres  of  olive 
oil.  An  imperfect  soap  was  thus  formed;  but  the  union  of  the  oil  with 
the  carbonate  is  less  perfect  than  with  the  solution  of  ammonia,  and  the 
preparation  is  consequently  less  elegant  than  the  officinal  liniment  of 
ammonia. 


CHAP.  I.]         ARTERIAL    STIMULANTS. — WATER   OF   AMMONIA.  567 

There  are  several  other  ammoniacal  preparations  which  are  more  or 
less  used  internally  for  their  stimulant  effects. 

1.  WATER    OF    AMMONIA.  — AQUA   AMMONIA.    U.  S.  —  LIQUOR 
AMMONI.E.  Br.,  U.S.  1850.  —  Solution  of  Ammonia. 

This  is  water  impregnated  with  gaseous  ammonia.  As  it  is  much 
more  used  as  an  external  irritant  than  as  a  stimulant  internally,  it  will 
be  more  particularly  treated  of  among  the  rubefacients.  Its  effects  upon 
the  system  are  essentially  the  same  as  those  of  the  carbonate  above  de- 
scribed, and  it  may  be  used  for  the  same  purposes ;  but,  as  it  would  be 
more  likely,  if  given  in  excess,  to  irritate  or  inflame  the  stomach,  the  salt 
is  generally  preferred.  As  a  stimulant  antacid,  it  is  sometimes  used  in 
heartburn,  and  in  sick-headache  dependent  on  acidity  of  stomach ;  and 
it  has  had  considerable  reputation  as  an  antidote  to  the  poison  of  ser- 
pents, being  applied  for  this  purpose  to  the  bite,  as  well  as  taken  intern- 
ally. There  is  some  reason,  however,  to  doubt  its  efficiency;  and, 
though  it  may  be  employed,  it  should  never  be  relied  on  to  the  exclusion 
of  more  efficient  measures.  When  taken  by  accident  undiluted,  or  in- 
sufficiently diluted,  it  produces  severe  inflammation  of  the  mucous  mem- 
brane of  the  mouth,  fauces,  and  stomach,  and  may  even  vesicate  or  act 
corrosively.  The  antidotes  are  the  vegetable  acids.  Much  more  caution 
is  requisite  in  applying  this  to  the  nostrils,  in  order  to  revive  fainting 
persons,  or  to  rouse  from  positive  syncope,  than  the  carbonate,  in  conse- 
quence of  the  causticity  of  the  vapour.  Several  instances  of  severe 
inflammation  of  the  air-passages  are  on  record  from  this  cause,  some  of 
which  proved  fatal.  In  one  of  the  instances,  the  vapour  of  the  ammo- 
nia was  inhaled  as  an  antidote  to  hydrocyanic  acid.  The  dose  is  from 
ten  to  thirty  drops,  which  should  be  given  in  one  or  two  fluidounces  of 
water. 

Water  of  ammonia,  much  diluted,  has  recently  been  employed  extern- 
ally, with  a  view  to  constitutional  effect,  by  Mr.  John  Grantham,  of  Kent, 
England,  with  great  apparent  advantage  in  certain  cases.  The  affections 
in  which  it  seemed  to  be  most  efficacious  were  purpura  hsemorrhagica, 
with  internal  hemorrhages  from  various  points,  and  of  a  most  serious 
character,  and  scarlatina  with  great  general  depression;  but  the  remedy 
is  probably  applicable  to  all  cases  of  low  disease  connected  with  a  mor- 
bid state  of  the  blood.  He  applies,  over  the  whole  surface  of  the  body, 
by  means  of  a  sponge,  a  mixture  of  from  one  and  a  half  to  two  fluid- 
ounces  with  two  quarts  of  water,  heated  to  120°.  (Ned.  Times  and  Gaz., 
May,  1860,  p.  521.) 

2.  SPIRIT  OF  AMMONIA.  — SPIRITUS  AMMONIA.  U,  S. 

This  is  a  solution  of  gaseous  ammonia  in  officinal  alcohol,  and  differs, 
therefore,  from  the  last-mentioned  preparation  only  in  the  menstruum. 
It  has  about  the  same  proportion  of  ammonia  as  the  watery  solution,  and 


568  GENERAL    STIMULANTS.  [PART  II. 

consequently  about  the  same  strength.  It  may  be  used  for  the  same 
purposes,  and  requires  the  same  caution.  The  dose  is  from  ten  to  thirty 
minims  in  one  or  two  fluidounces  of  water. 

3.  AROMATIC  SPIRIT  OF  AMMONIA.  — SPIRITUS  AMMONUB 
AROMATICUS.  U.  S.,  Br. 

As  now  directed  in  the  U.  S.  Pharmacopoeia,  this  is  simply  a  solution 
in  alcohol,  in  fixed  proportions,  of  carbonate  of  ammonia,  water  of  am- 
monia, and  the  volatile  oils  of  lemons,  nutmeg,  and  lavender.  The 
British  formula  differs  in  submitting  the  same  ingredients,  the  oil  of 
lavender  excepted,  to  distillation.  The  proportion  of  water  of  ammonia 
is  sufficient  to  convert  the  officinal  carbonate  used,  which  is  a  sesquicar- 
bonate,  into  the  neutral  carbonate. 

The  spirit  of  ammonia  has  an  agreeable  pungent  odour,  and  the  peculiar 
taste  of  ammonia  pleasantly  qualified  by  that  of  the  aromatic  oils.  Upon 
the  system  its  effects  are  the  same  as  those  of  the  officinal  carbonate  of 
ammonia,  and  it  may  be  employed  for  the  same  purposes.  The  use  of 
it,  however,  is  generally  confined  to  cases  in  which  its  influence  as  a 
stomachic  stimulant,  or  slight  excitant  of  the  nervous  system  is  wanted. 
Hence,  it  is  given  to  obviate  nausea  and  vomiting  in  debilitated  states 
of  the  stomach,  to  relieve  flatulence  and  flatulent  pains,  and  to  correct 
gastric  acidity,  and  the  heartburn  and  sick-headache  which  frequently 
attend  it.  Languor,  fainlness,  and  the  slight  nervous  disorder  incident 
to  hysteria  are  often  relieved  by  it;  and  it  is  occasionally  used  to  remove 
the  lighter  symptoms  of  intoxication  caused  by  alcoholic  drinks.  It  is 
a  good  addition  to  saline  cathartics  in  weak  conditions  of  the  stomach. 
The  dose  of  it  is  from  half  a  fluidrachm  to  a  fluidrachm,  in  a  wine^ 
ful  of  water. 


IV.  PHOSPHORUS.  U.S. 

Preparation.  This  is  obtained  by  first  decomposing  the  phosphate  of 
lime,  contained  in  calcined  bones,  by  means  of  dilute  sulphuric  acid,  and 
afterwards  decomposing  the  excess  of  phosphoric  acid  in  the  super- 
phosphate thus  procured,  by  heating  the  latter  with  charcoal,  which 
takes  the  oxygen  of  the  acid,  and  escapes  as  carbonic  acid,  while  the 
phosphorus  distils  over,  and  is  received  under  water,  where  it  hardens. 

Properties.  As  usually  kept  in  the  shops,  phosphorus  is  in  cylindrical 
sticks,  of  a  light-yellowish  colour,  translucent,  t:i>teless,  of  an  odour  like 
that  of  garlic,  quite  insoluble  in  water,  very  slightly  soluble  in  alcohol, 
of  which  a  fluidounce  dissolves  only  about  a  grain,*  and  considerably 

*  M.  Laharraque  supposed  that  alcohol  might  dissolve  a  grain  and  a  half  to  the 
ounce  (Diet,  dt  Ma'.  M>'/..  Mi'-rut  et  De  Lens,  v.  277]  :  and  Dr.  Holing,  of  Montgom- 
ery, Alabama,  found  that  an  ounce  would  dissolve  a  grain,  or  possibly  a  little  more. 


CHAP.  I.]  ARTERIAL   STIMULANTS. — PHOSPHORUS.  569 

more  soluble  in  ether,  chloroform,  and  the  fixed  and  volatile  oils.  In  the 
absence  of  air,  it  melts  and  is  volatilized  by  heat.  It  is  extremely  in- 
flammable, taking  fire  at  100°  Fahr.,  or  with  slight  friction  at  ordinary 
temperatures,  and  sometimes  when  held  between  the  fingers  without 
friction.  Exposed  to  the  air  at  common  temperatures,  it  undergoes  a 
slow  combustion,  emitting  white  fumes,  which  shine  like  flame  in  the 
dark.  Hence,  it  must  be  kept  under  water ;  but,  even  thus  protected, 
it  appears  to  unite  with  the  absorbed  oxygen  of  the  water,  as  it  is  as- 
serted to  impart  active  properties  to  the  liquid.  Phosphoric  acid  results 
from  its  rapid,  phosphorous  acid  from  its  slower  combustion.  To  the 
latter  it  no  doubt  owes  its  alliaceous  smell.* 

Effects  on  the  System.  Phosphorus  is  generally  admitted  to  be  irritant 
to  the  stomach,  and  powerfully  stimulant  to  the  system,  especially  to  the 
circulation.  It  is  said  also  to  stimulate  the  nervous  centres,  strongly  to 
excite  the  sexual  appetite,  and  to  promote  the  secretions,  especially  those 
of  the  skin  and  kidneys.  Its  stimulant  action  is  highly  diffusible,  oper- 
ating promptly  and  but  for  a  short  time,  so  that  to  sustain  its  effects, 
the  dose  must  be  frequently  repeated. 

When  given  in  moderate  medicinal  doses,  it  is  said  to  occasion  a  feel- 
ing of  warmth  in  the  stomach,  to  increase  the  frequency  and  fulness  of 
the  pulse  and  the  heat  of  the  skin,  to  invigorate  the  mental  functions  and 
muscular  power,  to  stimulate  the  sexual  organs  even  to  priapism  in  the 
male,  and  to  act  more  or  less  energetically  as  a  sudorific  and  diuretic. 
It  is  asserted  that  the  urine  sometimes  becomes  phosphorescent,  and  that 
a  garlic  odour  may  be  perceived  in  the  breath.  When  an  oleaginous 
solution  of  phosphorus  is  thrown  into  the  veins  of  an  animal,  the  expired 
air  becomes  luminous  in  the  dark,  showing  that  phosphorus  is  eliminated 
by  the  lungs  ;  and,  if  the  animal  be  killed  and  examined,  these  organs  are 
everywhere  congested,  and  spots  of  yellowish  hepatization  are  found 
here  and  there.  (Cl.  Bernard,  Med.  T.  and  Gaz.,  April,  1860,  p.  390.) 

Given  more  largely,  it  often  causes  burning  pain  in  the  stomach,  vom- 
iting, purging,  and  great  epigastric  tenderness;  and,  in  its  highest  degree 
of  action  upon  that  organ,  gives  rise  to  severe  inflammation,  and  some- 
times even  to  gangrene  and  perforation.  Upon  the  system  at  large  the 
poisonous  action  is  said,  after  great  excitement,  evinced  by  a  rapid  pulse, 
heat  of  skin,  headache,  giddiness,  sometimes  delirium,  pains  and  cramps 

(W.  Orleans  Med.  and  Surg.  Journ.,  x.  736.)  Dr.  Crawford,  however,  of  N.  Orleans, 
found  that  absolute  alcohol  dissolves  two  grains  to  the  fluidounce.  (Med.  Times  and 
Gaz.,  Feb.  1859,  p.  222.) 

*  It  is  an  interesting  fact,  in  relation  to  phosphorus,  that  its  slow  combustion  in 
the  air  is  entirely  prevented  when  the  air  is  impregnated  with  the  vapours  from 
tar.  The  fame  effect  is  produced  even  more  rapidly  by  several  of  the  volatile  oils, 
as  those  of  mint,  lemons,  and  turpentine,  and  by  the  vapours  of  benzine.  (Journ.  de 
Pharm.  et  de  Chim.,3e  s6r.,  xxxix.  331  and  414.) — Note  to  the  third  edition. 


570  GENERAL   STIMULANTS.  [PART  II. 

in  the  extremities,  paralysis  in  different  parts  of  the  body,  and  various 
other  symptoms,  to  be  accompanied  with  convulsions  and  insensibility 
before  death.  A  jaundiced  hue  of  the  surface  has  often  been  noticed. 
The  probability,  however,  is  that,  in  most  fatal  cases,  the  result  has  been 
attributable  to  intense  inflammation  or  disorganization  of  the  mucous 
membrane  of  the  stomach.  The  quantity  capable  of  causing  death  is 
exceedingly  variable.  Lobelstein  Lobel  asserts  that  he  has  seen  poison- 
ing produced  in  a  maniac  twenty-five  minutes  after  the  administration 
of  one-eighth  of  a  grain  in  substance  (Herat  et  de  Lens,  v.  281);  Dr. 
Christison  mentions  an  instance  of  fatal  result  from  one  grain  and  a  half: 
while  Dr.  Pereira  once  administered  sixteen  grains  to  Chabert,  famous 
as  the  fire  king,  without  any  injurious  consequences.  (Pereira,  Mat.  Mcd., 
3d  ed.,  p.  332.)  In  certain  cases  of  fatal  poisoning,  putrefaction  is  said 
to  have  been  singularly  retarded.  (Arch.  Gen.,  5e  ser.,  p.  374.) 

A  slow  poisoning  results  from  long  exposure  to  the  fumes  of  phos- 
phorus, as  in  the  manufacture  of  lucifer  matches.  The  operation  of  the 
poison  is  said  to  be  first  experienced,  occasionally  at  least,  in  toothache 
and  caries  of  the  teeth ;  but  necrosis  of  the  jaws  is  the  ultimate  and 
characteristic  effect.  This  has  been  ascribed  by  some  to  the  direct  ac- 
tion of  the  fumes  upon  the  bone  through  the  teeth ;  but  it  is  scarcely 
possible  that  an  acrid  substance  should  act  so  powerfully  from  without, 
and  yet  exhibit  no  effect  on  the  soft  parts ;  and  phosphoric  acid,  which 
has  been  conjectured  to  be  the  agent,  does  not  act  similarly  upon  those 
exposed  to  the  air  of  factories  impregnated  with  it.  Besides,  the  disease 
of  the  jaws  is  not  the  only  effect.  Sallowness  of  the  complexion,  bloated 
face,  a  dull  expression  of  the  eye,  and  gastric  derangement  have  also 
been  noticed;  and  a  case  is  on  record  in  which  copious  inhalation  of  the 
vapour  produced  various  functional  derangement,  ending  in  failure  of 
the  sexual  functions,  paralysis,  and  death  in  three  years.  (Arch.  Gen., 
Feb.  1853,  p.  219  )  The  probability  is  that  the  fumes  of  the  phospho- 
rus, consisting  either  of  phosphorous  or  hypophosphorous  acid,  enter 
the  circulation  through  the  lungs,  and  act  specifically  on  the  jaws,  as 
mercury  does  on  the  gums. 

The  fumes  of  phosphorus  are  said  to  be  locally  irritant  to  the  mucous 
membranes  of  the  eye  and  the  air  passages,  and  to  have  produced  serious 
inflammation  in  the  latter.  When  phosphorus  is  burned  in  contact  with 
the  skin,  it  sometimes  leaves  a  peculiarly  troublesome  and  obstinate 
ulceration  behind  it,  as  I  have  experienced  in  my  own  person.  Thi>  has 
been  ascribed  to  the  irritant  properties  of  the  phosphoric  acid  remaining 
in  the  wound. 

Mode  of  Operation.  Phosphorus  itself,  unchanged,  is  probably  quite 
inert  Its  entire  insolubility,  the  perfect  impunity  with  which  it  can  In- 
handled,  and  its  want  of  taste  when  quite  clean,  are  evidences  to  this 
effect.  Its  whole  influence  probably  depends  on  changes  which  it  under- 


CHAP.  I.]     ARTERIAL  STIMULANTS. — PHOSPHORUS.          571 

goes  in  the  stomach,  or  in  the  blood  after  absorption.*  In  relation  to  its 
direct  influence  on  the  gastric  mucous  membrane,  it  may  be  supposed  to 
produce  its  simple  excitant  effect  through  some  one  of  the  acids  resulting 
from  its  oxidation,  and.  when  it  is  taken  very  much  divided  in  solution, 
the  probability  is  that  it  is  mainly  the  phosphorous  acid  which  is  pro- 
duced, and  which  acts.  This  is  of  course  conjectural ;  for  we  do  not 
know  the  precise  effects  of  that  acid  when  given  in  substance.  It  may 
be  that  the  heat  evolved  by  the  slow  oxidation  of  the  phosphorus  may 
have  some  effect  in  producing  the  excitation  of  the  mucous  membrane. 
But,  in  relation  to  its  violent  and  poisonous  action  on  the  stomach,  to 
the  high  inflammation,  corrosion,  and  gangrene  which  have  sometimes 
resulted,  I  am  among  those  who  ascribe  them  to  the  active  combustion 
of  the  phosphorus.f  This  takes  fire  at  100°,  and  the  heat  of  the  stomach 
probably  is  equal  to  that  degree  or  above  it.  Atmospheric  air  is  often 
contained  in  the  organ.  These  then  are  the  two  requisites  for  combus- 
tion; and  it  is  probable,  whenever  phosphorus  is  swallowed  in  the  solid 
state,  and  comes  into  contact  with  the  air,  that  it  takes  fire.  Thus  we 
can  explain  why  it  is  that,  when  serious  accidents  have  occurred,  it  has 
generally  been  from  phosphorus  taken  undissolved.  Hence  too  the 
great  uncertainty  in  its  poisonous  effects.  It  may  be  readily  understood 
that  a  grain,  or  even  a  small  fraction  of  a  grain,  taking  fire  in  contact 
with  the  surface  of  the  stomach,  may  produce  fatal  disorganization ; 
while  sixteen  grains  may  be  swallowed  with  impunity,  if  shielded  from 
the  air,  or  if  no  air  is  present. 

The  effects  on  the  system  are  almost  certainly  the  result  of  absorption. 
That  in  one  form  or  another  the  phosphorus  enters  the  circulation,  is 
proved  by  the  alliaceous  odour  of  the  breath,  and,  as  has  been  asserted, 
of  the  blood.  It  is  probably  in  the  state  partly  of  phosphorous  acid,  and 
partly  of  phosphoric  acid,  that  it  is  taken  up.  The  odour  of  the  breath 
would  seem  to  indicate  the  former,  the  excess  of  phosphates  in  the  urine 

*  Recent  experiments  by  M.  Blondlot  prove  that  phosphorus  slowly  rises  in  va- 
pour at  104°  F.;  and  as  this  is  but  little  above  the  ordinary  interior  temperature  of 
the  body,  it  is  not  improbable  that  the  phosphorus  may  be  volatilized  in  the  stom- 
ach, and  that  it  is  really  in  the  state  of  vapour  that  it  is  absorbed.  (Journ.  de  Pharm. 
et  de  Chim.,  Nov.  1866,  p.  323.)— Note  to  the  third  edition. 

j-  Strongly  confirmatory  of  this  opinion  is  the  fact,  ascertained  by  Orfila  and  Ri- 
gaut  through  experiments  on  dog«,  that  phosphorus,  in  the  allotropic  state  de- 
nominated red  phosphorus,  is  wholly  destitute  of  poisonous  properties.  (Ann.  de 
Therap.,  1857,  p.  284.)  Now  this  variety  of  phosphorus  does  not  undergo  com- 
bustion at  ordinary  temperatures,  and  consequently  will  not  take  fire  in  the  stom- 
ach. It  is  true  that  its  want  of  poisonous  properties  may  be  ascribed  to  the  non- 
production  of  phosphorous  acid  by  its  oxidation.  But  it  has  been  ascertained  that 
it  really  does  undergo  a  slow  oxidation  at.  ordinary  temperatures.  (Jahretbericht, 
1857,  v.  46.)  Consequently  its  harmlessness  is  fairly  ascribable  to  its  incombusti- 
bility. (Note  to  Ike  second  edition.) 


572  GENERAL    STIMULANTS.  [PART  II. 

the  latter.  It  is  not  impossible  that  the  phosphorus  itself,  in  the  state 
of  solution,  or  in  that  of  vapour  (see  note,  p.  571),  is  also  absorbed;  and 
the  fact  must  be  admitted,  if  it  is  true  that  the  urine  sometimes  becomes 
phosphorescent  under  its  use.*  It  is  not  impossible  that  the  poisonous 
effects  of  the  absorbed  phosphorus  may  be  owing  to  its  combustion  in 
the  blood.  This  supposition  is  favoured  by  the  fact  that  phosphoric 
acid,  given  to  dogs  in  much  larger  doses  than  that  in  which  phosphorus 
proves  fatal,  has  evinced  no  poisonous  effect.  (T.  B.  Groves,  Fharm. 
Journ.  and  Trans.,  xvii.  510.) 

If  phosphorus  should  have  been  taken  in  dangerous  quantities,  it  should 
be  immediately  evacuated  by  an  emetic,  with  copious  draughts  of  mu- 
cilaginous drinks  to  envelop  the  poison,  and  keep  it  as  much  as  possible 
from  the  action  of  air  in  the  stomach ;  magnesia  being  at  the  same  time 
given  to  neutralize  any  acid  which  may  have  resulted  from  its  oxidation. 
Should  symptoms  of  inflammation  or  corrosion  remain  after  the  evacu- 
ation of  the  poison,  they  must  be  combated  by  the  ordinary  methods, 
such  as  leeches  followed  by  emollient  cataplasms  to  the  epigastrium, 
mucilaginous  drinks,  or  opiate  enemata;  while  one  of  the  alkaline  bicar- 
bonates  may  still  be  exhibited  to  neutralize  any  acid  that  might  remain. 
It  has  occurred  to  me  that,  should  a  piece  of  solid  phosphorus  be  swal- 
lowed, the  free  use  of  carbonic  acid  water,  with  bicarbonate  of  soda  in 
solution,  might  be  useful  until  the  poison  could  be  evacuated.  The  car- 
bonic acid  evolved  from  the  liquid  by  the  heat  of  the  stomach  would  fill 
its  cavity  with  a  gas,  which  not  only  does  not  support  combustion,  but, 
mingled  largely  with  atmospheric  air,  suppresses  the  supporting  power 
of  it  also;  while  the  alkaline  bicarbonate  would  neutralize  any  free  acid 
present,  and  still  further  increase  the  atmosphere  of  the  acid  gas.  It 
has  been  recommended  to  wash  the  burns  produced  by  inflamed  phos- 
phorus on  the  surface  with  an  alkaline  solution,  in  order  to  remove  the 
phosphoric  acid. 

Therapeutic  Application.  The  use  of  phosphorus  as  a  medicine  takes 
date  from  the  middle  of  the  last  century.  Though  now  little  employed, 
in  consequence  of  its  frequently  violent  effects,  it  has  at  different  times 
and  by  different  persons  been  used  in  a  great  number  of  diseases;  and, 
properly  guarded,  is  probably  capable  of  useful  therapeutic  application. 
Nervous  diseases,  acute  and  chronic,  as  epilepsy,  palsy,  catalepsy,  hypo- 
chondrias^, functional  apoplexy,  tetanus,  periodical  headache,  vene- 
real exhaustion,  and  amaurosis ;  intermittent  fevers;  smallpox;  vari- 

*  Though,  as  stated  in  the  text,  the  free  oxidation  of  phosphorus  in  the  stomach 
is  probably  owing  to  its  combustion,  yet  it  appears  to  be  capable  of  rajiHly  ami 
fatally  poisoning  the  system  through  absorption  also;  as  this  effect  has  resulted, 
without  any  decided  stomachic  symptoms  during  life,  or  any  evidence  of  materi.q 
derangement  of  the  mucous  membrane  of  the  stomach  after  death.  (See  Am.  Journ. 
of  tied.  Sci.,  N.  S.,  xxxv.  288.) 


CHAP.  I.]     ARTERIAL  STIMULANTS. — PHOSPHORUS.  573 

ous  other  febrile  diseases  of  a  low  or  malignant  form;  retrocedent 
eruptions;  hemorrhages;  different  forms  of  gout  and  rheumatism; 
cholera,  diarrhcea,  and  colica  pictonum;  chlorosis  and  amenorrhcea; 
sterility  and  impotence;  and  even  the  phlegmasise,  as  typhoid  pneumo- 
nia, calarrhal  croup,  chronic  pleurisy,  and  bronchitis,  have  been  enu- 
merated by  authors  among  the  diseases  in  which  phosphorus  has  been 
employed  and  recommended. 

A  sound  discretion,  however,  would  select,  from  this  list,  the  affections 
in  which  its  known  powers  might  justify  its  use.  The  collapse  which 
takes  place  in  the  early  stage  of  certain  fevers ;  great  prostration  occur- 
ring in  the  course  of  febrile  diseases  generally;  the  alarming  depression 
sometimes  attendant  upon  the  retrocession  of  scarlatina,  erysipelas,  etc.] 
in  short,  all  low  states  of  the  system  requiring  prompt  and  powerful 
stimulation,  and  in  which  ordinary  stimulants  fail ;  these  afford  the 
conditions  under  which  the  practitioner  would  be  justified  in  having  re- 
course to  this  energetic  remedy.  In  cases,  too,  of  morbid  depression  of 
the  generative  powers,  whether  in  the  male  or  female,  it  would  appear 
to  be  indicated,  through  one  of  the  best  established  of  its  physiological 
properties.  It  may,  moreover,  be  tried  in  old  and  very  obstinate  rheu- 
matic and  paralytic  cases,  when  no  discoverable  organic  lesion  renders 
any  amelioration  altogether  improbable. 

Administration.  With  proper  caution  in  its  use,  no  serious  danger 
need  be  apprehended.  In  the  first  place,  it  should  never  be  given  in  the 
solid  or  undissolved  form,  not  even  in  a  state  of  mechanical  division, 
however  minute.  It  should  be  exhibited  in  solution;  and,  happily,  its 
different  menstrua  take  up  so  small  a  portion  of  it,  that  it  is  brought 
into  contact  with  the  stomach  in  an  extremely  diluted  state,  and  the 
combustion  of  its  particles,  should  this  take  place,  could  do  little  or  no 
injury.*  In  the  second  place,  it  should  not  be  administered  when  the 

*  M.  Tavignot,  however,  who  has  used  phosphorus  very  extensively,  affirms  that 
the  pilular  form  is  preferable  for  internal  use;  being  perfectly  safe,  as  he  prepares 
the  pills,  and  much  more  acceptable  to  the  patient.  He  first  dissolves  one  deci- 
gramme (1.5  grain)  of  phosphorus  in  eight  grammes  (about  two  drachms)  of  sweet 
almond  oil,  with  the  aid  of  a  water-b:ith,  and  then  with  eight  and  a  half  grammes 
of  butter  of  cacao,  and  eighteen  grammes  of  marshmallow,  forms  a  mass,  which  he 
divides  into  one  hundred  pills.  To  a  child  from  three  to  seven  years  old  he  gives 
at  first  one,  and  then  two  pills  daily.  It  will  be  noticed,  however,  that  even  in  the 
pill  of  M.  Tavignot,  the  phosphorus  is  really  in  solution,  so  that  the  direction  in  the 
text  still  holds  good.  M.  Tavignot  affirms  that,  in  the  quantity  of  four  milligrammes 
(O.UGO  grain)  daily,  phosphorus  may  be  given  fur  months  without  the  least  dan- 
ger. He  also  uses  it  externally  in  the  form  of  a  liniment,  made  by  dissolving,  with 
the  aid  of  a  water-bath,  one  part  of  phosphorus  in  four  hundred  parts  of  sweet 
almond  oil,  and  one  hundred  parts  of  naphtha.  This  is  applied  by  friction,  and 
alterwards  by  means  of  flannels  impregnated  with  it.  He  uses  the  pills  and  the 
liniment  conjointly.  (.-i/i«.  de  Therap.,  1SGG,  p.  100.) — Note  to  the  third  edition. 


574  GENERAL   STIMULANTS.  [PART  II. 

stomach  is  quite  empty,  unless  accompanied  with  copious  nutritive  or 
enveloping  material,  which  would  secure  the  mucous  surface  against  its 
concentrated  effect. 

Very  different  opinions  have  been  advanced  as  to  the  suitable  dose. 
A  mean  between  the  extremes  would  give  one  grain  during  the  day,  in 
divided  doses,  frequently  repeated.  The  only  suitable  preparations  are 
solutions  in  ether,  chloroform,  olive  or  almond  oil,  or  some  analogous 
menstruum.  Ether  and  olive  oil  each  dissolves  about  four  grains  to  the 
fluidounce.  Objections  to  the  former  menstruum  are  the  length  of  ma- 
r-eration  necessary,  which  renders  extemporaneous  preparation  difficult, 
and  the  great  liability  to  the  loss  of  the  ether,  and  the  consequent  pre- 
cipitation of  the  phosphorus,  when  the  solution  is  kept.  The  solution  in 
oil  is  preferable,  as  it  is  made  more  speedily,  and  keeps  better.  It  is 
prepared,  according  to  the  Prussian  Pharmacopoeia,  in  which  it  is  desig- 
nated as  Oleum  Phosphoratum,  or  Phosphorated  Oil,  by  putting  twelve 
grains  of  phosphorus,  minutely  divided,  into  a  fluidounce  of  almond  oil, 
melting  the  phosphorus  by  means  of  a  water-bath,  and  then  agitating 
until  solution  seems  to  have  been  effected.  As  the  oil  really  dissolves 
but  four  grains,  the  undissolved  portion  should  be  separated  by  decanta- 
tion  or  filtration.  This  oil  should  be  phosphorescent  when  exposed  to 
the  air.  The  dose  of  it  is  from  five  to  ten  drops,  which  may  be  repeated, 
in  cases  of  urgency,  every  half  hour;  in  ordinary  cases  of  debility,  every 
hour  or  two  through  the  day.  It  should  be  given  in  emulsion  with  one 
of  the  aromatic  waters,  so  made  that  a  tablespoonful  may  contain  a 
dose  of  the  phosphorus.  Dr.  R.  M.  Glover  proposes  chloroform  as  a 
solvent.  This  dissolves  one-fourth  of  its  weight  of  phosphorus,  and  has* 
the  advantage  that  the  solution  is  not  inflammable.  (London  Lancet. 
Jan.  8,  1853,  p.  34.)  The  preparation  should  be  made  extemporane- 
ously, in  consequence  of  the  great  volatility  of  chloroform.  One  minim 
of  a  saturated  solution,  mixed  with  fifteen  minims  of  ether  and  half  a 
fluidounce  of  wine,  might  be  given,  in  acute  cases,  every  two  or  thn-i 
hours.  Dr.  Glover  also  proposes  a  solution  of  phosphorus  in  cod-liver 
oil,  containing  half  a  grain  to  the  ounce,  for  use  in  scrofula.  (See  U.  S. 
Dispensatory.) 


CHAP.  I.]  NERVOUS    STIMULANTS,  OR   ANTISPASMODICS.  575 


S    II. 
NERVOUS   STIMULANTS. 

Syn.  Anlispasmodics. 

Tins  class  of  medicines  is  characterized  by  the  property  of  stimulating 
the  nervous  system  generally,  without  specially  acting  on  the  brain. 
Most  of  them  are  also  more  or  less  stimulant  to  the  circulation,  increasing 
the  frequency  of  pulse  and  heat  of  skin,  and  often  exciting  the  secretory 
functions ;  but  these  properties  are  incidental,  and  not  essential  to  them 
as  a  class;  and  some,  as  coffee  and  tea,  are  nearly  or  quite  destitute 
of  them.  Their  peculiarity  is  simply  that  they  stimulate  the  nervous 
centres  generally  and  equably,  without  concentrating  their  force  upon 
upon  any  one  or  a  few  of  these  centres;  and  the  possession  of  this  prop- 
erty would  of  itself  be  sufficient  to  entitle  any  medicine  to  a  place  in  the 
class.  . 

It  is  this  universality  of  their  action  that  distinguishes  them  from  the 
following  class,  or  that  of  cerebral  stimulants.  As  one  of  the  nervous 
stimulants  may  superadd  to  its  own  characteristic  property  that  of  the 
arterial  stimulants,  so  may  it  also  possess  additionally  the  peculiar  influ- 
ence of  the  cerebral  stimulants,  only  that  its  own  action  would  in  that 
case  be  swallowed  up  or  overwhelmed  in  this  more  powerful  influence ; 
and  such  really  appears  to  be  the  case  with  some  of  the  nervous  stimu- 
lants. Thus,  while  assafetida,  valerian,  coffee,  tea,  etc.,  can  scarcely  be 
made  to  evince,  in  any  quantity,  or  by  any  mode  of  administration,  a 
peculiar  tendency  to  operate  on  the  cerebral  centres  beyond  others,  some 
medicines,  much  used  and  very  efficient  as  nervous  stimulants,  if  given 
more  fnvly  than  is  necessary  for  the  exertion  of  tfceir  influence  in  this 
way,  not  only  operate  on  the  brain  specially,  but  do  so  with  great 
energy;  as  is  the  case  with  ether,  camphor,  and  opium,  which,  in  small 
doses,  produce  all  the  effects  of  the  present  class.  The  only  difference 
between  these  two  sets  of  nervous  stimulants  is  that,  while  both,  in 
certain  doses,  stimulate  equably  the  general  nervous  system,  the  former 
cannot  be  made  to  operate  specially  on  the  brain,  and  the  latter  can  be 
made  so  to  act  by  simply  increasing  the  dose  ;  that  is,  in  small  doses 
they  appear  to  operate  diffusively  and  equably,  and  in  larger,  besides 
this  general  impression,  superadd  a  special  one  upon  the  brain,  which 
quite  covers,  if  it  does  not  supersede  the  first.  In  order  to  avoid  unne- 
cessary repetition,  T  shall  treat  of  these  latter  remedies  exclusively  with 


576  GENERAL   STIMULANTS.  [PART  II. 

the  cerebral  stimulants;  as  their  most  important  therapeutic  uses  wo.uld 
attach  them  to  that  class  ;  and  it  will  be  easy  to  point  out  their  appli- 
cations as  nervous  stimulants,  when  they  are  considered  individually. 
Ether,  camphor,  and  opium,  therefore,  will  be  found  among  the  medi- 
cines of  the  next  class. 

The  medicines  here  denominated  nervous  stimulants  are  generally 
called  antispasmodics  in  therapeutic  treatises,  in  consequence  of  the 
property  of  relaxing  spasm,  which  they  certainly  possess  under  favour- 
able circumstances,  in  a  very  high  degree.  But  spasm  depends  on  so 
many  causes,  and  is  associated,  as  an  effect,  with  so  many  diiferent  pa- 
thological conditions,  that  the  number  of  remedies  applicable  to  its  relief 
would  scarcely  fall  short  of  the  whole  therapeutic  catalogue.  Depend- 
ent often  upon  inflammation,  it  may  be  treated  advantageously  by  all 
the  means  which  prove  useful  in  the  latter  affection ;  that  is,  by  most  of 
the  evacuants,  revulsives,  sedatives,  and  alteratives;  in  other  instances, 
having  its  origin  in  debility,  it  will  yield  to  astringents,  tonics,  and  stim- 
ulants; and,  in  a  third  set  of  cases,  being  excited  or  sustained  by  various 
diseases  in  the  different  organs  and  functions,  it  must  be  encountered  by. 
measures  calculated  to  restore  the  affected  organ  or  function  to  health. 
Again,  this  class  of  medicines  is  by  no  means  confined,  in  its  therapeutic 
agency,  to  spasmodic,  diseases.  It  is  equally  effectual  in  numerous  other 
nervous  disorders,  to  which  more  particular  reference  will  be  made  di- 
rectly. The  nervous  stimulants  are  but  a  very  small  section  of  the  great 
host  of  antispasmodics,  while  they  are  themselves  much  more  than  mere 
antispasmodics.  The  name,  therefore,  being,  in  our  sense,  much  too 
comprehensive,  and,  in  another,  scarcely  in  a  less  degree  too  restricted, 
should  be  abandoned,  with  other  titles  of  a  similar  therapeutic  origin,  as 
the  antiphlogistics,  antiscorbutics,  antisyphilitics,  etc.,  which  it  has  been 
found  impossible  to  retain  in  any  well-considered  pharmacological  classi- 
fication. I  have  proposed  a  name  for  the  class  which  simply  expresses 
one  of  their  most  prominent  properties,  and  the  one  for  which  they  are 
most  used  in  medicine. 

1.  Effects  on  the  System. 

It  has  been  already  stated  that  most  of  these  medicines  stimulate  t he- 
circulation,  and  consequently  increase  the  temperature  of  the  surface. 
Indeed,  this  effect  is  often  more  obvious  in  health  than  their  influence 
over  the  nervous  system.  The  latter  is  so  diffusive  that  the  balance  of 
the  functions  is  little  disturbed  ;  and,  no  one  being  prominently  affected, 
there  is  no  striking  departure  from  their  healthy  condition.  Yet  some 
influence  upon  the  nervous  functions  may  almost  always  be  observed. 
A  feeling  of  cheerfulness,  a  gentle  exhilaration  of  the  spirits,  greater 
vividness  of  the  fancy  and  energy  of  intellect,  a  disposition  and  capacity 
for  increased  muscular  action,  and  some  excitement  of  the  organic  func- 


CHAP.  I.]         NERVOUS    STIMULANTS,  OR   ANTISPASMCDICS.  577 

tions,  which  are  more  or  less  under  the  influence  of  the  nervous  centres, 
and  particularly  the  function  of  secretion,  may  generally  be  noticed.  In 
great  excess,  some  of  them  produce  disordered  sensations  in  the  head,  as 
feelings  of  fulness,  vertigo,  and  headache;  but  very  rarely  do  any  of 
them,  not  belonging  also  to  cerebral  stimulants,  occasion  delirium,  intox- 
ication, or  stupor.  But  in  disease  their  effects  are  very  obvious;  the 
most  violent  apparent  disorder  of  the  nervous  functions  yielding  some- 
times promptly  to  their  influence. 

They  are  for  the  most  part  highly  diffusible,  acting  quickly,  and  soon 
ceasing  to  act.  They  differ,  however,  much  in  this  respect ;  and  some 
of  them  continue  to  operate  for  a  considerable  time. 

Most  of  them  are  either  volatile,  or  contain  a  volatile  principle,  which 
is  often  highly  odorous,  and  generally  disagreeabl}r  so  to  those  unaccus- 
tomed to  it,  though  it  is  often  rendered  tolerable  and  even  agreeable  by 
habit.  Many  persons  acquire  a  strong  relish  for  the  smell  and  taste  of 
as>tifetida  and  garlic. 

It  has  been  thought  by  some  that  the  nervous  stimulants  produce  their 
remedial  effects  exclusively,  or  nearly  so,  through  the  organ  of  smell.  I 
have  never  been  of  that  opinion.  They  will  often  operate  energetically 
when  taken  in  the  form  of  pill  so  as  to  conceal  their  smell  and  taste,  and 
not  unfrequently  will  produce  the  most  prompt  and  powerful  effects 
when  given  by  enema.  In  some  instances,  they  do  probably  act  by  an 
impression  made  on  the  nostrils,  which  is  conveyed  through  the  com- 
municating nerves  to  the  nervous  centres;  but,  in  general,  there  can  be 
no  doubt  that  it  is  through  the  alimentary  canal  that  they  affect  the 
system.  In  relation  to  some  of  the  more  odorous,  as  musk,  assafetida, 
and  garlic,  the  odour  which  they  impart  to  the  exhalation  from  the  lungs 
and  skin,  is  an  incontestable  proof  of  their  absorption ;  and  the  strong 
probability  is,  in  reference  to  all  of  them,  that  the  active  principle  enters 
the  circulation,  and  is  carried  with  the  blood  to  the  parts  upon  which  it 
is  to  operate.  When  their  volatile  principle  is  inhaled  into  the  lungs,  it 
finds  a  ready  entrance  into  the  circulation ;  and  some  of  the  class,  when 
applied  externally,  are  absorbed  with  consideraBw  facility;  as  is  cer- 
tainly the  case  with  garlic,  and  probably  with  assafetida. 


2.  Therapeutic  Application. 

- 

The  special  application  of  this  class  of  medicines  is  to  the  relief  of 
nervous  disorder.  They  are  used  in  all  affections  of  this  kind,  whether 
the  result  of  over-excitement,  or  of  depression  of  the  nervous  centres, 
provided  only  they  are  purely  functional;  that  is,  unconnected  with 
active  congestion  or  inflammation,  or  any  other  organic  disease  in  those 
centres.  This  may  at  first  sight  seem  singular ;  that  the  same  remedy 
should  prove  useful  in  morbid  excess  and  morbid  deficiency  of  action ; 
but  the  apparent  anomaly  is  not  insusceptible  of  explanation. 
VOL.  i — 37. 


578  GENERAL    STIMULANTS.  [PART  II. 

The  characteristic  effect  of  these  medicines  is  to  stimulate  the  nervous 
centres.  It  will,  therefore,  be  readily  conceded  that  they  may  prove 
serviceable  in  disease,  consisting  in  a  depressed  state  of  the  nervous 
functions.  But  how  can  they,  by  their  stimulating  power,  relieve  a 
disease,  consisting  essentially  in  an  already  morbidly  excited  condition 
of  the  parts  upon  which  they  act  ? 

To  answer  this  question,  we  must  admit,  as  a  starting  point,  that 
there  is  only  a  limited  amount  of  nervous  excitability  in  the  system;  in 
other  words,  that,  taking  the  whole  nervous  system  together,  it  is  insus- 
ceptible of  unlimited  exaltation,  and  that  there  is  a  point  beyond  which 
its  actions  cannot  be  elevated.  Again,  it  must  be  admitted  that  the 
nervous  energy  is  transferable,  like  the  blood,  from  one  part  to  another : 
that  an  over-excitement  in  one  or  more  parts  will  call  it  off  from  others  : 
and  that  in  health  there  is  a  general  tendency  to  an  equilibrium  of  dis- 
tribution. By  supposing  the  existence  of  a  nervous  fluid,  this  reasoning 
might,  perhaps,  be  rendered  somewhat  more  intelligible;  but  1  avoid 
this  advantage,  as  the  existence  of  such  a  fluid  has  not  been  proved ; 
and  the  argument  is  equally  cogent  without  it.  Admitting  the  above 
propositions,  which  I  believe  are  nothing  more  than  statements  of  facts 
susceptible  of  satisfactory  demonstration,  we  have  only  further  to  recol- 
lect, that  the  nervous  stimulants  are  characterized  by  the  universality 
and  equability  of  their  action  on  the  nervous  centres.  Suppose  now  that 
one  of  the  cerebral  centres  is  irritated  into  diseased  action,  which  ex- 
hibits itself  in  spasms  of  the  muscle  directly  connected  with  and  de- 
pendent on  that  centre.  A  nervous  stimulant  is  administered.  It  of 
course  excites  all  the  centres,  operating  on  the  one  diseased  in  the  same 
degree  as  on  the  others.  Each  becomes  the  seat  of  an  attractive  effort 
calling  to  itself  as  much  of  the  nervous  power  as  may  correspond  with 
the  degree  of  excitation  applied.  All,  therefore,  draw  with  a  united  force 
upon  the  surplus  in  that  one  centre,  in  which  there  is  supposed  to  be  a 
morbid  accumulation.  To  this  united  force  it  can  oppose  only  its  own 
attractive  force,  under  the  irritation  to  which  it  is  exposed.  If,  therefore, 
the  combined  excitat^a  applied  to  the  nervous  centres  generally,  is  not 
less  than  that  existing  in  the  one  diseased,  under  the  morbid  irritation, 
united  to  the  excitation  of  the  remedy,  which  it  shares  equally  with  the 
others,  it  must  part  with  its  surplus,  and  be  reduced  to  the  general  level, 
or  near  it  ff  the  causes  of  irritation  shall  have  ceased,  and  the  disor- 
dered centre  be  continuing  to  act  morbidly  simply  from  having  begun  to 
do  so,  the  equilibrium  can  be  entirely  restored,  and  the  disease  cured. 
If  not,  the  equilibrium  is  but  partial  or  temporary;  and  the  disease, 
though  relieved,  will  be  liable  to  return.  The  nervous  stimulants,  th> 
fore,  though  they  may  afford  much  relief,  even  during  the  continuance 
of  the  cause,  cannot  be  expected  to  effect  a  cure  until  this  shall  have 
ceased  to  act. 


CHAP.  I.]         NERVOUS    STIMULANTS,  OR   ANTISPASMODICS.  579 

In  former  times,  these  stimulants  were  said  to  prove  useful  by  equal- 
izing excitement.  This  term  conveys  succinctly  the  idea  which  I  have 
endeavoured  to  demonstrate  in  the  above  paragraph.  Our  predecessors 
could  not  but  notice  the  effect,  though  I  am  not  aware  that  they  have 
attempted  a  precise  explanation.  Their  notions  of  the  influence  of  the 
nervous  centres  were  less  definite,  probably,  than  those  now  prevailing. 

Functional  nervous  disease  may  be,  in  the  first  place,  idiopathic,  or 
self-existent,  and  alone ;  or,  secondly,  it  may  be  idiopathic,  and  asso- 
ciated with  other  diseases ;  or,  thirdly,  it  may  depend  upon  other  dis- 
i-;i<es;  and  each  of  these  conditions  has  a  bearing  upon  the  therapeutic 
application  of  this  class  of  medicines. 

1.  It  appears  to  me  beyond  dispute  that  the  nervous  centres  may  be- 
come originally  the  special  seat  of  functional  disease,  as  well  as  any 
other  part  of  the  body,  the  cause  operating  on  them  directly  through  the 
same  avenues  by  which  they  receive  impressions  in  health ;  and  the 
disease  may  exist  without  any  complication  whatever,  other  than  such 
as  may  be  induced  in  the  functions  under  the  control  of  the  centre  af- 
fected. It  is  to  disorders  of  this  kind  that  the  nervous  stimulants  are 
peculiarly  applicable.  Such  are,  in  many  instances,  the  morbid  phe- 
nomena denominated  hysterical.  There  is  here  no  other  disease  than 
that  directly  produced  by  causes-  external  or  internal,  operating  strongly 
upon  the  healthy  centres,  or  moderately  upon  centres  abnormally  excita- 
ble.  Even  during  the  continuance  of  the  cause,  the  nervous  stimulants 
will  often,  by  sustaining  an  equable  tension  of  the  nervous  force,  keep  the 
disorder  at  bay;  but,  for  a  permanent  cure,  measures  must  be  taken  to 
obviate  the  cause,  when  the  nervous  centres  are  not  in  fault,  or  to  give 
these  a  healthful  power  of  resistance  when  unduly  excitable.  When  the 
cause  has  been  removed,  and  the  disorder  continues,  as  it  often  does 
through  a  sort  of  law  of  continuity  in  the  actions  of  the  system,  the 
nervous  stimulants  will  often  remove  it  like  a  charm.  Thus  a  female 
ha*  been  thrown  into  violent  hysterical  disorder  by  some  exterior  influ- 
ence, slight  or  severe,  as  the  case  may  be,  which,  however,  no  longer 
acts ;  but  the  disorder  continues  with  little  abatement  for  hours,  perhaps 
for  days.  In  such  cases,  one  of  the  nervous  stimulants,  a  few  doses  of 
assafetida  for  example,  perhaps  even  a  single  dose,  may  put  a  speedy 
end  to  the  phenomena. 

2.  Sometimes  the  affection,  originating  as  above,  may  coexist  with 
other  diseases  originating  in  different  causes.  Inflammation  of  one  of 
the  important  organs  may  complicate  thegfiysterical  phenomena,  and 
demand  a  close  scrutiny.  The  danger  is  that,  in  the  turbulence  of  the 
nervous  phenomena,  the  more  serious  disease  may  be  overlooked.  It  will 
be  the  duty  of  the  practitioner  to  investigate  the  case  carefully,  and, 
having  made  the  diagnosis,  to  employ  the  nervous  stimulants  altogether 
in  subservience  to  the  measures  required  by  the  more  dangerous  affec- 


580  GENERAL    STIMULANTS.  [PART  II. 

tion.  To  go  on  stimulating  with  assafetida,  ether,  camphor,  etc.,  in  such 
a  case,  under  the  impression  that  it  is  merely  nervous,  might  prove  very 
detrimental,  perhaps  fatal.  Yet,  with  due  attention  to  the  coexisting 
disease,  the  nervous  stimulants  may  often  be  used  safely  in  conjunction 
with  other  remedies,  and  even  beneficially  to  the  more  serious  com- 
plaint, by  preventing  the  injurious  reaction  of  the  nervous  disorder 
upon  it. 

3.  More  frequent  than  either  of  the  preceding  categories,  is  that  in 
which  the  nervous  disorder  merely  complicates  some  other  pathological 
condition,  which  has  called  it  into  existence  and  sustains  it.  In  such 
cases,  much  injury  has  been  done  by  overlooking  the  real  disease,  and 
addressing  remedies  to  the  more  obvious  and  apparently  violent  nervous 
phenomena.  It  has  been  too  common  to  treat  them  by  the  nervous  stim- 
ulants chiefly  or  exclusively,  and  to  persevere  long  with  such  treatment 
to  the  unspeakable  injury  of  the  patient.  The  practitioner  should  be  al- 
ways on  his  guard  against  this  easy  mistake,  and  never  rest  satisfied,  in 
the  treatment  of  nervous  diseases  which  may  be  at  all  obstinate,  until 
he  has  traced  them  satisfactorily  to  their  cause.  Judicious  measures  now 
employed  will  often  put  an  end  to  an  affection,  which  may  have  been 
torturing  the  patient,  and  embarrassing  the  practitioner,  for  months,  per- 
haps for  years.  We  have  not  space  here  to  specify  the  several  morbid 
conditions  which  may  thus  give  rise  to  nervous  disorder.  The  considera- 
tion of  them  belongs  to  treatises  on  the  practice  of  medicine.  My  object 
here,  in  noticing  them,  has  been  to  complete  a  view  of  the  circumstances 
which  should  regulate  the  use  of  the  nervous  stimulants.  I  would 
merely  call  attention  to  the  stomach  and  bowels,  the  liver,  the  urinary 
organs,  and  in  women  the  uterus,  as  the  frequent  seats  of  disease  ex- 
hibiting itself  in  various  nervous  disorders ;  and  to  an  anemic  state  of 
the  blood,  as  one  of  the  most  prominent  and  efficient  causes  of  the  same 
affections.  This  impoverished  state  of  the  blood  may  act  doubly.  It 
directly  weakens  the  nervous  centres  through  the  want  of  material  for 
their  support ;  while  the  insufficiently  supplied  functions  of  the  system 
generally,  by  their  unceasing  calls  upon  the  nervous  centres  of  circula- 
tion and  respiration  to  supply  them  with  more  and  better  blood,  main- 
tain in  these  centres  a  high  degree  of  irritation,  leading  to  diversified 
nervous  disorder.  Now  the  indications,  in  all  such  cases,  is  to  address 
remedies  especially  to  the  original  disease,  and  to  employ  the  nervous 
stimulants  simply  as  adjuvants,  in  order  to  suppress  any  occasional  ex- 
cess of  nervous  derangement,  and  to  prevent  its  injurious  reaction  upon 
the  organs  or  the  system. 

In  the  use  of  this  class  of  remedies,  the  practitioner  should  also  bear 
in  mind  the  general  rule  in  relation  to  all  stimulants;  that  the  system 
becomes  habituated  to  them  by  constant  use,  and  thus,  after  a  time, 
almost  ceases  to  feel  their  influence,  unless  exhibited  in  constantly  in- 


CHAP.  I.]         NERVOUS    STIMULANTS,  OR   ANTISPASMODICS.  581 

creasing  quantity.  They  should,  therefore,  seldom  be  employed  con- 
tinuously for  any  great  length  of  time.  Hence,  in  persistent,  and  espe- 
cially incurable  organic  diseases,  the  nervous  stimulants  are  of  doubtful 
utility,  and  should  be  used  rather  to  correct  occasional  disorder,  than  to 
sustain  a  permanent  impression. 

This  class  of  medicines  is  contraindicated  in  inflammatory  and  febrile 
diseases,  when  the  state  of  the  system  is  sthenic,  and  the  blood  rich  and 
abundant.  Simple  fever,  or  even  inflammation,  does  not  always  forbid 
their  use ;  on  the  contrary,  when  the  blood  is  impaired  in  those  cases, 
and  a  tendency  to  a  low  condition  is  observable,  or  even  in  the  mere  ab- 
sence of  the  opposite  condition,  they  may  often  be  used  advantageously 
in  relieving  attendant  nervous  disorder.  They  are  especially  contrain- 
dicated, when  high  congestive  irritation,  positive  inflammation,  or  organic 
disease,  such  as  hemorrhage,  tumours,  etc.,  occupies  the  nervous  centres 
themselves. 

To  the  severest  nervous  diseases,  or  those  which  are  deeply  radicated 
in  the  cerebral  or  spinal  centres,  the  nervous  stimulants,  as  such,  are  in- 
applicable. Apoplexy,  epilepsy,  insanity,  palsy,  tetanus,  profound  coma, 
and  even  convulsions,  other  than  those  of  a  comparatively  light  char- 
acter, are  beyond  their  control.  They  may  occasionally  be  used  as  ad- 
juvants in  such  affections,  when  not  contraindicated;  but  should  not  be 
relied  on. 

Before  closing  these  general  observations,  it  will  be  proper  to  give  a 
brief  view  of  the  different  nervous  affections,  or  rather  forms  of  nervous 
disease,  in  which  this  class  of  medicines  is  employed. 

Preliminarily,  I  would  call  the  attention  of  the  reader  to  the  admitted 
fact,  that  depression  and  over- excitement  or  irritation  of  the  nervous 
centres  arc  attended,  to  a  considerable  extent,  with  the  same  phenomena. 
How  this  may  happen  I  have  endeavoured  to  explain  in  my  treatise  on 
the  Practice  of  Medicine.  The  circumstance  is  practically  of  little  im- 
portance as  concerns  the  use  of  the  present  class  of  medicines ;  for  they 
are  applicable,  as  already  explained,  to  both  these  opposite  conditions, 
except,  in  reference  to  irritation,  when  it  is  attended  with  active  con- 
gestion or  inflammation  in  the  centre  itself,  or  its  immediate  vicinity; 
but  the  view  which  the  practitioner  may  take  of  the  pathological  con- 
dition, whether  one  of  exaltation  or  depression,  will  very  much  influence 
the  coincident  treatment. 

The  nervous  conditions  or  affections  requiring  the  use  of  the  nervous 
stimulants  may  be  arranged  under  the  folltwing  heads. 

1.  Morbid  Excitability  of  the  Nervous  Centres.  This  is  a  morbid  con- 
dition, not  a  deranged  action.  The  patient  may  possess  it,  yet,  in  the 
absence  of  any  excitant  agency,  may  appear  perfectly  well.  The  con- 
dition, however,  is  on  the  brink  of  disease,  into  which  the  slightest  im- 
pulse may  precipitate  the  system.  It  is  often  the  result  of  a  luxurious 


582  GENERAL    STIMULANTS.  [PART  II. 

and  easy  life,  with  sedentary  habits,  and  a  feeble  restraint  over  the 
various  propensities,  moral,  sensual,  or  physical,  which  belong  to  our 
nature.  Some,  by  their  original  constitution,  inherited  or  accidental, 
have  a  tendency  to  it.  Such  persons  are  said  to  have  a  nervous  temper- 
ament. Women,  by  their  very  nature,  are  more  subject  to  it  than  men ; 
because,  having  a  great  additional  function  to  perform,  beyond  what  be- 
longs to  the  other  sex,  for  the  preservation  of  the  species,  they  require 
more  impressible  nervous  centres,  so  that  all  parts  of  the  double  exist- 
ence may  be  brought  into  a  due  relation,  by  a  ready  perception  of  their 
mutual  wants.  On  the  same  principle,  to  a  certain  extent,  children  are 
more  excitable  than  adults.  The  rapid  growth  of  their  systems  requires 
a  quick  impressibility  of  their  nervous  centres,  in  order  to  preserve  a 
proper  balance  of  the  functions.  Hence,  in  all  these  classes,  nervous  dis- 
eases are  more  common  than  in  others.  It  is  true,  that  the  nervous 
stimulants  have  little  effect  in  correcting  this  morbid  excitability ;  but 
they  may  be  occasionally  used  advantageously  to  guard  against  positive 
disorder,  under  circumstances  of  necessary  exposure.  The  cure  of  the 
condition  must  depend  upon  a  removal  of  its  causes,  and  the  employment 
of  measures  calculated  to  invigorate  without  exciting  the  system. 

2.  Spasmodic  Affections.  These  are  extremely  numerous,  and,  when- 
ever dependent  on  mere  depression  or  excitement,  without  active  con- 
gestion of  the  nervous  centres,  may  be  treated  advantageously  with  the 
nervous  stimulants.  These  medicines  are  equally  efficient,  whether  the 
spasm  occupies  the  voluntary  muscles,  the  involuntary,  or  those  partak- 
ing of  the  character  of  both. 

Of  the  first,  or  that  seated  in  the  voluntary  muscles,  we  have  examples 
in  subsultus  (endinum,  cramps  or  painful  spasms  of  particular  muscles, 
and  clonic  spasms  or  convulsions,  sometimes  confined  to  the  muscles  of 
one  or  a  few  parts  of  the  body,  and  sometimes  more  or  less  general.  In 
the  first  and  last  of  these  kinds  of  spasm,  the  nervous  stimulants  are 
more  efficient  than  in  the  intermediate.  This  generally  depends  on  an 
amount  of  irritation  either  in  the  nervous  centres  or  other  part,  which  is 
in  most  cases  beyond  the  reach  of  these  medicines.  For  example,  the 
spasms  of  tetanus,  the  external  cramps  of  cholera,  and  even  ordinary 
cramps  in  the  limbs,  are  little  influenced  by  the  nervous  stimulants,  given 
in  their  proper  capacity.  Such  of  them  as  have  narcotic  properties  are 
often  serviceable,  when  carried  to  the  point  of  narcotism. 

Among  the  spasmodic  affections  of  the  involuntary  muscles  are  cramps 
of  the  stomach  and  bowels,  (fill-ducts,  ureters,  and  bladder,  and  spasm 
of  the  bronchial  tubes  as  in  asthma,  of  the  cssopkagut,  and,  in  women, 
of  the  uterus  and  vagina.  There  are  none  of  these,  when  dependent  on 
mere  functional  disorder  of  the  nervous  centres,  whether  spinal  or  cere- 
bral, which  may  not  be  benefited  by  the  nervous  stimulants.  But  they 
are  often  produced  by  local  causes,  and  associated  with  inflammatory 
conditions,  which  contraindicate  the  medicines  of  this  cl 


CHAP.  I.]         NERVOUS   STIMULANTS,  OR  'ANTISPASMODICS.  583 

Of  spasm  in  the  mixed  voluntary  and  involuntary  muscles  we  have 
examples  in  the  diaphragm,  as  in  hiccough,  which  generally  yields  to 
the  nervous  stimulants,  and  in  painful  spasm  or  cramp,  which  may 
often  be  benefited  by  them,  but  often  also  requires  more  powerful  reme- 
dies; in  the  muscles  of  respiration  generally,  as  in  hooping-cough,  which 
is  much  alleviated,  but  seldom  or  never  cured  by  them ;  and  in  the 
muscles  of  the  glottis,  as  in  laryngismus  stridulus  and  catarrhal  croup, 
the  former  of  which  is  often  benefited  by  them,  the  latter  seldom. 

3.  Irregular  Movements  of  the  Voluntary  Muscles,  not  Spasmodic. 
Of  this  kind  are  general  restlessness,  jactitation,  aimless  muscular  mo- 
tions, whimsical  gesticulations,  imitative  or  suggestive  movements  but 
half  voluntary,  hysterical  laughter,  sobbings,  facial  distortions,  hur- 
ried respiration,  violent  coughing,  etc.,  all  of  which  are  often  happily 
controlled  by  these  remedies. 

4.  Disordered  Sensation.  This  is  extremely  frequent,  and  of  a  char- 
acter more  or  less  amenable  to  nervous  stimulation.     Examples  of  gen- 
eral disorder  of  this  kind  are  presented  in  malaise  or  uneasiness,  fidgeti- 
ness, weariness,  lassitude,  and  soreness;   and  of  local  disorders  an 
infinite  variety,   as   tingling,  itching,  prickling,  etc.,  in  the  skin  and 
other  parts;  neuralgic  pains,  which  may  occur  almost  anywhere;  head- 
ache, giddiness,  dizziness,  weight,  tension,  fulness,  etc.,  of  the  head; 
buzzing,  roaring,  hissing,  whizzing,  etc.,  in  the  ears;  sparkling,  flash- 
ing, perverted  colouring,  double  vision,  muscee  volitantes,  etc.,  in  the 
eyes;  false  odours  and  perverted  tastes;  feelings  of  want  of  breath, 
weight,  tightness,  oppression,  suffocation,  etc.,  in  the  chest;  constrictive 
globus  hystericus  in  the  throat :  and,  in  the  stomach,  bowels,  and  other 
abdominal  and  pelvic  viscera,  numerous  and  diversified  feelings  of  un- 
easiness, which  are  too  vague  to  be  described,  or  to  have  been  named. 

5.  Diminution  or  Loss  of  Muscular  Power  or  Sensation.     Dimness 
of  vision,  hardness  of  hearing,  loss  of  articulation,  aphonia  or  more  or 
less  complete  loss  of  voice,  paralysis  of  one  or  more  of  the  voluntary 
muscles,  incontinence  of  urine  and  feces,  constipation  ana  tympanites 
from  suspended  peristaltic  movement,  are  examples  of  nervous  disorder, 
which,  though  frequently  dependent  on  affections  quite  beyond  the  influ- 
ence of  the  nervous  stimulants,  are  sometimes  purely  functional,  and 
yield  more  or  less  to  their  influence. 

6.  Mental  Disorder.  Under  this  head  may  be  placed  depression  or 
false  elation  of  spirits,  hysterical  fancies  and  emotional  perversions, 
brief  delusions,  hypochondriasis,  hysterical  insanity,  and  the  delirium 
of  cerebral  exhaustion,  as  in  low  typhoid  fevers  and  proper  delirium 
tremens.     Obstinate  wakefulness,  untimely  drowsiness,  lethargy,  dis- 
turbed sleep,  nightmare,  uneasiness  or  whimsical  dreaming,  somnam- 
bulism, long-continued  hysterical  insensibility,  may  be  placed  in  the 
same  category. 


584  GENERAL    STIMULANTS.  [PART  II. 

7.  Derangements  of  the  Organic  Functions.  These  embrace  every 
conceivable  disorder  of  every  function,  whether  increase,  diminution,  or 
perversion,  provided  only  that  it  do  not  result  from  inflammation  or  or- 
ganic disease;  for  all  these  functions  are  more  or  less  under  the  control 
of  the  nervous  centres.  I  shall  not  pretend  to  enumerate  them ;  but  a 
brief  notice  of  a  few  of  them  may  serve  to  give  the  student  some  idea  of 
their  nature.  In  relation  to  the  lungs,  there  is  dyxpncea  and  asphyxia; 
to  the  heart,  palpitations  and  faintness,  or  positive  syncope;  to  the 
stomach,  nausea,  vomiting,  eructations,  flatulence,  loss  of  appetite,  mor- 
bid craving,  and  desire  for  strange  articles  of  food  or  medicine;  to  the 
bowels,  borborygmi,  diarrhoea,  and  constipation ;  to  the  kidneys,  exces- 
sive limpid  diuresis;  and  to  all  other  secretory  organs,  more  or  less 
perversion  of  their  office. 

Of  the  recognized  diseases  in  which  the  morbid  phenomena  above  no- 
ticed occur  most  frequently,  and  in  greatest  diversity,  and  in  which  they 
most  readily  yield,  at  least  temporarily,  to  the  nervous  stimulants,  hys- 
teria undoubtedly  stands  at  the  head.  Probably  nervous  rheumatism 
and  gout  come  next  in  order;  and  the  greater  number  of  the  phenomena 
above  mentioned  are  often  nothing  more  than  results  of  disordered  func- 
tion, arising  from  influences  which,  ordinarily  producing  the  inflamma- 
tory symptoms  of  those  diseases,  cause  only  nervous  disorder  when  they 
act  upon  feeble,  anemic,  or  nervous  individuals.  I  have  noticed,  how- 
ever, that  the  functional  disorder  in  these  affections,  though  occasionally 
much  benefited  by  this  class  of  remedies,  does  not  yield  to  them  so 
readily  as  the  analogous  affections  in  hysteria.  Chorea,  pertussis,  spas- 
modic asthma,  nervous  cough,  hypochondriasis,  and  delirium  tremens 
are  other  special  diseases  in  which  the  nervous  stimulants  are  often  in- 
dicated, but  are  generally  alone  insufficient  to  effect  a  cure.  Epilepsy 
and  neuralgia  are  sometimes  benefited  by  them,  but  very  seldom  cured. 
There  are,  indeed,  few  diseases  which  are  not  occasionally  attended,  in 
certain  stages  of  their  progress,  or  in  certain  associated  conditions  of  the 
system,  wit&  one  or  more  of  the  symptoms  enumerated,  and  in  which  the 
nervous  stimulants  are  not  sometimes  indicated. 


There  are  various  remedial  influences  which  act  upon  the  nervous  cen- 
tres in  a  manner  somewhat  analogous  to  the  nervous  stimulants,  and 
which,  not  being  properly  medicines,  must  be  considered  in  this  place. 
They  may  be  included  under  the  heads  of  the  emotional  and  the  sensa- 
tional. 


CHAP.  I.]   NERVOUS  STIMULANTS. — EMOTIONAL  INFLUENCES.    585 

1.  EMOTIONAL  INFLUENCES. 

The  excitant  emotions  may  often  be  usefully  brought  into  play,  in  de- 
pressed or  disordered  states  of  the  nervous  functions.  Hope,  confidence, 
joy,  love,  ambition,  and  other  analogous  states  of  mind,  exercise,  within 
due  bounds,  a  most  happy  influence,  overflowing,  as  it  were  from  their 
own  special  centres,  over  the  whole  cerebral  and  spinal  regions,  and 
throughout  the  sensitive  system,  diffusing  a  sort  of  physical  exhilaration, 
which  is  admirably  adapted  to  equalize  excitement,  and  raise  up  the 
morbidly  depressed  nervous  functions  to  their  healthy  level.  Their  effects 
are,  indeed,  closely  analogous,  in  several  respects,  to  that  of  the  purer 
nervous  stimulants.  They  not  only  excite  the  nervous  centres,  but, 
through  them,  increase  the  frequency  of  the  pulse,  diffuse  a  glow  over  the 
frame,  and  not  unfrequently  increase  the  various  secretions,  including 
even  the  menstrual.  These  are  ordinary  effects  of  the  class  of  medicines 
we  are  now  considering.  Another  coincidence  is  the  wakefulness  which 
they  often  occasion  in  a  state  of  health,  while  they  sometimes  produce 
sleep  by  quieting  the  nervous  disorder,  which  prevents  it  in  disease. 
Like  these  medicines,  also,  in  excess,  they  may  give  rise  to  vertigo,  head- 
ache, mental  confusion,  tremors,  etc.;  but  very  seldom,  like  the  narcotics, 
cause  positive  intoxication,  delirium,  or  stupor,  by  their  own  immediate 
action. 

The  methods  of  bringing  their  influence  to  bear  upon  a  patient  in  any 
particular  case,  and  the  precise  circumstances  under  which  they  should 
be  resorted  to,  must  be  left  to  the  sagacity  and  judgment  of  the  practi- 
tioner. But  every  one  should  bear  in  mind  their  great  efficiency,  and  be 
prepared  to  avail  himself  of  it  when  the  occasion  may  offer.  He  should 
also  bear  in  mind  one  important  rule ;  to  proportion,  namely,  the  degree 
of  the  influence  wanted  to  the  requisitions  of  the  case,  and  take  care 
that  injury  is  not  done  by  excess.  He  must  be  as  cautious  not  to  over- 
dose his  patient,  in  the  use  of  these  remedial  means,  as  in  that  of  med- 
icines. Hysteria,  hypochondriasis,  and  insanity,  are  aflwtions  upon 
which  the  medicina  mentis  may  often  be  brought  usefully  to  bear.  The 
influence  of  hope  and  confidence  in  favouring  the  action  of  other  remedies 
is  well  known.  How  often  do  neuralgic  pain  and  even  spasm  seem  to 
yield  to  means  wholly  inert,  as  to  the  metallic  tractors,  or  the  globules 
of  the  hornceopathist,  when  the  hopes  of  the  patient  are  strongly  excited, 
or  his  full  confidence  gained  in  the  efficacy  of  the  measures  used!  How 
often  do  we  see  epileptic  convulsions  postponed  for  months  in  pure  func- 
tional cases,  or  perhaps  set  aside  completely,  under  the  use  of  remedies 
from  which  the  patient  confidently  expected  relief,  though  long  experience 
may  have  satisfactorily  proved  their  utter  worthlessness!  Intermittent 
fever,  and  other  periodical  diseases,  are  often  interrupted  by  a  conviction 
inspired  into  the  patient,  by  whatever  means,  that  he  will  miss  the  ap- 


586  GENERAL   STIMULANTS.-  [PART  II. 

preaching,  or  any  particular  paroxysm.  It  is  well  known  that  successful 
love  has  often  arrested  approaching  insanity,  if  it  has  not  proved  reme- 
dial even  after  the  disease  has  been  established.  But  it  is  unnecessary 
to  multiply  instances.  I  have  no  doubt  that  the  various  excitements  of 
travel,  its  anticipations,  novelties,  surprises,  diversified  incidents,  va- 
rieties of  scene,  and  multiplied  enjoyment  of  social  pleasures  and  the 
beauties  of  nature  and  art,  contribute,  in  many  cases  of  nervous  disorder, 
more  powerfully  to  the  cure,  than  any  medicine  or  combination  of  med- 
icines which  could  be  applied. 

Under  the  same  head  may  also  be  placed  the  effects  of  surprise,  or 
other  startling  impression  upon  the  mind,  in  overcoming  neuralgic 
pains,  and  morbid  mental  or  physico-nervous  associations.  One  of  the 
most  efficient  methods  of  checking  mild  singultus  is  to  startle  the  patient 
by  a  sudden  exclamation,  or  by  a  declaration  calculated  to  produce  quick 
and  strong  emotion.  The  hysterical  female,  or  hypochondriac  male, 
will  be  roused  out  of  apparent  stupor  in  the  case  of  the  former,  or  some 
morbid  conceit  in  that  of  the  latter,  by  skilfully  contrived  plans  of  pow- 
erfully impressing  their  feelings  or  imagination.  Nervous  headaclie  is 
often  relieved  by  a  sudden  and  strong  diversion  of  the  attention,  how- 
ever effected. 

2.  SENSATIONAL  INFLUENCES. 

These  may  often  be  so  employed  as  to  become  powerful  means  in  the 
cure  of  various  functional  disorder.  They  operate  either  by  a  direct 
excitation  of  depressed  nervous  centres,  or  by  revulsively  relieving  those 
which  a're  in  a  state  of  irritation.  There  are  two  sets  of  them,  one 
acting  through  the  special  senses,  the  other  through  the  general  sen- 
sibility. 

1.  Through  the  Special  Senses.  A  sudden  impression  on  the  retina, 
as  from  a  flash  of  sunlight  in  a  dark  place,  or  of  lightning  in  the  night, 
may  sometimes  rouse  a  torpid  brain,  when  only  functionally  affected. 

Similar  mipressions  on  the  sense  of  smell  will  often  check  asphyxia; 
and  the  disagreeable  odour  of  fetid  substances  is  one  of  the  means  by 
which  they  relieve  nervous  disorder. 

A  sudden  sharp  sound  may  arrest  a  threatened  attack  of  syncope; 
and  blowing  in  the  ear  is  one  of  the  remedies  recommcnde'd  for  laryn- 
gismus  stridulus.  It  is  probable  that  music  operates  remedially,  in  part, 
by  a  moderately  stimulant  influence  on  the  auditory  centres;  although 
something  higher  than  sensation  is  here  also  concerned ;  for  sounds  ar- 
ranged melodiously,  or  in  harmony,  have  associations  with  our  mental 
constitution,  which  often  powerfully  excite  emotion,  and  thus  produce 
nervous  stimulation  by  an  additional  influence.  In  c;ilmin<r  morbid  ner- 
vous irregularity  or  excitement,  music  is  well  known  to  have  had  extra- 
ordinary influence  from  the  times  of  the  Hebrews,  when  the  harp  of 


CHAP.  I.]     NERVOUS  STIMULANTS. — SENSATIONAL  INFLUENCES.      587 

David  composed  the  mental  distemperature  of  the  Jewish  monarch.  I 
was  once  witness  to  a  striking  case  of  this  kind.  It  was  in  a  stage-coach 
full  of  passengers,  among  whom  were  two  or  three  women  who  could 
sing.  A  young  man  was  suddenly  seized  with  symptoms  of  insanity. 
After  having  attempted  to  escape  by  jumping  out  of  the  window  of  the 
vehicle,  he  was  seized  by  the  passengers,  and  compelled  to  remain.  The 
idea  took  possession  of  his  mind  that  he  was  in  the  power  of  robbers, 
who  intended  to  kill  him.  He  began  to  scream  violently  and  incessantly ; 
and  no  assurances,  nor  anything  else  that  could  be  done,  seemed  to  pacify 
him.  At  length  our  female  companions  suggested  the  effects  of  music. 
The  suggestion  was  approved,  and  they  began  to  sing  in  concert;  enter- 
taining us  with  song  after  song  with  the  greatest  zeal  and  good  nature. 
The  poor  maniac  gradually  began  to  show  the  influence  of  the  music. 
His  cries  became  less  violent,  and  by  degrees  subsided  into  complete 
calmness ;  and  before  the  strains  ceased  he  was  fast  asleep  The  music 
probably  acted  as  a  stimulant,  calming  the  perturbation,  by  bringing  the 
nervous  centres  to  a  similar  level  of  excitement,  after  which  they  fell 
into  a  state  of  exhaustion  consequent  on  the  previous  exaltation,  and 
sleep  ensued. 

There  is  no  doubt  that  an  excessively  disagreeable  taste  may  operate 
similarly  in  rousing  the  nervous  centres  of  respiration  and  circulation. 

A  strong  pressure  on  the  upper  lip  will  sometimes  enable  one  to  con- 
trol an  otherwise  irresistible  tendency  to  sneeze ;  and  a  smart  slap  on  the 
back  may  surprise  nervous  spasm  of  the  glottis  into  relaxation. 

2.  Through  the  General  Sensibility.  Smart  pain  produced  by  any 
cause  will  often  relieve  nervous  disease.  Not  unfrequently  a  restless 
patient  may  be  made  to  sleep  by  a  pair  of  blisters  to  his  extremities.  I 
knew  a  gentleman  who  was  never  free  from  morbid  hypochondriacal  sen- 
sations except  when  he  had  a  blister  drawing  upon  his  epigastrium.  The 
pain  produced  by  a  sinapism  over  the  stomach  is  probably  quite  as  effi- 
cient as  the  revulsive  effect  of  the  inflammation,  and  even  more  so,  in 
relieving  spasm  of  that  organ.  But  pain  may  be  carried  so  far  as 
to  overwhelm  instead  of  rousing  the  nervous  centres,  as  we  see  con- 
stantly in  violent  spasms  of  the  stomach,  bowels,  ureters,  etc.  As  a 
remedial  measure,  therefore,  it  must  be  used  with  discretion.  To  this 
category  belong  the  shock  produced  on  the  nervous  centres  by  cold  and 
by  electricity,  each  of  which  merits  a  brief  notice. 

Cold  as  a  Nervous  Stimulant.  Cold  operates,  in  this  capacity,  solely 
through  the  sensation  produced  by  its  contact  with  the  surface.  Though 
a  depressing  agent  in  its  direct  action  upon  the  part  with  which  it  comes 
in  contact,  it  yet  communicates  to  the  nervous  centres  an  impression, 
denominated  the  sensation  or  sense  of  cold,  which  is  really  excitant. 
This  excitant  impression  may  often  be  taken  advantage  of  therapeutically 
to  arouse  the  nervous  system  generally,  or  some  great  function,  as  the 


588  GENERAL   STIMULANTS.  [PART  II. 

circulatory  or  respiratory,  the  nervous  centres  of  which  may  be  pros- 
trated. Cold  is  applied  in  various  methods,  and  in  various  degrees  of 
intensity  for  this  purpose.  1.  One  of  the  mildest  is  by  simply  sprinkling 
cold  wafer  on  the  face,  or  dashing  it  with  a  slight  degree  of  force  by 
means  of  the  finger.  This  often  answers  an  excellent  purpose  in  obviating 
syncope  or  asphyxia,  and  will  suffice  to  arouse  a  patient  from  slight  attacks 
of  this  kind.  2.  A  stronger  method,  is  to  dash  it  upon  the  head,  back 
of  the  neck,  and  shoulders,  out  of  a  small  vessel.  This  plan  may  be 
resorted  to  in  cases  of  stupefaction  from  narcotic  poisoning,  as  by  opium 
for  example,  in  which  it  will  sometimes  temporarily  excite  the  suscepti- 
bility of  the  brain,  and  enable  it  to  feel  the  impression  of  emetic  medi- 
cines upon  the  stomach.  Vomiting  may  thus  be  induced,  which  the 
medicine  unaided  might  be  incompetent  to  effect.  In  asphyxia  from 
hydrocyanic  acid,  it  is  one  of  the  most  efficient  means  of  bringing  about 
a  return  of  respiration.  One  of  the  first  effects  of  cold,  suddenly  applied 
to  the  surface,  is  to  induce  an  involuntary  inspiratory  effort,  through  its 
excitant  influence  on  the  nervous  centre  of  respiration.  This  inspiration 
is  what  is  needed  for  the  recommencement  of  the  vital  movements.  Air 
is  inhaled,  the  blood  is  changed,  the  pulmonary  capillaries,  before  torpid, 
carry  onward  the  arterialized  fluid,  this  reaches  the  heart,  and  the  cen- 
tral organ  of  circulation,  thus  reanimated,  sends  the  life-giving  current 
everywhere  through  the  body.  If  the  poison  has  ceased  to  act,  this 
simple  measure  may  be  sufficient ;  if  not,  it  at  least  gives  the  opportu- 
nity for  the  employment  of  others  more  efficient.  So  also  in  the  asphyxia 
from  chloroform,  and  other  poisons  operating  in  a  similar  manner.  Spas- 
modic closure  of  the  glottis  in  hysteria,  epilepsy,  and  laryngismns  stridu- 
lus  may  be  relieved  in  the  same  way;  the  excitant  impression  on  the 
nervous  centre,  which  causes  the  effort  at  inspiration,  operating  so  as  to 
relax  the  spasm  which  would  impede  the  entrance  of  air.  3.  A  third  and 
still  more  energetic  method  of  applying  cold  for  the  purpose  of  a  ner- 
vous stimulant,  is  by  means  of  the  cold  shower  bath.  This  may  be 
employed,  in  cases  of  mental  torpor,  to  rouse  the  energies  of  the  brain ; 
but  care  must  always  be  taken  that  there  is  sufficient  energy  in  the  sys- 
tem to  insure  reaction  against  the  immediately  depressinir  influence  of 
the  cold  on  the  surface.  4.  A  fourth  method,  more  energetic  as  a  ner- 
vous stimulant  than  either  of  the  others,  is  cold  affusion,  or  the  pouring 
of  cold  water,  in  considerable  quantities,  from  pails,  or  other  vessels, 
held  two  or  three  feet  above  the  body.  This  was  recommended  by  Dr. 
Currie,  of  Liverpool,  in  fevers,  with  the  view  of  cutting  them  short ;  an 
object  which  is  effected  in  some  cases  of  typhus,  and  possibly  in  remit- 
tents, but  never  in  typhoid  or  enteric  fever.  The  operation  of  the  remedy 
is  partly  by  cooling  the  heat  of  the  surface ;  but  it  is  mainly  by  the 
powerful  shock  upon  the  nervous  centres,  breaking  the  morbid  associa- 
tions upon  which  the  disease  may  depend,  and  introducing  a  new  series 


CHAP.  I.]      NERVOUS  STIMULANTS. — SENSATIONAL  INFLUENCES.       589 

of  actions  which  may  subside  into  health.  But  the  measure  does  not 
always  succeed,  and  is  somewhat  hazardous  where  it  does  not ;  and  in 
general  there  are  other  and  milder  means  which  are  in  the  end  probably 
more  effectual.  But  there  is  a  condition  of  great  danger,  in  which  cold 
affusion  has  been  employed  with  much  asserted  success  ;  and  in  which, 
should  other  measures  fail,  the  practitioner  would  be  justified  in  having 
recourse  to  it.  I  allude  to  the  condition  of  collapse  sometimes  occurring 
at  the  commencement  of  malignant  febrile  diseases,  and  often  character- 
izing the  onset  of  pernicious  or  congestive  fever.  The  patient  in  this  con- 
dition, though  really  cold  both  without  and  within,  as  shown  by  the  state 
of  the  breath,  not  unfrequcntly  complains  of  burning  heat.  The  sensation 
of  the  cold  affusion  is  said  to  be  agreeable  to  him  at  first ;  and  the  mo- 
ment at  which  he  begins  to  feel  an  unpleasant  sense  of  chilliness,  is  the 
time  to  cease  with  the  application  of  cold,  and  to  apply  measures  requi- 
site for  favouring  reaction  ;  as  wiping  him  dry,  wrapping  him  up  in  blank- 
ets, etc.  The  powerful  stimulus  of  the  cold  to  the  nervous  centres  is, 
under  these  circumstances,  the  great  agent  of  restoration.  Other  affec- 
tions in  which  cold  affusion  has  been  used  are  the  collapse  of  cholera, 
asphyxia  from  carbonic  acid,  and  puerperal  convulsions.  In  the  use 
of  affusion  the  patient  should  be  stripped  naked,  and  may  either  have 
the  water  poured  upon  him  from  above  while  sitting  over  a  tub  ;  or, 
what  is  more  convenient,  he  may  be  placed  horizontally,  and  the  affusion 
be  made  from  a  pitcher  from  one  end  of  the  body  to  the  other.  5.  The 
most  energetic  method  of  applying  cold  as  a  nervous  stimulant  is  by 
immersing  a  patient  in  the  cold  bath.  Generally  speaking,  this  is  too 
powerful  for  the  object  aimed  at,  which  can  be  sufficiently  accomplished 
by  one  of  the  other  plans.  Nevertheless,  I  have  known  it  to  be  resorted 
to  in  one  case  of  apparently  almost  fatal  prostration  in  the  pernicious 
paroxysm,  with  the  supposed  effect  of  producing  reaction,  and  saving 
the  life  of  the  patient. 

The  temperature  of  the  water  for  these  purposes  may  be  from  33°  to 
60°  F.,  but  must  vary  with  the  method  of  application.  When  merely 
sprinkled  upon  the  face,  it  can  scarcely  be  too  cold.  When  dashed 
moderately  on  the  head  or  shoulders,  or  used  in  the  form  of  a  shower 
bath,  it  may  be  at  the  mean  between  the  two  extremes  mentioned. 
When  poured  from  a  height  over  the  whole  body,  or  used  in  the  form  of 
a  bath,  it  may  be  between  the  mean  and  the  highest  temperature.  The 
period  of  application  should  always  be  very  short.  It  is  the  shock  that 
is  wanted,  not  the  depressing  influence  of  the  cold.  If  it  be  continued 
too  long,  the  depressing  effect  will  reach  even  the  nervous  centres  them- 
selves, and  a  result  exactly  the  reverse  of  that  desired  will  be  obtained. 
An  instant  is  often  enough ;  and  the  application  should  seldom  be  pro- 
tracted more  than  two  or  three  minutes. 

Electricity  in  Relation  to  its  Sensational  Effect.  In  the  precise  sense 


590  GENERAL   STIMULANTS.  [PART  IT. 

iii  which  the  remedy  is  here  considered,  electricity  acts  merely  by  excit- 
ing sensation.  In  regard  to  its  influences  in  general,  it  is  a  universal 
stimulant,  and  has  been  treated  of,  along  with  heat,  under  the  general 
head  of  stimulation.  The  various  methods  of  applying  it  have  there 
been  considered.  Here  we  have  only  to  do  with  the  influence  of  its 
shock,  in  other  words,  with  the  sensation  it  excites  when  applied  so  as  to 
make  a  painful  impression  upon  the  nervous  centres,  which  painful  im- 
pression is  the  source  of  the  remedial  influence.  For  this  purpose,  it 
may  .be  applied  in  two  modes,  either  by  the  discharge  of  a  Leyden  jar, 
or  by  rapid  intermissions  of  the  current  by  means  of  the  different  coil 
machines.  The  latter  is  the  more  effective  method,  as  the  impression  is 
sustained,  and  can  be  graduated  exactly  to  the  requisitions  of  the  case. 
The  therapeutic  effect  aimed  at  by  thus  exciting  sensation,  is  to  rouse 
the  functions  from  torpor  by  the  diffusive  stimulation  which  such  an  im- 
pression produces,  when  not  overwhelmingly  violent.  It  is  not  in  the 
prostration  from  long-continued  disease,  or  that  which  often  attends  the 
progress  and  close  of  febrile  and  inflammatory  affections,  that  the  remedy 
is  indicated.  There  is  here  not  force  enough  to  sustain  the  excitement 
after  it  has  been  produced ;  and  a  continuance  of  the  measure  would  only 
further  exhaust  the  excitability.  The  cases  in  wrhich  electricity  is  appli- 
cable, upon  this  principle,  are  those  in  which  the  system  has  been  sud- 
denly prostrated  into  more  or  less  complete  insensibility  through  impres- 
sions on  the  nervous  centres,  and  in  which  the  excitability  remains 
unexhausted.  Such  are  attacks  of  syncope  or  asphyxia,  especially  after 
the  cause  has  ceased  to  act.  The  cases  of  poisoning  by  opium,  before 
referred  to  (see  page  537),  in  which  the  electro- magnetic  machine  aroused 
sensation  in  the  advanced  stage,  when  the  direct  symptoms  of  the  poison 
had  been  followed  by  great  prostration,  and  in  which  life  appeared  to  be 
saved  in  consequence,  are  examples  of  this  kind.  The  apparently  co- 
matose state  of  hysteria  is  another  condition  which  indicates  the  use  of 
the  remedy.  It  would,  probably,  moreover,  serve  an  excellent  purpose 
in  some  cases  of  malingering. 


I.  MUSK. 

MOSCHTJS.  U.  S.,  Br, 

I.  Origin.  Musk  is  the  product  of  an  animal  bearing  some  resem- 
blance to  the  deer,  usually  less  than  three  feet  high,  with  elevated 
haunches,  long  and  narrow  ears,  a  short  tail,  and  tusks  projecting  down- 
wards from  the  upper  jaw.  It  is  of  various  colours,  but  the  most  com- 
mon is  a  deep  iron-gray.  The  musk  is  contained  in  an  oval  sac,  situated 


CHAP.  I.]  NERVOUS    STIMULANTS. — MUSK.  591 

between  the  umbilicus  and  prepuce,  and  opening  outwards  by  a  small 
orifice. 

The  animal  inhabits  the  mountainous  regions  of  Central  Asia,  lying 
between  Siberia  in  the  north  and  the  Himalaya  Mountains  on  the  south, 
and  comprehending  Chinese  Tartary  and  Thibet.  It  is  solitary  and  timid, 
preferring  the  highest  and  most  inaccessible  places  among  the  mount- 
ains, and  seeking  its  food  at  night.  The  natives  catch  it  in  snares,  or 
kill  it  by  means  of  cross-bows  set  in  its  paths.  Sometimes  they  also 
shoot  it  with  guns,  or  with  the  bow  and  arrow.  After  its  death,  the  bag 
is  cut  off  and  dried. 

The  musk  of  commerce  is  brought  from  two  sources ;  from  Siberia, 
through  Russia,  and  from  China,  by. the  port  of  Canton.  The  Chinese 
variety  is  the  best,  and,  so  far  as  I  know,  is  the  only  one  imported  into 
this  country. 

The  great  value  of  musk  leads  to  its  frequent  adulteration,  and  it  sel- 
dom reaches  our  shops  quite  pure.  The  Chinese  open  the  sacs,  remove 
their  contents,  which  they  mix  with  dried  bullock's  blood  and  other  im- 
purities, and  then  reintroduce  a  portion  of  the  mixture  into  the  sac,  and 
close  the  opening  more  or  less  carefully.  Another  portion  they  inclose 
in  artificial  sacs,  made  from  the  skin  or  scrotum  of  the  animal ;  and  it  is 
•  these  latter  which  are  most  frequently  brought  to  the  United  States,  ac- 
cording to  my  own  observation.  After  importation,  the  contents  of  the 
bags  are  removed,  and,  as  we  are  informed,  undergo  another  adulteration, 
in  the  process  of  granulation,  by  which  it  is  prepared  for  the  shops. 

2.  Sensible  and  Chemical  Properties.  The  true  musk  sac  is  oval,  be- 
tween two  and  three  inches  long,  bare  on  the  side  at  which  it  was 
attached,  and  covered  on  the  other  with  coarse  hairs,  arranged  concen- 
trically about  a  small  opening.  The  sacs  commonly  imported  are  of 
about  the  same  size,  but  are  full  and  rounded  as  if  stuffed,  have  a  piece 
of  membrane  on  one  side,  and  a  portion  of  hairy  skin  on  the  other,  and 
show  clearly  where  the  two  pieces  have  been  clumsily  sewed  together. 

As  usually  kept  in  the  shops,  the  musk  is  in  irregular  grains,  soft  and 
unctuous  to  the  touch,  of  a  brown  or  reddish-brown  colour,  and  fre- 
quently mingled  with  the  short  hairs  of  the  sac,  which  appear  to  have 
been  added  to  increase  the  weight.  The  smell  is  strong,  extremely  dif- 
fusive and  permanent,  to  most  persons  very  disagreeable  in  its  greatest 
intensity,  but  usually  considered  agreeable  when  slight,  and  much  es- 
teemed in  perfumery.  So  diffusive  and  so  permanent  is  it,  that  a  small 
portion  of  musk  will  scent  the  whole  atmosphere  of  a  chamber  for  many 
days,  without  losing  any  appreciable  portion  of  its  weight ;  and  the  slight- 
est contact  with  it  will  give  an  odour  to  the  person  or  clothing,  which 
remains  for  a  considerable  time.  In  some  very  nervous  persons,  the 
smell  produces  giddiness  and  faintness;  and  it  has  been  known  to  throw 
hysterical  women  into  convulsions.  The  taste  is  bitter,  somewhat  acrid, 


592  GENERAL   STIMULANTS.  [PART  II. 

and  disagreeable.  Musk  is  inflammable.  It  imparts  its  virtues  par- 
tially to  water  and  alcohol ;  but  neither  fluid  has  been  found  to  act  satis- 
factorily as  a  menstruum  in  pharmacy.  The  active  principle  has  not 
been  isolated.  Though  musk  contains  a  considerable  proportion  of  mat- 
ter volatilizable  by  heat,  yet  it  cannot  be  deprived  of  its  odour  by  dis- 
tillation with  water. 

Murk  will  keep  for  a  long  time  unimpaired  in  a  well-closed  glass  bottle, 
in  a  dry  place.  It  should  always  have  its  own  strong  characteristic 
odour  and  taste,  a  colour  neither  very  pale  nor  blackish,  and  an  unctuous 
feel,  without  grittiness. 

3.  Effects  on  the  System.  In  medicinal  doses,  musk  produces  a  feeling 
of  warmth  in  the  stomach,  followed  by  slight  cerebral  excitement,  some 
increase  in  the  frequency  and  fulness  of  the  pulse,  and  a  warm  softness 
of  the  skin,  which  continue  for  a  short  time,  and  then  subside  without 
leaving  any  unpleasant  effect  behind.     Taken  more  largely,  it  is  said  to 
disturb  the  stomach,  and  to  occasion  a  feeling  of  weight,  giddiness,  and 
pain  in  the  head,  with  considerable  excitement  of  the  circulation,  and  a 
tendency  to  sleep.     I  have,  however,  never  noticed  this  last  effect.     In 
very  large  doses,  we  are  told  by  Jorg,  that  it  causes  trembling  of  the 
limbs,  and  sometimes  convulsions.     It  is,  then,  a  moderate  stimulant  to 
the  circulation,  and  a  powerful  stimulant  of  the  nervous  system,  though 
possessed  of  little  narcotic  power.    Trousseau  and  Pidoux  have  found  it 
somewhat  excitant  to  the  genital  organs.  (Trait,  de  Thcrap.,  4e  ed.,  ii. 
218.)     It  is  said  also  to  have  sometimes  proved  diaphoretic  and  diuretic ; 
which,  indeed,  may  be  said  of  all  the  stimulants. 

Its  odorous  principle,  which  is  probably  also  the  source  of  its  medicinal 
activity,  is  certainly  absorbed ;  as  it  was  noticed  by  Tiedemann  and 
Gmelin  in  the  blood,  and  is  often  strongly  perceptible  in  the  urine,  per- 
spiration, and  pulmonary  exhalation. 

4.  Therapeutic  Application.  Musk  was  unknown  to  the  ancients,  and 
is  said  to  have  been  introduced  into  Europe  by  the  Arabians.     It  may 
be  used  for  the  general  purposes  of  the  nervous  stimulants  already  de- 
tailed ;  and  probably  exercises  their  peculiar  influence  in  a  higher  degree 
than  any  other  of  the  class.     It  would  appear  to  be  specially  applicable 
to  cases  in  which  severe  spasm,  or  great  nervous  disturbance,  is  asso- 
ciated with  a  prostrate  circulation. 

Low  Fevers.  It  was  formerly  much  used  in  low  fevers,  with  subsultus 
tendinum,  nervous  tremors,  and  hiccough  ;  and,  so  far  as  these  nervous 
phenomena  were  concerned,  it  was  no  doubt  useful ;  but  its  stimulant 
powers  are  inadequate  to  the  demands  of  such  cases,  and  it  is  now  IktU- 
employed. 

Adynamic  Pneumonia.  M.  Recamier  has  recommended  musk  in  a 
certain  condition  which  occasionally  supervenes  upon  pneumonia,  and  is 
characterized  by  the  occurrence  of  delirium,  with  a  general  failure  of  the 


CHAP.  I.]  NERVOUS    STIMULANTS. — MUSK.  593 

vital  forces,  and  dangerous  prostration.  MM.  Trousseau  and  Pidoux 
have  tried  it,  in  similar  cases,  with  favourable  results,  and  are  disposed 
to  prize  it  highly  under  these  circumstances.  (Ibid.,  p.  223.)  The  condi- 
tion alluded  to  is  not  that  debility  which  attends  typhous  pneumonia, 
and  may  be  supposed  to  depend  on  a  depraved  state  of  the  blood. 
Neither  is  it  that  which  comes  on  after  the  occurrence  of  the  suppura- 
tive  stage  of  the  disease.  It  is  one  in  which  the  nervous  power  appears 
to  fail  at  once,  and  the  general  powers  of  the  system  to  give  way  with 
it,  as  happens  in  sudden  attacks  of  the  pernicious  state  in  our  remittent 
miasmatic  fevers.  The  last-mentioned  writers  have  found  it  to  occur  in 
pneumonia  of  the  upper  lobe  of  the  lung,  which  seems  to  be  a  preferable 
seat  of  the  disease  in  adynamic  cases.  A  few  successive  doses  of  musk 
have  been  sufficient  to  raise  the  patient  out  of  this  adynamic  state,  and 
to  remove  the  delirium,  after  which  the  disease  has  followed  a  regular 
march  towards  health. 

Pernicious  Fever.  It  has  been  stated  that  the  condition  of  pneumonia 
just  mentioned  was  analogous  to  the  pernicious  paroxysms  which  some- 
times supervene  on  miasmatic  fever,  in  which  the  prominent  symptoms 
depend  on  vast  prostration  or  disorder  of  the  nervous  power.  From  the 
experience  of  the  highly  authoritative  practitioners  above  mentioned  in 
these  pneumonic  cases,  I  would  suggest  the  use  of  musk  in  the  stage  of 
collapse  of  our  miasmatic  pernicious  or  congestive  fevers,  ia  which  the 
pathological  state  certainly  affords  a  fair  indication  for  its  use.  Though 
less  stimulant  to  the  circulation  than  some  of  the  medicines  employed  in 
this  affection,  it  is  very  powerful  in  its  influence  on  the  nervous  centres, 
which  are  probably  specially  in  fault.  It  might  be  used  in  conjunction 
with  the  other  remedies,  and  certainly,  I  think,  could  do  no  harm. 

Gouty  Spasms  in  the  Stomach.  Dr.  Cullen  speaks  in  very  strong 
terms,  from  his  own  experience,  in  favour  of  musk  in  gout  attacking 
the  stomach ;  and  there  can  be  no  doubt  of  its  efficiency  in  spasmodic 
cases  of  this  kind,  whether  retrocedent  or  original.  If  the  spasm  is 
accompanied  with  coldness  of  the  skin  and  depressed  pulse,  and  resists 
ordinary  measures,  recourse  should  always  be  had  to  musk,  which 
should  be  given  freely.  Cullen  recommends  it  in  other  cases  of  retro- 
cedent gout;  and,  whenever  the  affection  is  spasmodic,  or  purely  nerv- 
ous, and  the  same  depressed  condition  of  the  circulation  exists,  it  may 
be  employed  with  propriety;  but  it  is  contraiudicated  in  the  internal 
inflammatory  attacks  of  that  disease,  and  might  do  serious  injury. 

Painful  Spasms  of  the  Involuntary  or  Semivohtnlary  Muscles.  In 
all  cases  of  painful  spasm  of  the  muscles  of  organic  life,  as  of  the  resoph- 
agus,  stomach,  bowels,  bladder,  ureter,  and  gall-ducts,  or  of  those  con- 
jointly of  animal  and  organic  life,  as  of  the  diaphragm,  if  attended 
with  collapse  of  the  circulation,  and  especially  when  other  measures 
fail,  musk  may  be  used  as  one  of  the  most  powerful  antispasmodics  at 
VOL.  i.— 38 


594  GENERAL   STIMULANTS.  [PART  II. 

command.  But,  as  in  the  case  of  gout  in  the  stomach,  it  must  be  given 
freely. 

Infantile  Convulsions  from  Intestinal  Spasm.  The  late  Dr.  Joseph 
Parrish  employed  musk  in  this  affection  with  great  success;  and,  follow- 
ing his  practice,  I  have  found  it  extremely  useful  in  similar  cases  of  a 
very  threatening  character.  A  proper  diagnosis,  however,  is  all-import- 
ant. In  many  of  the  convulsive  affections  of  children,  with  strong 
determination  to  the  brain,  it  would  be  not  only  useless,  but  injurious. 
In  the  cases  referred  to,  the  convulsions  are  frequently  preceded  by  a 
sudden  stiffening  of  the  body,  as  if  the  child  were  in  great  pain,  and 
sometimes  by  a  quick  piercing  scream ;  and,  if  the  abdomea  be  exam- 
ined, it  will  generally  be  found  more  or  less  tympanitic.  These  convul- 
sions are  also  strongly  characterized  by  a  sudden  return  of  intelligence 
after  they  have  ceased,  instead  of  the  protracted  coma  which  is  apt  to 
follow  those  in  which  the  brain  is  actively  congested.  The  effect 
depends  on  a  sudden  impression  made  on  the  cerebral  centres  by  the 
painful  spasm  of  the  bowels;  and,  under  the  disturbance  of  these  centres, 
before  time  has  been  allowed  for  the  occurrence  of  vascular  irritation, 
the  convulsive  movements  take  place.  In  many  cases  the  convulsions 
return  frequently,  from  hour  to  hour,  or  even  at  shorter  intervals,  and 
the  life  of  the  child  is  in  imminent  danger.  The  musk  may  be  given,  in 
these  cases,  by  enema;  two  or  three  grains  being  administered  to  chil- 
dren a  year  old,  and  repeated  every  two  hours,  if  necessary. 

Hiccough.  Within  my  experience,  there  is  no  remedy  or  combination 
of  remedies  so  efficacious  in  hiccough  as  musk;  and,  were  its  only 
recommendation  the  almost  certain  command  which  it  has  over  this 
affection,  it  would  be  a  highly  valuable  medicine.  Ordinary  hiccough 
is  quite  trivial ;  but  sometimes,  whether  as  an  apparently  original  affec- 
tion, or  as  an  attendant  on  other  diseases,  it  is  extremely  obstinate  and 
troublesome,  racking  the  patient,  preventing  sleep,  and  wearing  out  the 
strength  by  its  constant  agitation.  I  have  known  it  to  continue  in  this 
way  for  a  week,  resisting  all  ordinary  measures,  and  reducing  the  patient 
almost  to  despair.  So  far  as  my  observation  has  gone,  and  it  has  been 
somewhat  extensive,  musk  has  never  failed  to  put  an  end  to  the  affec- 
tion, and  in  general  very  promptly.  The  only  instance  in  which  it  did 
not  effect  an  entire  c,nre  was  an  intermittent  attack  of  the  spasms,  occur- 
ring in  paroxysms  at  regular  intervals.  Musk  always  controlled  the 
paroxysms,  but  they  returned  at  the  stated  period,  and  were  finally 
arrested  by  quinia.  In  another  case,  of  an  extremely  obstinate  charac- 
ter, I  had  used  the  remedy  for  twenty-four  hours  without  effect;  when, 
on  examining  the  musk,  I  found  it  very  feeble.  Another  parcel  was 
sent  for  from  a  different  quarter,  and  promptly  arrested  the  affection.  It 
was  used  in  the  ordinary  dose. 

Various  Nervous  Diseases.  Musk  has  been  commended  in  hysteria, 


CHAP.  I.]  NERVOUS   STIMULANTS. — CASTOR.  595 

chorea,  epilepsy,  tetanus,  eclampsia,  mania,  and  even  hydrophobia,  and 
has  been  employed  also  in  asthma,  hooping-cough,  palpitations,  cholera, 
and  colic.  It  may  no  doubt  be  useful  in  most  of  these  affections,  under 
circumstances  calling  for  the  nervous  stimulants;  but  it  is  probably  in  no 
case  more  efficacious  than  some  other  articles  of  the  class,  might  under 
many  circumstances  prove  injurious  if  not  used  with  great  discrimina- 
tion, and  has  been  abandoned  generally  by  the  profession  after  a  fair  trial. 
I  need  not  say  that  it  is  altogether  useless  in  hydrophobia.  Its  enor- 
mously high  price  when  pure,  and  the  great  uncertainty  as  to  the  degree 
of  its  purity  as  it  is  kept  in  the  shops,  are  also  strong  objections  to  its 
use,  and  have,  no  doubt,  very  much  contributed  to  the  neglect  into  which 
it  has  fallen.  I  would,  however,  urge  its  use  upon  the  profession,  in  the 
affections  in  which  it  has  been  recommended  above;  namely,  in  obsti- 
nate hiccough,  and  the  convulsions  of  infants  from  intestinal  spasm, 
from  my  own  experience;  in  painful  spasms  of  the  involuntary  muscles 
with  collapse  of  the  system,  especially  when  gouty,  upon  the  authority 
of  Cullen,  and  general  experience;  in  the  peculiar  condition  of  pneu- 
monia referred  to,  on  the  authority  of  M.  Recamier  and  of  MM.  Trous- 
seau and  Pidoux;  and  in  the  collapse  of  the  first  stage  of  pernicious 
fever,  upon  the  ground  of  reason  and  analogy. 

Administration.  Musk  is  given  in  substance;  all  officinal  liquid  pre- 
parations of  it  having  been  generally  abandoned.  The  dose  is  from  five 
to  thirty  grains;  but  the  least  quantity  which  should  be  given  to  an 
adult,  as  the  drug  is  usually  found  in  the  shops,  is  ten  grains;  and  this 
should  always  be  increased,  if  found  to  produce  no  observable  effect  on 
the  system.  Should  the  dose  occasion  a  feeling  of  weight,  vertigo,  or 
pain  in  the  head,  it  ought  to  be  somewhat  diminished.  It  may  be  given 
in  pill,  or  emulsion ;  in  the  latter  form,  being  suspended  in  peppermint 
water  or  diluted  cinnamon  water,  by  means  of  gum  arabic  and  sugar. 
Great  care  should  be  taken  that  no  particle  should  be  spilled  when  it  is 
exhibited  ;  as  it  will  long  scent  the  apartment  disagreeably,  and  to  some 
perhaps  injuriously. 


II.  CASTOR. 

CASTOREUM.  U.  S.,  Br. 

• 

Origin.  Castor  is  a  product  of  the  beaver,  Castor  Fiber  of  natural- 
ists. In  this  animal,  in  both  sexes,  there  are  two  pairs  of  follicles  or 
small  sacs,  situated  between  the  anus  and  external  genitals,  of  which  the 
lower  and  larger  contains  the  castor.  After  death,  this  is  removed  and 
driril.  the  pair  being  still  connected  by  a  slender  cord,  which  is  their 
excretory  duct. 


596  GENERAL   STIMULANTS.  [PART  II. 

Two  varieties  of  castor  are  recognized  in  the  books,  one  collected  in 
Russia,  the  other  in  the  northwestern  parts  of  this  Continent,  distin- 
guished as  the  Russian,  and  American  or  Canadian  castor.  The  latter 
alone  is  used  in  this  country. 

Properties.  The  two  sacs  composing  the  pair  are  of  unequal  size,  the 
larger  being  usually  two  inches  or  more  in  length.  They  are  pear- 
shaped,  but  much  flattened  and  wrinkled,  brown  or  blackish  externally, 
and  internally  divided  by  a  whitish  membrane  into  cells,  which  contain 
the  castor.  This  is  softish  when  fresh,  but  hardens  with  time,  and  then, 
though  somewhat  unctuous  to  the  touch,  is  brittle,  and  exhibits  when 
broken  a  resinous  lustre.  Its  colour  is  brown  or  reddish-brown;  its 
odour  strong,  fetid,  and  peculiar ;  and  its  taste,  bitter,  acrid,  and  disa- 
greeable. It  yields  its  virtues  to  alcohol  or  ether,  but  not  to  water. 
Upon  distillation  it  yields  a  little  volatile  oil,  having  its  characteristic 
odour  and  taste,  and  upon  which  possibly  its  virtues  may  depend ;  but 
this  point  has  not  been  decided. 

Castor  deteriorates  by  time,  but  very  slowly  if  kept  in  a  cool,  dry 
place.  Exposed  to  heat  and  moisture,  it  speedily  undergoes  decompo- 
sition. 

Effects  on  the  System.  From  the  small  doses  in  which  castor  is  usually 
given  as  a  medicine,  no  observable  effect  is  experienced  unless  occasion- 
ally unpleasant  eructations.  Mr.  Alexander  states,  in  his  experimental 
essays,  that  he  took  two  drachms  of  it,  at  various  doses,  without  any 
other  effect  than  this.  Jorg  and  his  pupils  experienced  only  slight  un- 
easiness of  the  stomach,  with  disagreeable  eructations.  Thouvenal, 
however,  found  it,  in  the  quantity  of  about  half  an  ounce,  to  increase 
the  frequency  of  pulse  and  heat  of  skin,  and  to  produce  other  excitant 
effects.  If  a  stimulant,  therefore,  to  the  circulation,  it  is  a  very  mild 
one;  but  it  must  not  be  inferred  that  it  is  inert  as  a  medicine  ;  for  the 
influence  of  the  class  of  medicines  now  under  consideration  upon  the 
nervous  system  is,  in  no  degree,  measured  by  that  which  they  may  exer- 
cise upon  the  heart  and  arteries  ;  nor  is  their  remedial  power  in  nervous 
diseases  to  be  measured  by  their  apparent  effect  in  health;  so  that  the 
efficiency  of  castor  as  a  medicine  must  be  decided  solely  upon  the  ground 
of  experience.  This  would  seem  to  have  determined  in  its  favour,  if 
medical  testimony  is  io  be  admitted  as  having  any  authority ;  yet  tin- 
medicine  is  certainly  not  very  powerful. 

Therapeutic  Application.  Castor  was^hsed  by  the  ancient  Greeks,  and 
has  ever  since  held  its  place  in  the  Materia  Medica  catalogues.  It  was 
anciently  employed  chiefly  in  hysteria  and  amenorrhrea.  By  modern 
physicians  it  has  been  given  in  most  of  the  nervous  diseases,  already 
enumerated  as  affording  indications  for  the  nervous  stimulants.  At  pres- 
ent it  is  probably  most  used  to  relieve  the  disordered  nervous  phenomena 
of  low  fevers,  and  in  the  different  phases  of  hysteria,  especially  when 


CHAP.  I.]  NERVOUS    STIMULANTS. — ASSAFETIDA.  597 

associated  with  suppression  or  retention  of  the  menses.  Trousseau  and 
Pidoux  speak  in  decided  terms  of  its  utility  in  amenorrhcea,  attended 
with  painful  tympanites,  and  in  hysterical  colic,  with  paleness,  cold 
sweats,  and  sudden  prostration.  In  the  North  of  Europe  it  is  said  to  be 
used  for  promoting  labour,  and  the  expulsion  of  the  placenta.  I  can  say 
nothing  of  it  from  experience,  having  very  seldom  used  it. 

The  dose  of  ten  or  twenty  grains,  usually  mentioned  in  the  books,  is 
probably  too  small,  and  may  be  at  least  doubled.  It  may  be  given  in 
pill  or  emulsion. 

Tincture  of  Castor  (TINCTURA  CASTOREI,  U.  S ,  Br.)  is  prepared  with 
undiluted  officinal  alcohol,  and  given  in  doses  vary  ing  from  thirty  minims 
to  two  fluidrachms,  which  might  be  doubled,  should  the  quantity  of  alco- 
hol not  be  contraindicated. 

An  Ammoniated  Tincture  (TiNOTURA  CASTOREI  AMMONIATA,  Ed.) 
was  directed  by  the  Edinburgh  College,  but  has  been  omitted  by  the 
British  Pharmacopoeia.  It  was  made  with  assafetida,  castor,  and  the 
spirit  of  ammonia  of  that  College,  itself  a  very  active  stimulant.  It  was 
no  doubt  an  energetic  antispasmodic  and  stimulant;  but  owed  its  powers 
much  less  to  the  castor  than  the  other  ingredients.  It  might  be  used  in 
spasm  of  the  stomach,  and  other  nervous  affections  demanding  active 
stimulation.  The  dose  would  be  from  thirty  minims  to  two  fluidrachms. 


III.  ASSAFETIDA. 
ASSAFOSTIDA.  U.  S.,  Br. 

Origin.  Assafetida  is  a  concrete  juice,  derived  from  the  root  of  Nar- 
thex  Assafcelida,  an  umbelliferous  herb,  from  six  to  nine  feet  high,  grow- 
ing in  the  interior  mountainous  regions  of  Persia,  and  neighbouring 
countries. 

It  is  obtained  by  twisting  the  leaves  from  the  root,  digging  the  earth 
from  about  it,  then  slicing  off  the  top  of  it  transversely,  and  scraping  the 
juice  from  the  surface  as  it  exudes :  the  leaves  being  employed  to  shelter 
the  wounded  root  from  the  sun.  When  the  exudation  ceases,  another 
slice  is  removed ;  and  so  on,  till  the  root  is  exhausted. 

The  juice  thus  collected  is  allowed  to  concrete  in  the  sun,  and  is  then 
taken  to  Bushire,  whence  it  is  carried  in  vessels  to  Bombay,  and  from 
that  port  is  distributed  over  the  world. 

Properties.  Assafetida  is  in  irregular  lumps  or  masses,  often  softish 
in  the  interior  as  first  imported,  but  gradually  becoming  hard  and  brittle. 
The  colour  is  brownish  externally,  but,  upon  the  freshly  broken  surface, 
is  whitish  or  variegated,  quickly  becoming  red  on  exposure  to  the  air, 
and  ultimately  changing  to  brown.  The  lumps  are  sometimes  homo- 


598  GENERAL    STIMULANTS.  [PART  II. 

geneous  or  nearly  so;  but  usually  consist  of  smaller  portions  aggregated, 
or  of  whitish  tears  imbedded  in  a  darker  paste.  The  odour  is  strong 
and  extremely  fetid,  so  as  to  have  acquired  for  the  drug  the  name  of 
stercus  diaboli.  Yet  it  sometimes  becomes  tolerable  by  habit ;  and  it  is 
not  requisite  to  go  so  far  as  the  East  Indies  to  find  individuals  who  are 
even  fond  of  it.  The  taste  is  bitter  and  subacrid.  In  certain  parts  of 
Hindosten,  the  inhabitants  use  it  habitually  as  a  luxury ;  and  the  streets 
of  Surat  are  said  to  be  sometimes  redolent  of  the  drug.  Both  the  smell 
and  taste  are  diminished  by  drying,  and  by  age ;  and,  in  the  recent  con- 
dition of  the  juice,  the  former  is  said  to  be  intensely  offensive.  Assa- 
fetida  softens  by  heat,  but  cannot  be  quite  melted.  It  is  very  inflam- 
mable. 

In  chemical  constitution  it  is  a  gum-resin,  consisting  of  gum,  iv,-in, 
and  volatile  oil.  The  odour  is  owing  to  the  oil,  the  medical  virtues  to 
that  and  the  resin  conjointly,  and  the  gam  is  inert.  When  rubbed  with 
water,  the  gum-resin  forms  a  white  milky  emulsion;  the  resin  and  oil 
being  suspended  by  the  intervention  of  the  gum.  This  emulsion  often 
assumes  a  pinkish  hue  on  exposure.  Alcohol  dissolves  all  the  active 
matter,  forming  a  transparent  tincture,  which  becomes  turbid  on  the  ad- 
dition of  water,  in  consequence  of  the  separation  of  the  resin. 

Effects  on  the  System  Assafetida  stimulates  the  stomach  and  the  cii'- 
culatory  system  moderately,  and  the  general  nervous  system  powerfully, 
is  somewhat  expectorant  and  often  laxative,  and  is  believed  by  some  to 
have  emmenagogue  and  anthclmintic  properties.  In  moderate  medicinal 
doses,  it  produces  a  feeling  of  warmth  in  the  stomach,  somewhat  in- 
creases the  frequency  of  the  pulse  and  the  heat  of  skin,  often  more 
or  less  exhilarates  the  spirits,  and  is  said  also  to  excite  the  genital 
organs,  and  sometimes  to  bring  on  the  menstrual  flow  in  women.  When 
rather  freely  taken,  it  occasionally  produces  slight  vertigo  or  headache, 
but  never  intoxication  or  stupor.  It  not  unfrequcntly  operates  a<  a 
cathartic,  but  not  so  uniformly  as  to  deserve  to  rank  in  that  class  of 
medicines.  In  large  doses  it  disturbs  the  stomach,  and  may  even  excite 
nausea  and  vomiting;  but  these  are  rare  effects  when  that  organ  is  quite 
sound.  That  it  should  cause  offensive  eructations  is  a  necessary  result 
of  its  fetid  odour  and  carminative  properties. 

The  volatile  oil  of  assafetida  is  certainly  absorbed.  A  sufficient  proof 
of  this  is  the  fetid  odour  of  all  the  secretions  under  its  use,  of  the  breath, 
the  perspiration,  the  urine,  and,  as  has  been  asserted,  of  the  discharu-i^ 
from  ulcerated  surfaces.  As  the  oil  is  probably  the  main  active  princi- 
ple, the  drug  no  doubt  produces  its  constitutional  impression  through  the 
circulation ;  though  it  is  highly  probable  that  the  offensive  odour  may 
sometimes  also  act  favourably  on  the  cerebral  centres,  through  the  sense 
of  smell. 

Therapeutic  Applications.  Assafetida  is  a  highly  important  medicine, 


CHAP.  I.]  NERVOUS    STIMULANTS. — ASSAFETIDA.  599 

and  there  is  reason  to  apprehend  that  it  may  be  too  much  neglected  in 
consequence  of  its  extreme  offensiveness.  The  probability  is  that  it  was 
employed  by  the  ancient  Greek  physicians ;  though  some  doubt  has  been 
entertained  upon  that  point.  It  was  certainly  known  to  the  Arabians, 
and  appears  to  have  been  introduced  by  them  into  modern  Europe, 
through  the  school  of  Salernum. 

It  may  be  employed  in  almost  all  cases  of  nervous  disease  calling  for 
medicines  of  this  class,  and,  upon  the  whole,  may  be  regarded  as  the 
most  useful  of  them.  Less  powerful  than  musk  in  overcoming  obstinate 
hiccough,  in  relaxing  those  painful  spasms  of  the  involuntary  muscles 
which  have  a  deeper  source  than  mere  hysteria,  and  in  rousing  up  the 
nervous  centres  from  profound  torpor  or  prostration,  it  is  superior  to  it 
in  hysteria,  and  in  certain  other  nervous  affections  which  will  be  noticed 
immediately,  and  probably  quite  equal  in  general  efficiency. 

In  hysteria,  in  almost  all  its  forms,  assafetida  is  a  most  valuable  rem- 
edy. Even  the  convulsions  of  this  disease  will  often  yield  to  it,  or  un- 
dergo favourable  modification  under  its  use.  In  such  cases,  as  it  is 
often  impossible  for  the  patient  to  swallow,  it  should  be  exhibited  by 
enema.  In  the  same  form,  also,  it  may  be  employed  in  general  hysteri- 
cal insensibility  simulating  coma,  and  in  dysphagia  arising  from  hyster- 
ical spasm  of  the  oesophagus. 

In  the  allied  disease  of  hypochondriasis  in  males,  it  is  among  the 
remedies  which  afford  most  relief  to  the  various  nervous  disorders, 
though  it  may  be  inadequate  to  the  cure. 

In  all  convulsive  affections,  purely  functional,  that  is,  unconnected 
with  active  congestion,  inflammation,  or  other  form  of  organic  disease,  it 
may  be  used  with  reasonable  hope  of  benefit.  The  particular  form,  be- 
sides the  hysterical,  in  which  most  good  may  be  expected  from  it  is  that 
of  infantile  convulsions,  arising  from  spasm  in  the  intestinal  tube.  It 
should  be  given,  in  cases  of  this  kind,  by  enema  during  the  convulsion, 
and  by  the  mouth,  at  regular  periods,  every  hour,  two,  or  three  hours, 
in  the  interval.  Epilepsy  is  quite  beyond  its  unaided  powers;  though 
the  medicine  may  sometimes  relieve  it,  and,  in  connection  with  other 
medicines,  may  even  contribute  to  its  cure  when  purely  functional.  In 
chorea  it  is  occasionally  adequate  to  the  cure,  if  employed  in  association 
with  cathartics;  the  patient  being  kept  steadily  under  the  use  of  the 
assafetida,  while  a  purgative  is  given  every  second  or  third  day. 

Hooping-cough  is  one  of  the  complaints  in  which  assafetida  is  most 
useful.  After  the  subsidence  of  the  initial  catarrhal  symptoms,  and 
when  those  of  a  spasmodic  character  have  become  fully  established,  it 
should  be  given  regularly,  every  two  or  three  hours,  until  the  violence  of 
the  paroxysms  has  begun  to  abate.  The  child  receives  so  much  relief 
from  the  medicine,  that,  after  having  become  accustomed  to  its  taste,  he 
will  often  call  for  it,  even  by  cries,  if  too  young  to  speak.  This  I  have 
seen  repeatedly. 


»300  GENERAL   STIMULANTS.  [PART  II. 

Nervous  coughs  sometimes  occur,  which,  after  obstinately  resisting 
measures  addressed  to  them  as  catarrhal,  will  yield  at  once  to  a  few 
doses  of  assafetida.  They  are  most  frequent  in  women,  though  I  have 
seen  them  when  there  was  no  reason  to  suppose  them  hysterical,  and 
have  found  them  to  yield  as  promptly  as  if  they  had  been  merely  a 
phase  of  that  disease.  In  some  of  these  cases,  the  cough  may  be  a  form 
of  nervous  gout  or  rheumatism.  I  would  urge  upon  the  inexperienced 
practitioner  to  be  on  the  watch  for  these  cases.  When  he  encounters  a 
severe  and  harassing  cough,  which  can  be  traced  to  no  special  source, 
and  which,  he  is  satisfied,  cannot  depend  on  inflammation  of  any  part  of 
the  air-passages,  let  him  try  assafetida,  and  I  feel  quite  sure  that  he  will 
often  find  it  successful.  The  nervous  element  may  even  complicate 
ordinary  coughs,  and  give  them  an  unusual  obstinacy,  which  will  yield 
by  combining  the  use  of  assafetida  with  the  other  measures  indicated. 

The  medicine  may  be  employed  in  the  paroxysms  of  spasmodic  asthma, 
but  cannot  be  relied  on  in  that  affection.  In  complicated  cases,  how- 
ever, in  which  the  dyspnoea  is  associated  with  chronic  catarrh,  the  sys- 
tem being  feeble,  and  the  circulation  and  skin  relaxed,  it  may  be  of  much 
service  by  its  combined  expectorant  and  antispasmodic  powers. 

Laryngismus  stridulus,  or  pure  spasm  of  the  glottis  occurring  in  in- 
fants, is  said  to  have  been  beneficially  treated  with  it,  but  I  have  not 
used  it  in  that  complaint. 

I  would  particularly  call  attention  to  a  certain  condition  in  the  ad- 
vanced stage  of  pectoral  inflammation  in  infants  and  young  children, 
whether  bronchial  or  parenchymatous,  in  which  assafetida  is  an  admir- 
able remedy.  In  patients  of  this  age,  the  nervous  system  is  very  apt  to 
suffer,  whatever  may  be  the  nature  of  the  case,  if  in  any  degree  severe. 
Even  in  their  inflammations,  the  nervous  centres  seem  to  become  ex- 
hausted before  the  disease  has  run  its  course,  and  alarming  symptoms 
from  this  cause  not  unfrequently  complicate  the  case.  In  the  pectoral 
inflammations,  this  condition  may  be  readily,  and,  I  believe,  often  has 
been  fatally  overlooked.  This  is  probably  one  of  the  reasons  of  the 
great  mortality  of  infantile  bronchitis  and  pneumonia.  The  nervous  ex- 
haustion shows  itself  by  symptoms  which  may  be  readily  mistaken  for 
an  aggravation  of  the  original  affection.  The  respiration  is  much  hur- 
ried, the  ala3  nasi  visibly  expand  and  contract,  the  child  is  sometimes 
anxious  and  restless  when  not  stupid,  and  the  pulse  is  very  frequent  and 
feeble.  Under  such  circumstances,  if  the  patient  is  at  a  somewhat  ad- 
vanced period  of  the  disease,  and,  upon  application  «f  the  hand,  it  should 
be  found  that  the  ears,  tip  of  the  nose,  cheek,  or  fingers  feel  cold,  or  even 
cool,  it  may  be  taken  for  granted  that  the  system,  and  especially  the  ner- 
vous centres  of  respiration,  need  support ;  and  this  support  assafetida, 
freely  used,  and  repeated  every  hour  or  two,  will  often  yield,  to  the  vast 
relief  of  the  patient.  I  am  quite  confident  that  I  have  seen  lives  saved, 


CHAP.  I.]  NERVOUS    STIMULANTS. — AS3AFETIDA.  601 

mainly  by  this  remedy,  in  the  condition  referred  to.  While  useful  as  an 
expectorant,  it  operates,  I  believe,  chiefly  by  stimulating  the  exhausted 
nervous  centres.  My  attention  was  first  called  to  such  cases  by  my  pre- 
ceptor, the  late  Dr.  Jos.  Parrish,  and  I  have  since  had  frequent  occasion 
to  thank  him  for  the  valuable  practical  lesson. 

In  low  slates  of  fever,  assafetida  is  sometimes  useful  in  obviating  ner- 
vous symptoms,  such  as  subsullus,  general  tremors,  restlessness,  hic- 
cough, etc.;  but  it  is  not  more  efficacious  than  other  much  less  disagree- 
able remedies,  and  is,  therefore,  little  used.  In  the  tympanites,  however, 
of  these  complaints,  given  as  an  injection,  it  is  a  valuable  remedy,  sec- 
ond only  to  the  oil  of  turpentine  in  efficiency. 

In  constipation  with  flatulence  in  old  people  or  hysterical  women,  and 
in  the  colicky  affections  of  the  latter  class,  assafetida  may  often  be  ad- 
vantageously combined  with  laxatives,  such  as  aloes  and  rhubarb.  If 
amenorrhcea  be  superadded,  myrrh  may  be  combined  with  the  other  in- 
gredients; and,  if  anaemia,  one  of  the  preparations  of  iron. 

The  laxative  properties  of  the  gum-resin  often  add  to  its  advantages 
as  a  nervous  stimulant;  but  sometimes  it  is  necessary  to  counteract  them 
with  a  little  laudanum. 

Of  the  special  uses  of  this  gum-resin  as  a  stimulating  expectorant 
there  will  be  occasion  to  treat  hereafter. 

Assafetida  is  contraindicated  in  acute  inflammation,  and  in  fever  with 
hot  skin,  and  a  full,  strong  pulse;  and  especially  so  when  the  nervous 
centres  themselves  are  the  seat  of  high  vascular  irritation,  inflammation, 
or  organic  disease,  even  though  convulsions,  spasm,  or  other  nervous 
disorder  should  appear  to  indicate  the  use  of  this  class  of  medicines. 

Administration.  The  dose  of  assafetida  is  from  five  to  twenty  grains. 
More,  however,  might  sometimes  be  given  with  safety  and  probable  ad- 
vantage. It  should  generally  be  administered  in  pill  or  emulsion ;  the 
former  being  preferable  whenever  the  latter  form  is  not  specially  called 
for,  in  consequence  of  the  opportunity  it  affords  of  concealing  the  taste 
and  smell.  The  emulsion,  however,  is  always  preferable  when  a  prompt 
effect  is  desirable  ;  and  this  is  most  frequently  the  case.  It  may  be  made 
by  simply  rubbing  the  gum-resin  thoroughly  with  water,  and  straining. 

The  emulsion  is  directed,  in  the  U.  S.  Pharmacopoeia,  under  the  name 
of  Assafetida  Mixture  (MISTURA  ASSAFCETID.E).  It  is  the  milk  of  assa- 
fetida or  lac  assafcetidae  of  the  older  pharmacy.  A  fluidounce  contains 
fifteen  grains,  and  one  or  two  tablespoonfuls  may  be  given  for  a  dose. 

As  an  enema,  assafetida  is  administered  in  the  form  of  emulsion;  and 
from  half  a  drachm  to  two  drachms  may  be  used  in  half  a  pint  of  water. 

The  Tincture  of  Assafetida  (TINCTURA  ASSAFCETID^;,  U.  S.,  Br.)  may 
be  given  in  cases  where  a  prompt  effect  is  required,  and  there  is  no  ob- 
jection to  the  alcohol.  Officinal  or  undiluted  alcohol  is  used  in  its  pre- 
paration. The  medium  dose  is  a  fluidrachm.  It  should  be  diluted  with 
water,  which  becomes  milky  by  the  separation  of  the  resiu. 


602  GENERAL    STIMULANTS.  [PART  II. 

Pills  of  Aloes  and  Assafetida  (PILUL^E  ALOES  ET  ASSAFCETIDJE,  U.  S., 
Br.)  are  officinal.  They  contain  equal  quantities  of  aloes  and  assafetida 
mixed  with  soap,  and  are  given  in  torpid  bowels  with  flatulence  and  de- 
bility of  the  alimentary  canal.  From  two  to  five  of  the  pills,  each  con- 
taining four  grains,  may  be  given  for  a  dose. 

A.  Plaster  of  Assafetida  (EMPLASTRUM  ASSAFOSTID^E,  U.S.)  is  also 
officinal.  It  is  used  as  an  application  to  the  chest,  or  between  the  shoul- 
ders, in  hooping-cough,  and  over  the  abdomen  in  the  flatulent  colics  of 
hysteria. 


Several  other  gum-resins,  having  properties  analogous  to  those  of  as- 
safetida, though  much  inferior,  have  been  more  or  less  in  use  from  the 
times  of  the  ancient  Greeks  and  Romans.  At  present,  however,  they 
are  much  less  employed  than  formerly.  A  very  brief  notice  of  them 
will  be  sufficient ;  as  there  is  not  one  of  them  which  might  not  very 
well  be  dispensed  with,  in  reference  merely  to  its  powers  as  a  nervous 
stimulant.  The  medicines  alluded  to  are  sagapenum,  galbanum,  and 
ammoniac. 

1.  SAGAPENTTM.  Lond. 

Though  recognized  in  the  late  London  Pharmacopeia,  this  is  no 
longer  officinal,  having  been  discarded  in  the  British.  It  is  the  concrete 
juice  of  an  unknown  Persian  plant,  supposed  to  be  umbelliferous;  and 
is  imported  from  the  Levant.  As  brought  to  us,  it  is  either  in  irregular 
masses  of  agglutinated  tears,  translucent,  and  of  a  wax-like  consistence, 
or  in  soft  adhesive  masses,  in  which  no  tears  are  visible.  It  has  a 
brownish-yellow,  reddish-yellow,  or  olive  colour,  paler  within  than  with- 
out, and  becoming  darker  by  time.  The  odour  is  alliaceous,  but  weaker 
and  less  disagreeable  than  that  of  assafetida;  the  taste,  bitterish,  some- 
what acrid,  and  nauseous.  It  becomes  softer  and  tenacious  by  heat,  and 
is  inflammable.  Water  and  alcohol  dissolve  it  partially,  diluted  alcohol 
completely.  It  consists  essentially  of  volatile  oil,  resin,  and  gum,  of 
which  the  two  former  are  probably  the  active  constituents.  The  odour 
depends  upon  the  oil. 

This  gum-resin  produces  effects  on  the  system  similar  to  those  of  assa- 
fetida, but  is  too  feeble  to  be  depended  on  as  a  substitute,  in  which  capa- 
city it  might  otherwise  be  used,  in  consequence  of  its  less  offensive  odour. 
It  is  occasionally  employed  as  an  adjuvant  to  cathartics,  in  flatulent 
states  of  the  stomach  and  bowels.  The  dose  is  from  ten  to  thirty  grains. 
which  may  be  given  in  pill  or  emulsion. 

2.  GALBANUM.  U.S.,  Br. 

Galbanum  is  the  concrete  juice  of  an  uncertain  plant,  probably  a 
species  of  Ferula,  growing  in  Persia,  on  the  borders  of  the  Caspian.  It 


CHAP.  I.]  NERVOUS    STIMULANTS. — GALBANUM.  603 

is  said  sometimes  to  be  procured  by  incision,  sometimes  to  exude  spon- 
taneously, and  harden  in  the  form  of  tears.  In  this  latter  state  it  is 
occasionally,  though  rarely,  imported ;  the  tears  being  about  as  large  as 
a  pea,  round,  shining,  translucent,  and  of  a  yellowish  or  brownish-yellow 
colour.  More  frequently  it  is  in  masses  composed  of  whitish,  reddish, 
or  yellowish  tears,  simply  agglutinated  together,  or  imbedded  in  a  darker, 
yellowish-brown,  or  greenish  substance.  It  has  the  consistence  of  wax, 
but  softens  with  heat,  and  at  the  temperature  of  the  surface  becomes 
adhesive.  At  212°  Fahr.  it  melts  so  that  it  can  be  strained,  and  is  thus 
freed  from  impurities.  Its  odour  is  peculiar  and  disagreeable ;  its  taste, 
bitterish,  warm,  and  acrid.  Water  dissolves  it  partially ;  alcohol,  its  oil 
and  resin  ;  diluted  alcohol,  the  whole  of  it,  excepting  impurities.  It 
consists  of  gum,  resin,  and  volatile  oil,  of  which  the  two  latter  are  active. 

Its  medical  properties  are  similar  to  those  of  sagapenum,  though  gen- 
erally considered  feebler.  With  a  slightly  stimulant  influence  over  the 
circulation  and  nervous  system,  it  has  been  supposed  to  unite  expecto- 
rant and  emmenagogue  powers ;  and  hence  has  been  given  in  hysteria 
and  other  nervous  disorders,  enfeebled  digestion,  flatulence,  chronic  bron- 
chial affections,  chlorosis,  amenorrhoea,  chronic  rheumatism,  etc.  It  was 
formerly  very  much  employed,  and  entered  into  a  large  number  of  pre- 
parations for  internal  and  external  use.  But  it  has  been  almost  wholly 
superseded  by  assafetida,  and  is  little  used  at  present.  The  dose  is  from 
ten  to  twenty  grains,  given  in  pill  or  emulsion. 

Compound  Galbanum  Pills  (PILULE  GALBANI  COMPOSITE,  U.  S.; 
PILULA  ASSAFOSTID^E  CoMPOSiTA,  Br.),  composed  of  galbanum,  myrrh, 
and  assafetida,  are  officinal.  They  are  used  as  a  nervous  stimulant  and 
emmenagogue,  in  hysteria  and  amenorrhcea,  in  the  dose  of  from  ten  to 
twenty  grains. 

Dr.  Arnold  has  strongly  recommended  the  local  use  of  a  tincture  of 
galbanum  in  various  diseases  of  the  eye,  such  as  scrofulous  ophthalmia, 
ocular  debility  from  prolonged  reading,  spasmodic  motions  of  the  eyelids, 
oedema  of  the  eyelids,  weakness  of  the  lachrymal  canal,  etc.  He  moist- 
ens the  surface  of  a  compress  with  the  tincture,  and  applies  it  imme- 
diately over  the  eye  for  an  hour ;  then  removes  it  for  several  hours, 
and  again  applies  it ;  and  thus  successively  till  the  object  is  accom- 
plished. A  burning  heat  is  first  felt,  which  gradually  lessens,  and  ceases 
within  an  hour,  when  the  compress  becomes  dry.  The  tincture  may  be 
made  by  dissolving  an  ounce  in  a  pint  of  diluted  alcohol.  (Me'rat  et  De 
Lens,  Diet,  de  Mat.  Med.,  i.  685.) 

The  Compound  Galbanum  Plaster  (EMPLASTRUM  GALBANI  COMPOS- 
ITUM,  U.  S.},  which  consists  of  galbanum,  Burgundy  pitch,  turpentine, 
and  lead  plaster,  is  a  good  discutient  application  in  chronic  scrofulous 
swellings,  inflammatory  indurations,  and  chronic  rheumatic  and  gouty 
disease  of  the  joints;  care  being  taken  that  signs  of  acute  inflammation 
should  always  be  absent. 


604  GENERAL   STIMULANTS.  [PART  II. 

3.  AMMONIAC.  — A MMONIACUM.    U.S.,Sr. 

This  gum-resin  will  be  hereafter  treated  of  as  a  stimulant  expectorant, 
when  its  origin,  properties,  composition,  and  physiological  effects  will  be 
detailed.  In  the  present  place  it  is  sufficient  to  state  that,  along  with 
other  properties,  it  is  supposed  to  possess  those  of  a  nervous  stimulant, 
in  a  degree  somewhat  less  than  the  two  preceding  gum-resins.  In  this 
capacity,  it  has  been  considered  useful  in  obstinate  colicky  affections 
of  the  bowels  with  constipation,  and  in  asthma  complicated  with  chronic 
bronchitis,  being  aided  in  the  former  of  these  affections  by  its  laxative, 
and  in  the  latter  by  its  expectorant  properties.  The  dose  of  it  is  from 
ten  to  thirty  grains,  given  in  the  form  of  pill  or  emulsion. 

Ammoniac  is  used  externally,  as  a  local  stimulant,  in  the  form  of 
Plaster  (EMPLASTRUM  AMMONIACI,  U.  £).  This  often  produces  a  papu- 
lous eruption,  and  sometimes  considerable  inflammation  of  the  skin.  It 
is  used  chiefly  to  promote  resolution  of  scrofulous  tumours,  and  other 
chronic  swellings  of  the  joints.  Combined  with  mercury,  as  it  is  in  the 
Plaster  of  Ammoniac  with  Mercury  (EMPLASTRUM  AMMONIACI  CUM 
HYDRARGYRO,  U.  S.,  Br.),  it  acquires  increased  discutient  powers;  and 
in  this  form  is  applied  additionally  to  venereal  nodes  and  tumefactions, 
and  over  the  region  of  the  liver  in  chronic  hepatitis.  This  plaster  some- 
times affects  the  gums. 


IV.  VALERIAN. 
VALERIANA.   U.  S.,  Br. 

Origin.  This  is  the  root  of  Valeriana  officinalis,  a  European  herba- 
ceous perennial  from  two  to  four  feet  high,  with  branches  terminating 
in  clusters  of  small  sweet-scented  flowers.  The  plant  is  now  cultivated 
in  this  country  for  medical  use.  The  root  is  collected  preferably  in  the 
autumn  after  the  decay  of  the  leaves,  or  early  in  the  spring  before  they 
appear. 

Properties.  The  root  consists  of  a  small  tuberculated  head,  sending 
forth  numerous  long  cylindrical  fibres  or  radicles,  and  bears  no  incon- 
siderable resemblance  to  Virginia  snakeroot.  The  colour  of  the  radicles 
is  externally  yellowish  or  brownish,  internally  white ;  that  of  the  powder 
yellowish-gray.  The  odour,  which  in  the  fresh  root  is  slight,  is,  in  the 
dried,  strong,  somewhat  aromatic,  and  highly  peculiar.  To  some  it  is 
agreeable,  to  others  the  reverse.  Cats  are  said  to  be  extremely  fond  of 
it,  and  under  its  influence  to  experience  a  kind  of  intoxication.  The 
taste  is  at  first  sweetish,  afterwards  bitterish,  somewhat  acrid,  and  disa- 
greeable. 

Active  Principles.  The  active  principles  are  a  peculiar  volatile  oil, 


CHAP.  I.]       NERVOUS  STIMULANTS. — VALERIAN.  605 

and  probably  an  extractive  matter  of  a  sweetish  and  slightly  bitter  taste 
called  valerianin.  Upon  the  former  depend  the  stimulant  properties  of 
the  root;  the  latter  may  be  slightly  tonic.  The  oil  of  valerian,  being 
one  of  the  officinal  preparations  of  the  root,  will  be  noticed  more  partic- 
ularly below. 

Effects  on  the  System.  Different  opinions  are  held  as  to  the  stimulant 
influence  of  valerian  on  the  circulation  ;  some  believing  it  to  have  such 
an  influence,  others  denying  it  altogether.  I  am  among  those  who  con- 
sider it  as  in  general  very  moderately  stimulant,  though  its  effects  in  this 
respect  are  somewhat  uncertain.  Upon  the  stomach  it  also  produces  a 
slightly  excitant  impression,  which,  when  it  is  largely  taken,  often 
amounts  to  irritation.  Upon  the  nervous  system,  however,  its  action  is 
more  decided.  This  is  shown,  in  the  ordinary  medicinal  doses,  rather 
by  its  influence  in  composing  nervous  disorder,  than  by  any  decided  dis- 
turbance of  the  nervous  functions  in  health,  unless,  perhaps,  in  certain 
very  susceptible  persons.  But  in  very  large  doses,  it  produces,  even  in 
robust  individuals,  some  degree  of  headache,  vertigo,  and  disturbance  of 
sight  and  hearing ;  and  in  others  of  a  more  nervous  temperament,  may 
superadd  to  these  effects  more  or  less  mental  excitement,  visual  illusion, 
general  agitation,  and  even  involuntary  muscular  movement.  It  never, 
however,  causes  positive  delirium  or  coma ;  and  is  probably  incapable, 
in  any  quantity,  of  acting  as  a  poison.  It  sometimes  disturbs  the 
bowels. 

Therapeutic  Application.  We  have  no  proof  that  valerian  was  em- 
ployed by  the  ancients.  Much  more  efficacy  has  been  ascribed  to  it  by 
many  writers  than  it  is  noAv  generally  believed  to  possess.  I  have  never, 
myself,  seen  from  it  anything  more  than  very  moderate  remedial  influ- 
ences. It  was  brought  into  notice  by  Fabius  Columna,  a  Neapolitan  of 
high  birth,  who,  labouring  himself  under  epilepsy,  and  searching  eagerly 
in  the  field  of  botany  for  a  remedy,  thought  he  had  found  it  in  valerian. 
Many  reports  have  since  then  been  made  of  its  efficiency  in  that  disease ; 
but  the  credit  of  curing  epilepsy  is  one  which  it  must  share  with  numer- 
ous other  substances,  not  a  few  of  which  are  much  more  inert  than  itself. 
In  this  disease,  the  mental  condition  of  the  patient  has  great  influence; 
and  anything  which  strongly  excites  his  confidence  or  his  hopes,  may, 
for  a  time,  and  occasionally  does,  for  a  considerable  time,  suspend  the 
recurrence  of  the  paroxysms.  If,  in  the  mean  time,  the  cause  which  sus- 
tained the  disease  should  have  ceased,  a  permanent  cure  might  seem  to 
have  been  effected  by  what  is  in  itself  wholly  useless.  Nevertheless,  it 
would  not  be  proper  to  deny  all  efficiency  to  valerian  in  epilepsy.  In 
some  purely  functional  cases,  before  the  disease  had  become  firmly  seated 
in  the  habits,  if  not  in  the  structure  of  the  brain,  it  may  possibly  have 
set  it  aside ;  and  it  may  be  exhibited,  with  some  hope  of  benefit,  as  an 
adjuvant  of  more  powerful  remedies ;  but  no  curative  effect  can  be  ex- 


606  GENERAL   STIMULANTS.  [PART  II. 

pected  from  it,  unless  freely  given  and  long  persevered  with ;  and  reliance 
should  never  be  placed  upon  its  exclusive  use.  To  the  cure  of  fixed  epi- 
lepsy it  is  quite  inadequate. 

The  morbid  conditions  to  which  valerian  is  most  appropriate  are  the 
milder  forms  of  hysteria  and  hypochondriasis,  in  which  the  indication 
is  to  obviate  depression  of  spirits,  or  to  control  the  slighter  nervous 
irregularities,  which,  in  countless  diversity,  are  springing  up  in  the 
course  of  the  former  disease.  Even  under  such  circumstances,  it  is 
probably  more  used  as  an  adjuvant  to  other  remedies  intended  to  make 
a  permanent  and  curative  impression  than  exclusively  for  its  own  effects. 
Thus,  in  a  case  of  chlorosis,  while  the  disease  is  pursuing  a  regular 
march  towards  health,  under  the  use  of  the  chalybcates  and  a  good  diet, 
valerian  may  sometimes  be  employed  advantageously  to  quiet  palpita- 
tions, relieve  unpleasant  cerebral  sensations,  or  general  uneasiness,  and 
obviate  irregular  muscular  movements  of  various  kinds. 

Not  unfrequently,  dyspepsia  is  accompanied  with  much  nervous  dis- 
composure, especially  in  women,  and  in  those,  too,  who  have  shown  no 
tendency  to  hysteria.  Valerian  may  often  be  usefully  associated,  in  such 
cases,  with  the  bitter  tonics,  laxatives,  etc.,  which  may  be  employed  to 
meet  more  important  indications.  The  same  may  be  said  of  its  use  in 
other  diseases  of  depression  or  debility,  in  which  nervous  disorder  is  a 
mere  attendant  phenomenon,  having  no  important  signification,  but  never- 
theless often  very  annoying  to  the  patient.  Its  application  to  the  relief 
of  wakefulness,  restlessness,  general  uneasiness,  muscular  tremors,  etc., 
complicating  low  febrile  diseases,  would  come  into  this  category; 
though  the  same  ends  may  generally  be  bettor  attained  by  the  use  of 
Hoffmann's  anodyne,  sweet  spirit  of  nitre,  camphor  water,  etc..  than  by 
valerian.  Dr.  D.  Leasure,  of  New  Castle,  Pennsylvania,  speaks  very 
favourably  of  oil  of  valerian,  in  typhoid  fever,  alternated  with  oil  of 
turpentine.  (Transact,  of  the  Med.  Soc.  of  the  Slate  of  Pa.,  1856,  p.  102.) 

In  the  treatment  of  hemicrania,  it  has  enjoyed  some  reputation  in 
connection  with  Peruvian  bark  or  sulphate  of  quinia.  I  have  repeatedly, 
in  former  times,  seen  this  very  troublesome  affection  yield,  in  two  or 
three  days,  to  an  ounce  or  two  of  bark  taken  daily,  in  divided  doses,  in 
a  pint  or  two  of  infusion  of  valerian.  The  first  effect  was  generally 
somewhat  to  augment  the  pain;  but  it  ceased  at  the  end  of  the  time 
specified.  On  making  similar  attempts  more  recently,  with  sulphate  of 
quinia  and  oil  of  valerian,  I  have  not  been  in  an  equal  degree  successful. 
It  is  not  impossible  that  the  oppression  of  stomach,  produced  by  the 
bark  in  powder,  may  have  had  something  to  do  with  the  result, 

M.  Rayer  has  found  valerian  efficacious  in  a  case  of  excessive  thirst  in 
a  boy,  attended  with  a  copious  discharge  of  light -coloured,  limpid,  ino- 
dorous, and  tastless  urine.  The  quantity  of  liquid  drank  and  discharged 
was  enormous.  The  affection  was  looked  on  as  nervous,  and  yielded  in 


CHAP.  I.]  NERVOUS    STIMULANTS. — VALERIAN.  607 

about  a  month  to  the  powder  of  valerian,  employed  under  this  view  of 
its  nature. 

Administration.  Valerian  is  most  effectively  given  in  the  form  of 
powder,  which  should  be  preferred  when  a  strong  impression  is  desired. 
The  dose  is  from  thirty  to  ninety  grains  three  or  four  times  a  day,  and 
may  be  increased,  if  thought  desirable,  so  that  an  ounce  may  be  taken 
in  twenty-four  hours;  the  quantity  being  of  course  diminished  if  unpleas- 
ant cerebral  phenomena  should  occur. 

The  Infusion  (!NFUSUM  VALERIANS,  U.  S.,  Br.}  is  officinal,  and  is 
directed  to  be  made  in  the  proportion  of  half  an  ounce  to  a  pint  of  boiling 
water.  The  medicine  is  said  to  be  less  apt  to  irritate  the  bowels  in  this 
form,  than  in  that  of  powder.  The  dose  is  two  fluidounces. 

There  is  also  an  officinal  Tincture  (TINCTURA  VALERIANS,  V.  S.,  Br.), 
which  has  the  virtues  of  the  medicine,  but  unfortunately  also  the  stimu- 
lant properties  of  alcohol,  which,  except  under  rare  circumstances,  should 
forbid  its  use.  The  danger  of  its  abuse,  when  carelessly  prescribed  for 
slight  nervous  affections,  is  too  obvious  to  require  that  more  should  be 
said  to  put  the  young  practitioner  on  his  guard.  The  dose  of  it  is  one 
or  two  fluidrachms. 

The  Ammoniated  Tincture  (TiNCTURA  VALERIANS  AMMONIATA,  U.S., 
Br.)  is  a  much  more  effective  preparation,  being  made  with  aromatic 
spirit  of  ammonia  instead  of  diluted  alcohol.  The  dose  is  from  thirty 
minims  to  a  fluidrachm,  which  should  be  largely  diluted.  It  is  espe- 
cially indicated  in  cases  of  hysteric  spasm  of  the  stomach,  or  troublesome 
flatulence  having  the  same  origin. 

An  Alcoholic  Extract  (EXTRACTUM  VALERIANS  ALCOHOLICUM,  U.  S.) 
is  directed  in  the  U.  S.  Pharmacopoeia,  but,  though  prepared  with  every 
precaution  to  avoid  the  volatilization  of  the  active  principles  of  the  root, 
is  scarcely,  I  think,  an  eligible  preparation  ;  yet  it  has  the  advantage 
that  it  may  be  given  in  the  pilular  form.  The  dose  is  from  ten  to  thirty 
grains. 

The  Fluid  Extract  of  Valerian  (EXTRACTUM  VALERIANS  FLUIDUM, 
U.  S.),  which  is  peculiar  to  the  U.  S.  Pharmacopoeia,  is  an  elegant  pre- 
paration, concentrating  the  virtues  of  the  medicine  in  a  small  bulk,  con- 
venient for  administration.  The  dose  is  about  a  fluidrachm. 

The  Volatile  Oil  (OLEUM  YALERIAN^E,  U.  S.),  which  is  supposed 
to  have  all  the  virtues  of  valerian  as  a  nervous  stimulant,  is  now 
much  used  as  a  substitute.  It  is  obtained  from  the  root  by  distillation 
with  water.  As  first  procured,  it  is  of  a  pale-green  colour,  with  a 
pungent  odour  of  valerian,  and  a  somewhat  aromatic  taste.  By  expo- 
sure, however,  it  becomes  yellow  and  viscid,  in  consequence  of  the  ab- 
sorption of  oxygen.  Much  importance  has  recently  been  attached  to  the 
fact,  that  this  oil  contains,  associated  with  it,  a  peculiar  volatile  acid 
denominated  valerianic  acid,  which  may  be  separated  by  a  chemical 


608  GENERAL    STIMULANTS.  [PART  II. 

process.  This  acid  is  a  colourless  volatile  liquid,  having  a  very  offensive 
odour,  recalling  that  of  valerian,  yet  quite  different,  and  a  sour  disagree- 
able taste.  It  forms  salts  with  the  acids,  and  carries  its  odour  in  some 
degree  with  it  in  the  combination.  It  has  been  supposed  to  be  one  of 
the  active  principles  of  valerian,  if  not  the  most  active;  but,  when  it  is 
considered  that,  if  it  exist  at  all  in  valerian  uncombined,  it  cannot  be  in 
any  considerable  proportion,  this  idea  must  be  abandoned.  It  is  the 
result  of  the  oxidation  of  one  of  the  two  oils  which  conjointly  constitute 
the  oil  of  valerian,  and  may  be  much  increased  by  the  reagency  of  an 
alkali,  which  disposes  to  its  formation,  and  then  combines  with  it.  The 
dose  of  the  oil  is  from  four  to  six  drops. 

Various  salts  of  valerianic  acid  have  been  introduced  into  medicine, 
under  the  notion  that  this  acid  was  the  active  principle  of  valerian,  and 
would  carry  its  peculiar  virtues  with  it  into  the  combinations  it  might 
form  with  salifiable  bases.  Hence  the  valerianotes  of  iron,  of  zinc,  and 
of  quinia,  which  have  been  added  to  the  list  of  medicinal  preparations. 
Experience  has  not  shown  that  they  possess  any  peculiar  advantages 
over  the  other  salts  of  those  bases  respectively,  while  their  repulsive 
odour  and  comparative  cost  are  real  objections.  Valerian  ate  of  ammo- 
nia, however,  has  acquired  a  reputation  which  demands  for  it  a  par- 
ticular consideration. 

VALERIANATE  OF  AMMONIA.  — AMMONIA  VALERIANAS.  U.S. 

This  salt  is  prepared  by  saturating  valerianic  acid  with  ammonia. 
The  chief  difficulty  is  in  obtaining  it  dry  and  crystallized,  in  consequence 
of  its  extreme  deliquescence. 

It  is  in  white  pearly  quadrangular  plates,  of  a  strong  very  disagree- 
able smell  like  that  of  valerianic  acid,  and  of  a  peculiar  sweetish  taste, 
with  little  pungency.  It  is  very  deliquescent  in  a  moist  air,  soluble  in 
all  proportions  in  water  and  alcohol,  and  volatilizable  by  heat  with  par- 
tial decomposition.  When  kept  in  a  bottle,  which  is  occasionally  opened, 
the  crystals  acquire  a  yellowish  colour. 

Its  effects  on  the  healthy  system  in  remedial  doses  are  not  striking; 
and  the  only  inconvenience  experienced,  when  it  has  been  taken  too  freely, 
is  some  disturbance  of  the  head.  From  trials  made  by  MM.  Laboureur 
and  Fontaine,  it  seems  to  exercise  no  injurious  influence  on  the  animal 
economy;  two  or  three  drachms  of  it  having  been  given  to  dogs  without 
serious  effect.  It  appears  that  the  idea  of  employing  it  therapeutically 
originated  with  M.  Pierlot,  an  apothecary  of  Paris;  but  the  attention  of 
the  profession  was  first  decidedly  directed  towards  it  by  Dr.  Declat,  who, 
in  December,  1855,  used  it  in  an  obstinate  facial  neuralgia,  which  had 
lasted  very  long,  and  resisted  all  remedies,  but  yielded  immediately  to 
this.  It  was  afterwards  employed  in  similar  cases  with  remarkable  suc- 
cess, and  is  now  among  the  most  esteemed  remedies  in  neuralgic  affec- 
tions. It  has  since  been  given  in  other  nervous  affections,  as  epilepsy, 


CHAP.  I.]  NERVOUS   STIMULANTS. — GARLIC.  609 

hysteria,  chorea,  etc.  The  dose  of  it  is  from  one  to  six  or  eight  grains, 
which  may  be  dissolved  in  from  one  to  four  fluidrachms  of  pure  or  aro- 
matic water,  and  sweetened  if  desired.  A  single  dose  is  said  often  to 
relieve  the  pain ;  but  it  may  be  repeated,  if  needful,  several  times  a  day. 
In  relation  to  the  valerianates  used  in  medicine,  M.  Landerer  has 
found  that  the  valerianic  acid  artificially  prepared,  is  decidedly  inferior 
to  that  obtained  from  the  root,  which,  therefore,  should  always  be 'pre- 
ferred in  medicine.  (Journ.  de  Pharm.  et  de  Ckim.,  3e  ser.,  xlii.  7*7.) 


V.  GARLIC. 
ALLIUM.  U.S. 

Origin.  Garlic  consists  of  the  bulbs  of  Allium  sativum,  or  common 
garden  garlic,  a  native  of  Europe,  but  cultivated  in  most  civilized  coun- 
tries. The  bulbs,  when  taken  from  the  ground,  are  dried,  usually  with 
portions  of  the  stems  remaining,  by  which  they  are  tied  into  bundles, 
and  thus  brought  into  market, 

Properties.  The  bulb  of  garlic  consists  of  five  or  six  smaller  bulbs, 
commonly  called  cloves,  each  invested  with  a  distinct  coat,  and  the 
whole  compactly  arranged  around  the  stem  at  its  base,  and  inclosed  in 
a  white  membranous  covering,  consisting  of  several  thin,  delicate  layers. 
The  substance  of  the  minor  bulbs,  deprived  of  their  coat,  is  whitish, 
moist,  and  fleshy,  and  contains  a  juice,  whteh,  on  the  addition  of  a  little 
water,  may  be  separated  by  expression.  When  these  little  bulbs  become 
dry,  as  they  do  when  very  long  kept,  the  medicine  is  wholly  useless. 

The  odour  of  garlic  is  strong,  penetrating,  disagreeable,  and  charac- 
teristic; so  much  so  that  it  serves  as  a  standard  of  comparison  for  other 
odours,  which,  when  thought  to  resemble  it,  are  said  to  be  alliaceous. 
The  taste  is  bitter  and  acrid.  These  properties,  as  well  as  the  medical 
virtues  of  garlic,  are  yielded  to  water,  vinegar,  or  alcohol;  but  are  im- 
paired or  destroyed  by  boiling.  They  depend  on  a  peculiar  volatile  oil, 
which  pervades  the  whole  plant ;  but  is  especially  abundant  in  the  bulb. 
This  is  easily  separated  by  distillation  with  water,  leaving  the  residue 
quite  inert.  The  oil,  when  pure,  is  a  combination  of  carbon,  hydrogen, 
and  sulphur,  constituting,  according  to  Wertheim,  the  sulphuret  of  a  com- 
pound radical  denominated  allyl,  which  consists  of  carbon  and  hydrogen 
(C6H.).  After  exposure  to  the  air  it  contains  oxygen. 

Effects  on  the  System.  Garlic  is  a  local  and  general  stimulant,  oper- 
ating directly  upon  the  part  to  which  it  may  be  applied,  and,  through 
the  absorption  of  its  active  principle,  upon  the  circulatory  and  nervous 
VOL.  i.— 39 


610  GENERAL   STIMULANTS.  [PART  II. 

systems,  and  the  various  secretions.  Its  influence  upon  the  nervous 
centres,  though  very  decided,  and  quite  sufficient  to  allow  it  to  rank  in 
the  present  class  of  medicines,  has  not,  I  think,  been  so  prominently  no- 
ticed by  pharmacological  writers  as  it  deserves  to  be.  It  agrees,  too, 
with  the  nervous  stimulants  in  having  no  tendency  to  disturb  the  special 
cerebral  functions. 

Moderate  doses  warm  the  stomach,  excite  the  appetite,  and  facilitate 
digestion.  In  a  short  time  the  frequency  of  the  pulse  and  general 
warmth  are  somewhat  increased ;  and  the  patient  feels  an  agreeable  ex- 
citement, which,  though  little  noticed,  contributes,  I  have  no  doubt,  to 
the  favour  in  which  it  is  held  as  a  condiment,  notwithstanding  its  origin- 
ally very  repulsive  odour  and  taste,  by  vast  numbers  of  people,  indeed 
by  whole  nations  in  some  parts  of  the  world.  Through  its  influence  on 
the  secretions,  it  acts  as  an  expectorant,  sometimes  as  a  diuretic  or  dia- 
phoretic, according  as  it  is  directed  by  circumstances  preferably  to  the 
kidneys  or  the  skin,  and  also  as  an  emmenagogue.  It  is  said  occa- 
sionally to  prove  anthelmintic.  Too  largely  taken,  it  causes  uneasiness 
of  stomach,  sometimes  even  nausea  and  vomiting,  occasionally  purges, 
and  is  capable  of  producing  a  febrile  state  of  system,  with  headache, 
quickened  pulse,  heat  of  skin,  etc.  Applied  to  the  skin  it  acts  as  a  rube- 
facient,  and  will  sometimes  vesicate. 

All  these  effects  it  owes  to  the  volatile  oil,  which  is  absorbed  with 
great  facility,  and  rapidly  pervades  the  whole  system.  Its  absorption 
is  proved  by  the  odour  it  imparts  to  the  breath,  perspiration,  urine,  and 
even  the  secretions  from  the  surface  of  ulcers.  In  the  lower  animals,  it 
affects  the  milk  and  the  flSsh  with  its  peculiar  properties  of  smell  and 
taste.  The  absorption  takes  place  not  only  from  the  stomach,  but 
readily  also  from  the  rectum,  and  even  from  the  skin.  Garlic  poultices 
applied  to  the  soles  of  the  feet  will  sometimes  communicate  their  odour 
to  the  breath.  The  oil,  therefore,  though  quickly  entering  the  circula- 
tion, has  a  tendency  to  leave  it  rapidly,  and,  as  it  passes  out  through 
the  different  emunctories,  stimulates  them  into  an  increase  of  their  several 
functions. 

In  its  whole  medicinal  character,  garlic  bears  a  considerable  resem- 
blance to  assafetida,  though  perhaps  somewhat  more  stimulant  locally 
and  to  the  circulation,  and  somewhat  less  so  to  the  nervous  system. 

Therapeutic  Application.  Garlic  has  been  used  as  a  condiment  and 
medicine  from  times  immemorial.  Some  of  its  nfost  beneficial  applica- 
tions are  grounded  upon  its  properties  as  a  nervous  stimulant;  and  these 
are  to  be  particularly  noticed  here.  Its  uses  as  a  stimulating  expecto- 
rant and  diuretic  will  bo  referred  to,  under  the  heads  of  those  classes 
respectively. 

As  a  stimulant  to  the  stomach  it  is  useful  in  debility  of  that  organ, 
enabling  food  of  difficult  solubility  to  be  digested  more  readily,  and  more 


CHAP.  I.]  NERVOUS   STIMULANTS. — GARLIC.  611 

comfortably  to  the  patient.  It  is  also  an  excellent  carminative,  produc- 
ing the  expulsion  of  flatus,  and  relieving  spasmodic  pains  which  its  pres- 
ence is  apt  to  occasion,  whether  in  the  stomach  or  bowels.  But  as  the 
expelled  air  is  impregnated  with  the  oil,  the  eructations  are  apt  to  be 
offensive,  if  not  to  the  patient,  at  least  to  others  in  his  vicinity. 

One  of  the  most  useful  effects  of  the  medicine  is  to  relieve  the  various 
disturbances  of  the  nervous  system  which  are  so  apt  to  attend  the  febrile 
diseases  of  children,  such  as  restlessness,  wakefulness,  vague  general 
uneasiness,  twitchings  of  the  muscles,  starlings,  and  convulsions.  For 
this  purpose  it  is  almost  always  used  externally,  being  applied  in  the 
form  of  poultices  to  the  feet,  and  as  a  lotion  to  the  spine,  made  either 
by  infusing  the  bruised  bulbs  for  a  short  time  in  hot  brandy,  or  by  incor- 
porating the  expressed  juice  with  oil  or  lard.  The  reader  will  observe 
that  it  is  used  here  not  merely  as  a  revulsive  agent,  in  which  capacity 
it  is  inferior  to  mustard  and  other  rubefacients,  but  in  reference  to  the 
absorption  of  the  oil,  and  its  operation  upon  the  nervous  centres.  It 
often  most  happily  quiets  the  disturbance,  and  promotes  sleep  by  correct- 
ing  the  state  of  the  nervous  system  which  prevented  it. 

In  the  advanced  stage  of  the  inflammatory  diseases  of  children,  and 
especially  the  pectoral,  there  is  often  a  prostrated  condition  of  the  nerv- 
ous centres,  which  very  injuriously  complicates  the  case.  I  have  already, 
under  the  head  of  assafetida,  called  attention  to  this  condition,  and 
pointed  out  how  it  may  be  recognized,  especially  as  attendant  upon 
advanced  bronchial  and  pulmonary  inflammations.  Garlic  is  scarcely 
inferior  as  a  remedy  to  assafetida  in  some  of  these  cases.  I  have  used 
it  often,  and  am  quite  sure  with  much  benefit.  It  is  not  merely  as  an 
expectorant  that  it  operates.  It  stimulates  the  nervous  centres,  and 
en  iibles  them  to  supply  the  necessary  support  to  the  functions  of  respira- 
tion and  circulation,  which  are  failing-  for  the  want  of  it.  The  remedy  is 
specially  useful,  when,  with  this  debility  of  function,  there  is  also  spas- 
modic complication,  as  in*the  affections  referred  to  occurring  in  the 
advanced  stages  of  hooping-cough,  or  in  asthmatic  children.  I  have 
usually  employed  it,  in  these  cases,  internally,  in  the  form  of  syrup. 

In  almost  all  the  spasmodic  and  convulsive  complaints  of  children, 
whether  affecting  the  alimentary  canal,  the  chest,  or  the  external  mus- 
cles, or  occurring  as  original  affections,  or  as  attendants  on  other  dis- 
eases, garlic  may  be  used  externally,  in  the  form  of  lotion  or  poultice; 
the  application  bein£  made  along  the  spine  in  convulsions,  and  both 
there  and  over  the  organ  affected  in  internal  spasms.  The  only  contra- 
indication would  be  high  vascular  congestion  or  inflammation  in  the 
nervous  centres. 

In  mild  cases  of  hysteria,  especially  when  affecting  the  stomach  and 
bowels,  as  in  spasmodic  pains,  flatulent  discharges,  borborygmi,  etc., 
garlic  is  often  useful,  though  not  unfrequently  objectionable  in  conse- 


612  GENERAL   STIMULANTS.  [PART  II. 

quence  of  the  odour  imparted  to  the  breath.  In  all  hysterical  affections, 
it  may  be  freely  employed  externally. 

The  medicine  was  formerly  used  in  intermittent  fever ;  but  has  been 
abandoned  since  the  discovery  of  Peruvian  bark. 

As  a  topical  application  to  the  ear,  it  has  been  used  advantageously 
in  atonic  deafness.  For  this  purpose,  a  small  piece  of  raw  cotton  may 
be  impregnated  with  the  juice,  and  introduced  into  the  external  nieatus. 
If  it  irritate  too  much,  the  juice  should  be  diluted. 

Applied  in  the  shape  of  a  large  cataplasm  to,  the  hypogastrium,  it  has 
been  recommended  in  retention  of  urine  from  debility  of  the  muscular 
coat  of  the  bladder,  and  incontinence  from  weakness  of  the  sphincter. 

As  an  anlhelmintic  it  has  enjoyed  some  credit,  being  used  by  the 
mouth,  and,  in  the  instance  of  ascarides,  by  the  rectum. 

As  a  resolvent  in  indolent  tumours,  and  a  stimulant  in  chronic  palsy 
and  rheumatism,  it  has  been  employed  locally  in  the  form  of  lotion  or 
poultice. 

Administration.  The  dose  of  garlic,  in  substance,  is  from  half  a 
drachm  to  one  or  two  drachms  for  an  adult.  It  may  be  given  in  the 
shape  of  pills,  or  bruised  and  mixed  with  syrup  or  other  vehicle  as  an 
electuary,  or  in  the  state  of  the  unprepared  clove  or  small  bulb,  either 
whole,  or  cut  into  pieces  of  convenient  size  for  swallowing.  But  neither 
of  these  forms  is  adapted  to  children. 

The  most  convenient  preparation  for  internal  use  in  the  case  of  chil- 
dren is  the  syrup.  This  may  be  made  extemporaneously  by  bruising 
the  cloves,  adding  a  little  water,  so  as  to  enable  the  juice  to  flow  out, 
then  expressing,  and  mixing  the  liquid  obtained  with  twice  its  weight  of 
sugar.  There  is  an  officinal  Syrup  (SYHUPUS  ALLII,  U.  $.),  which  is 
prepared  by  first  forming  an  infusion  with  vinegar,  and  afterwards  incor- 
porating this  with  sugar.  The  dose  of  cither  preparation  for  a  child  a 
year  or  two  old  is  a  fluidrachm,  which  may  be  repeated  every  hour  or 
two,  in  acute  cases. 

For  external  use,  cataplasms  are  made  by  thoroughly  bruising  the 
garlic,  and  incorporating  it  with  the  bread  and  milk  poultice,  or  mixing 
it  up  with  flaxseed  meal  or  other  adhesive  powder,  and  hot  water. 

Lotions  may  be  made  by  bruising  the  garlic,  and  heating  it  with  proof 
spirit,  which  may  then  be  applied  by  means  of  flannels  wet  with  it,  or 
by  gentle  friction. 

A  liniment  may  be  prepared  by  incorporating  the  expressed  juice  with 
olive  oil  or  lard. 

A  boiling  heat  should  not  be  employed  in  the  preparation  of  garlic,  as 
it  has  the  effect  of  driving  off  the  oil. 

Other  species  of  Allium  have  effects  analogous  to  those  of  A.  sativum. 
The  native  garlic  of  our  fields  might  probably  be  substituted  without 
disadvantage.  The  onion  (A.  Cepa)  and  the  leek  (A.  Porrum)  have 


CHAP.  I.]         NERVOUS    STIMULANTS. — COFFEE   AND   TEA.  613 

similar  properties,  but  are  much  weaker.  Nevertheless,  a  syrup  made 
with  expressed  onion  juice  and  sugar  will  be  found  useful  in  some  of  the 
pectoral  affections,  in  which  garlic  has  been  recommended. 


VI.  COFFEE  AND  TEA. 

I  consider  these  two  substances  together,  because  their  effects  are  of  a 
closely  similar  character,  and,  where  any  difference  exists,  it  can  be 
readily  indicated  without  producing  confusion. 

Coffee  was  introduced,  under  the  officinal  title  of  GAFFE  A,  into  the 
U.  S.  Pharmacopoeia,  at  the  late  revision  of  that  work,  and  fully  merits 
the  recognition. 

Of  the  origin  and  physical  properties  of  coffee  and  tea  it  is  neces- 
sary to  say  little,  as  they  are  generally  well  known.  It  will  be  suf- 
6cient  to  state,  in  relation  to  coffee,  that  it  is  the  seed  of  the  Gaffea 
Arabica,  a  small  tree,  indigenous  in  Arabia  and  Africa,  and  largely  cul- 
tivated in  various  tropical  countries  of  the  old  and  new  continents;  and, 
in  relation  to  tea,  that  it  is  the  prepared  leaves  of  at  least  two  shrubs, 
distinct  species  of  Thea,  T.  viridis,  and  T.  Bohea,  both  natives  of  China, 
the  former  of  which  probably  produces  green,  and  the  latter  black  tea. 

As  regards  the  composition  of  these  two  products,  there  is  one  prin- 
ciple which  they  both  possess,  and  upon  which  it  is  highly  probable  that 
the  effects  they  produce  in  common  upon  the  system,  in  some  measure 
at  least,  depend.  This  has  been  called  caffein  as  found  in  coffee,  and 
thein  as  in  tea ;  but  the  name  generally  recognized  at  present  is  the  former, 
from  whatever  source  the  principle  may  be  derived.  So  far  as  we  are  at 
present  concerned  with  caffein,  it  is  sufficient  to  state  that  it  is  a  highly 
nitrogenized  body,  with  feeble  basic  properties,  crystallizable,  of  a  slightly 
bitter  and  disagreeable  taste,  and  soluble  in  water,  alcohol,  and  ether. 
A  remarkable  fact  in  connection  with  this  principle  is,  that  it  has  been 
found  in  three  vegetable  products,  namely,  coffee,  tea,  and  Paraguay  tea, 
all  quite  distinct  in  their  botanical  affinities,  inhabiting  widely  distant 
regions  of  country,  and  yet  each  one  of  them  employed  by  the  natives 
of  the  several  regions  they  inhabit,  and  for  the  same  purposes,  without 
any  previous  intercourse.  Providence  seems  to  have  distributed  them 
over  the  world  for  the  enjoyment  at  least,  if  not  for  the  profit  of  the 
human  family,  and  a  sort  of  instinct  to  have  led  to  their  discovery  and 
use.  Caffein  is  thought  to  exist  in  coffee  partly  free,  and  partly  combined 
with  a  peculiar  acid. 

Besides  this  principle,  which  is  common  to  coffee  and  tea,  there  is 
in  the  former,  according  to  Pfaff,  a  variety  of  tannin  which  he  calls 
caffeo-tannic  acid;  and,  after  it  has  been  roasted  for  use,  two  new  sub- 


614  GENERAL    STIMULANTS.  [PART  II. 

stances  appear  to  have  been  generated,  one  a  bitter  principle,  and  the 
other  an  empyreumatic  oil  to  which  it  owes  its  peculiar  flavour  in  this 
state.  It  is  probably  to  the  combined  influence  of  the  caffein,  the  tan- 
nin, and  the  two  newly  developed  empyreumatic  products,  that  we  must 
ascribe  the  effects  of  coffee  on  the  system. 

Tea  probably  owes  its  active  properties  chiefly  to  the  caffein,  which  is 
in  somewhat  smaller  proportion  than  in  coffee,  jointly  with  a  considera- 
ble quantity  of  tannic  acid  of  the  variety  found  in  galls,  a  peculiar  bitter 
principle,  and  a  volatile  oil  to  which  may  be  ascribed  its  characteristic 
aroma.  Though  the  two  varieties  of  tea,  the  green  and  black,  differ 
considerably  in  their  taste,  they  agree  very  closely  in  chemical  composi- 
tion, and  in  their  effects  on  the  system  ;  the  latter  being  somewhat 
weaker  than  the  former. 

For  a  more  particular  account  of  the  origin,  preparation,  and  sensible 
and  chemical  properties  of  coffee  and  tea,  the  reader  is  referred  to  the 
II.  S.  Dispensatory.  I  have  here  called  attention  only  to  those  points 
which  have  some  immediate  bearing  upon  their  physiological  and  thera- 
peutic effects. 

Effects  on  the  System.  I  shall  first  treat  of  the  effects  of  roasted  coffee, 
and  afterwards  allude  to  the  slight  differences  which  exist  between 
them  and  the  effects  of  tea.  Unroasted  coffee,  being  almost  never  used, 
will  not  be  considered. 

In  moderate  quantities,  coffee  stimulates  the  stomach  gently,  and  the 
nervous  system  decidedly,  without  much  exciting  the  circulation,  or  pro- 
ducing any  narcotic  impression  on  the  brain.  These  are  the  properties 
which  characterize  the  nervous  stimulants,  and  to  this  class,  therefore, 
it  properly  belongs.  It  will  be  found  to  belong  to  the  same  class  equally 
by  its  therapeutic  effects.  Upon  those  who  use  it  habitually,  its  charac- 
teristic influence  is  not  fully  evinced ;  as  it  has  either  lost  its  power  in 
great  measure  by  repetition,  or  the  secondary  are  so  mingled  with  the 
primary  effects,  that  the  latter  are  not  readily  distinguishable.  The  fol- 
lowing are  the  phenomena  of  its  operation  in  a  system  not  yet  rendered 
insensible  to  it  by  habit. 

The  first  effect  of  a  moderate  quantity  is  usually  a  warming  cordial 
impression  on  the  stomach,  which  is  followed  after  a  short  time  by  an 
agreeable  feeling  of  comfort  or  satisfaction,  and  an  obvious  exaltation  of 
the  imagination  and  intellectual  faculties.  The  disposition  to  cheerful 
conversation,  or  to  other  exercise  of  the  mental  powers,  is  awakened 
along  with  this  increase  in  their  vigour.  Every  one  accustomed  to  wit- 
ness social  coffee  or  tea-drinking,  must  have  noticed  the  increased  vivacity, 
the  more  rapid  interchange  of  thought,  the  general  buzz  which  spreads 
through  the  company  after  partaking  of  the  beverage.  The  student  finds 
himself  capacitated  for  a  clearer  understanding,  and  more  prompt  appro- 
priation of  the  subjects  of  his  study ;  the  writer,  for  a  more  vigorous  ex- 


CHAP.  I.]         NERVOUS    STIMULANTS. — COFFEE   AND    TEA.  615 

ercise  of  his  mental  powers,  a  quicker  and  happier  arrangement  of  his 
thoughts  or  fancies,  and  a  much  greater  facility  of  expression.  In  my 
own  person,  I  every  day  experience  something  of  this  effect  from  black 
tea.  For  hours  after  dinner,  even  a  moderate  and  entirely  temperate 
dinner,  I  am  often  unable  to  perform,  at  all  to  my  own  satisfaction,  any 
intellectual  task  which  may  have  devolved  upon  me.  An  immediate 
change  is  produced  by  the  tea,  and,  after  the  closing  meal  of  the  day,  I 
find  myself  possessed  of  my  intellectual  capabilities,  whatever  they  may 
be,  to  their  full  extent.  Along  with  this  nervous  excitement,  there  is  a 
strong  tendency  to  wakefulness  produced ;  and,  under  the  influence  of 
the  beverage,  if  taken  rather  late  in  the  evening,  one's  labours  may  often 
be  prolonged  far  into  the  night,  without  any  sense  of  fatigue  or  dispo- 
sition to  sleep.  One  or  two  cups  of  strong  coffee  at  bedtime  not  unfre- 
quently  prevent  sleep  for  the  whole  night;  and  persons  who  wish  to 
watch  prepare  themselves  often  in  this  way.  During  all  this  time  there 
is  little  acceleration  of  the  pulse ;  and  that  which  may  be  noticed  is  prob- 
ably rather  owing  to  the  reaction  of  the  excited  nervous  centres  upon  the 
heart,  than  the  result  of  a  direct  influence  upon  the  circulation.  The  state 
of  exaltation  subsides  after  many  hours  into  a  corresponding  depression ; 
and  the  self-indulgence  is  paid  for  the  next  day  by  feelings  of  gastric  un- 
easiness, languor,  and  general  malaise,  which  gradually  wear  off,  or  dis- 
appear under  a  repetition  of  the  stimulant.  It  will  be  readily  under- 
stood, therefore,  that  the  habit  of  coffee-drinking  is  not  on  the  whole 
healthful,  unless  carefully  guarded  as  to  extent,  or  counteracted  by  ac- 
tive physical  exercise.  I  shall  refer,  directly,  to  the  evils  which  are  apt 
to  result  from  the  abuse  of  this  luxury. 

When  coffee  is  taken  in  excess,  it  causes  a  feeling  of  oppression  or 
anxiety  in  the  epigastrium,  with  over-excitement  of  the  nervous  system, 
indicated  frequently  by  vertigo,  headache,  palpitation,  muscular  tremors, 
and  other  symptoms  of  irritation  of  the  nervous  centres.  But,  even  in 
the  largest  quantities,  it  never  produces,  so  far  as  I  have  ever  witnessed, 
intoxication  or  stupor,  or  any  other  of  those  peculiar  effects  on  the  brain, 
which  characterize  the  cerebral  stimulants  or  stimulating  narcotics  in 
full  action. 

The  habitual  use  of  coffee  in  excess  is  very  apt  to  occasion  a  train  of 
very  disagreeable  and  annoying  symptoms,  which  can  only  be  got  rid  of 
by  abandoning  the  habit.  The  constantly  repeated  over-excitement,  fol- 
lowed by  the  as  constant  depression  of  the  nervous  functions,  give  rise 
at  length  to  persistent  irregularity;  and  the  exhaustion  of  the  excitability 
of  the  nervous  centres  by  the  strain  to  which  they  are  subjected,  ends  in 
a  deficiency  of  power,  and  a  consequent  insubordination  of  all  the  func- 
tions placed  under  their  regulating  influence.  These  effects  are  espe- 
cially displayed  in  persons  of  susceptible  nervous  temperament,  and 
those  of  sedentary  habits.  Some  individuals  appear  to  be  almost  insus- 


616  GENERAL   STIMULANTS.  [PART  II. 

ceptible  to  influence  of  any  kind  from  the  ordinary  use  of  coffee  ;  and  its 
effects,  whether  direct  or  indirect,  may  be  greatly  controlled  by  habits  of 
steady  and  vigorous  muscular  exercise.  Indigestion,  habitual  constipa- 
tion, and  torpor  of  the  liver,  are  among  the  effects  of  its  abuse  exhibited 
in  the  digestive  function  ;  nervous  headache,  sick-headache,  vertigo,  va- 
rious disorders  of  sight  and  hearing,  neuralgic  pains  and  an  infinite  di- 
versity of  disordered  sensation,  palpitations,  muscular  tremors,  hysterical 
symptoms  in  women,  hypochondriacal  in  men,  are  some  of  the  conse- 
quences of  the  same  abuse  in  the  nervous  system.  As  the  blood-vessels 
are  little  excited  directly  by  the  stimulant,  the  vascular  system  is  apt  to 
suffer  less  than  the  nervous;  and  it  is  unusual  to  encounter,  from  the 
abuse  of  coffee,  any  of  those  inflammations,  as  of  the  stomach,  liver, 
brain,  etc.,  which  are  so  apt  to  follow  the  use  of  the  cerebral,  or  even  the 
arterial  stimulants  in  excess.  Hence  it  happens  that,  unless  the  nervous 
disorder  has  been  so  long  continued  as  to  have  at  last  brought  about  or- 
ganic change,  all  that  is  necessary,  in  order  to  escape  from  the  evils,  is 
to  abandon  the  use  of  coffee. 

As  illustrative  of  the  above  statements  I  will  observe  that,  personally, 
being  of  a  somewhat  nervous  temperament,  I  am  unable  to  use  coffee 
steadily  without  much  suffering ;  and  the  same  peculiarity  belongs  to  most 
of  my  immediate  family.  For  years  I  was  troubled  with  frequently 
recurring  nervous  headache,  which  at  times  incapacitated  me  for  the  per- 
formance of  any  active  duty.  Scarcely  a  day  passed  without  some  un- 
easiness or  deranged  sensations  in  the  head  ;  such  as  roaring,  buzzing, 
and  singing  in  the  ears,  sounds  as  of  pounding,  or  bell-ringing  in  the 
distance,  swimming  or  vertiginous  feelings,  muscae  volitantes,  etc.,  etc. ; 
and  I  never  walked  in  the  streets  without  the  fear  of  a  sudden  attack  of 
these  symptoms,  which,  when  they  came,  took  away  all  mental  energy. 
It  occurred  to  me  that  a  single  cup  of  coffee,  which  I  was  in  the  habit 
of  taking  daily  in  the  morning,  and  to  which  I  had  reduced  myself 
from  the  necessity  of  escaping  the  dyspeptic  sufferings  which  a  more 
free  use  of  it  had  occasioned,  might  be  the  cause  of  these  distressing 
phenomena.  I  abandoned  the  habitual  use  of  it,  substituting  black  tea 
for  coffee;  and  from  two  weeks  after  that  time  up  to  the  present,  a 
period  of  many  years,  I  have  been  almost  entirely  free  from  the  symp- 
toms referred  to. 

I  was  once  called  to  a  female  patient  labouring  under  great  gastric 
uneasiness,  troublesome  palpitations,  distressing  nervous  disorder  of  va- 
rious kinds,  and  extreme  emaciation.  I  requested  to  see  her  tongue.  It 
was  covered  with  small  black  points,  which  she  told  me  proceeded  from 
some  burnt  coffee  she  had  been  chewing.  I  wished  to  know  if  she  was 
in  the  habit  of  using  coffee  freely.  "Yes,  doctor,"  she  replied,  "I  drink 
it  at  breakfast,  dinner,  and  supper,  and  chew  the  grains  between  whiles." 
I  requested  her  to  leave  off  the  use  of  it  entirely.  She  did  so,  and 


CHAP.  I.]         NERVOUS    STIMULANTS. — COFFEE    AND    TEA.  617 

quickly  recovered  her  health.  I  have  no  doubt  that  a  vast  deal  of 
disease  in  our  country,  especially  among  the  women,  who  in  general 
drink  coffee  habitually,  and  use  too  little  exercise,  originates  in  this 
cause  ;  and  I  have  often  been  able  to  afford  relief,  in  long  standing 
cases  of  distress,  by  the  simple  measure  recommended  in  the  above  case. 
I  have  dilated  more  largely  on  this  point  than  may  be  deemed  exactly 
in  accordance  with  the  general  scope  of  this  work;  but  I  am  desirous  of 
impressing  my  views  upon  the  profession,  feeling  confident  that,  if 
adopted,  they  will  lead  to  beneficial  results. 

Method  of  Operating.  The  immediate  effects  of  coffee  on  the  stomach 
result,  I  presume,  from  its  direct  contact  with  the  tissue.  Those  upon 
the  nervous  system  are  probably  produced  by  some  one  or  more  of  its 
ingredients  being  absorbed,  unaltered  or  modified,  into  the  circulation. 
I  do  not  know  that  any  positive  proof  has  been  adduced  upon  this  point. 
Certainly  caffein  does  not  escape  with  the  urine ;  and  the  odour  of  coffee 
is  not  sensible  in  the  breath  or  perspiration.  A  few  years  since  some 
interesting  experiments  were  made,  which  were  supposed  to  prove  that 
coffee  and  tea  diminish  the  rapidity  of  the  physiological  change  of  structure 
in  nutrition.  It  has  been  found  that  certain  miners,  and  other  labourers, 
are  enabled,  by  the  use  of  coffee,  to  do  as  much  work,  without  loss  of 
flesh  or  strength,  upon  a  much  smaller  amount  of  food,  as  when  they 
drink  water  alone  ;  and  the  experiments  of  Drs.  F.  W.  Bo'cker  and  Julius 
Lehmann  seemed  to  show,  that  the  quantity  of  urea  and  other  results  of  the 
metamorphosis  of  the  tissues,  lost  through  the  emunctories,  is  much  dimin- 
ished by  the  use  of  these  beverages.  (See  Brit,  and  For.  Med.-chirurg. 
Rev.,  Oct.  1854,  Am.  ed.,  p.  313.)*  These  are  important  results;  but 

*  These  results  have  be<=n  confirmed  by  the  experiments  of  Dr.  Wm.  A.  Ham- 
mond, of  the  U.  S.  Army,  who,  however,  found  all  the  constituents  of  the  urine, 
and  the  quantity  of  the  urine  itself,  to  be  diminished  under  the  use  of  coflFee  and 
tea,  which  may,  therefore,  merely  have  acted  as  astringents,  causing  a  retention  of 
the  urinary  matters  somewhat  longer  in  the  blood  than  in  the  state  of  health,  with- 
out any  reference  to  the  disintegration  of  the  tissues.  (Am.  Journ.  of  Mfd.  Set.,  N  S., 
xxxi.  p.  833.) — Note  to  the  second  edition. 

Experiments  by  Mr.  Charles  E.  Squarey,  a  report  of  which  was  presented  by  Dr. 
Garrod  to  the  Royal  Medical  and  Chirurgical  Society  of  London,  render  doubtful 
the  statements  above  made,  in  relation  to  the  effect  of  coffee  in  diminishing  the 
excretion  of  urea.  Mr.  Squarey's  conclusion  from  his  observations,  which  were 
made  on  the  human  subject,  was  that  coffee  neither  increases,  nor,  to  an  apprecia- 
ble extent,  diminishes  the  proportion  of  urea  eliminated  by  the  kidneys  (Med.  T. 
and  Gaz.,  Dec.  2,  1865,  p.  613.)  The  researches  of  C.  Voil,  previously  made,  upon 
the  effects  of  coffee  on  dogs,  are  of  a  similar  bearing  as  to  the  diminution  of  the 
urea,  which  he  found  rather  to  be  increased  than  otherwise.  (Am.J.of  Med.  Set., 
Oct.  1862,  p.  507.)  Still  stronger  is  the  statement  of  Dr.  Geo.  Harley,  who  asserts, 
as  the  result  of  his  own  observation,  that  coffee  directly  increases  the  excretion  of 
urea;  and  ascribes  the  contrary  results  of  Bockerand  Hammond  to  their  probably  hav- 
ing drank  their  coffee  with  sugar,  which  is  well  known  to  have  the  effect  of  lessening 


618  GENERAL   STIMULANTS.  [PART  II. 

I  would  attach  a  different  explanation  to  them.  It  is  difficult  to  con- 
ceive how  stimulant  medicines,  which  are  acknowledged  to  increase  the 
activity  of  the  functions,  particularly  those  of  digestion  and  of  the  nerv- 
ous system  generally,  can  diminish  the  amount  of  organic  change  which 
takes  place  in  the  exercise  of  the  functions.  It  is  much  more  probable 
that  these  substances  act  by  enabling  the  digestive  organs,  and  others 
concerned  in  the  conversion  of  the  food  into  blood,  to  effect  this  conver- 
sion more  thoroughly,  and  thus,  not  only  to  enable  the  system  to  do 
with  less  food,  as  the  little  which  is  used  is  thoroughly  appropriated, 
but  to  diminish  also  the  amount  of  excretion ;  because  the  food  being 
converted  more  thoroughly  into  blood,  is  less  wasted  by  those  imperfect 
attempts  at  assimilation  which  only  effect  the  change  partial^,  and 
cause  the  remainder  of  the  food  to  be  thrown  off  in  the  form  of  urea. 
A  proof  of  the  correctness  of  this  view  is  afforded  by  experiments  of  Dr. 
Bocker,  which  show  that  not  only  is  the  urea  thrown  off  by  urine  dimin- 
ished, but  the  amount  of  feculent  matter  discharged  from  the  bowels  is 
remarkably  diminished  also  (Ibid.)  Now  it  is  much  easier  to  conceive 
how  a  more  thorough  consumption  of  the  food  shall  produce  this  dimi- 
nution of  feculent  discharge,  than  that  the  same  thing  shall  be  effected 
by  a  reduction  in  the  activity  of  the  metamorphosis  of  the  tissues  in 
the  nutritive  process.  Besides,  it  is  the  nitrogenous  articles  of  food  only 
to  which  the  remark  applies;  and  these  are  the  very  articles  which 
alone  can  furnish  urea  by  their  imperfect  conversion  into  blood  or  solid 
tissue.  I  believe,  therefore,  that,  should  this  important  result  be  verified, 
it  would  be  really  ascribable  to  the  stimulant  influence  of  the  medicines 
upon  the  processes  of  digestion  and  assimilation,  by  which  the  nitroge- 
nous food  is  more  thoroughly  converted  into  blood  and  consumed  in  nu- 
trition, and  consequently  less  of  it  escapes  from  the  bowels  undigested, 
and  less  from  the  kidneys,  in  the  form  of  urea,  in  consequence  of  im- 
perfect assimilation.*  It  is  stated  by  Dr.  Lehmann  that,  in  persons  fol- 
lowing an  active  occupation,  the  use  of  an  ounce  of  roasted  coffee  in 
infusion  daily,  reduces  the  daily  waste  one-fourth,  and  consequently  di- 
minishes, in  the  same  proportion,  the  quantity  of  nitrogenous  food  neces- 
sary to  health.  (Ed.  Month.  Journ.  of  Med.,  Jan.  1855,  p.  9.)  It  is  not 
at  all  improbable,  that  the  highly  nitrogenous  caffein  is  itself  decom- 


the  discharge  of  this  principle.  (Med.  Times  and  Gaz.,  April,  1864,  p.  419.)  At  pres- 
ent, therefore,  the  question  must  be  considered  as  undecided  ;  but  in  uo  event  can 
coffee  be  considered  as  exercising,  in  its  immediate  operation,  a  depressing  influ- 
ence on  the  nutritive  process.  (Note  to  the  third  edition.) 

*  Confirmatory  of  these  views  are  the  results  of  experiments  by  Dr.  John  C. 
Draper,  •which  prove  that  muscular  exercise  does  not  materially  increase  the 
amount  of  urea  in  the  urine;  while  an  increase  of  food  has  this  effect.  (N.  }'. 
Journ.  ofMed.,  N.  8.,  xvi.  1G7.) 


CHAP.  I.]         NERVOUS   STIMULANTS. — COFFEE   AND   TEA.  619 

posed,  and  made  to  contribute  to  the  nourishment  of  the  body;  so  that 
in  this  way  also  the  necessary  proportion  of  food  is  diminished. 

In  relation  to  the  different  actions  of  the  several  constituents  of  roasted 
coffee,  Dr.  Lchmann  thinks  he  has  proved  that  the  empyreurnatic  oil  is 
that  which  most  powerfully  contributes  to  the  results  just  stated,  while 
it  operates  as  a  laxative,  diaphoretic,  and  diuretic,  invigorates  the  intel- 
lect, and,  in  excessive  doses,  produces  irregular  mental  action,  restless- 
ness, and  insomnolency.  Caffe.in  he  found,  in  excess,  to  occasion  rigors, 
acute  pulse,  urinary  disorder,  headache,  and  delirium.  (Ibid.,  p.  314.) 
Experiments  with  caffein  upon  the  lower  animals  seem  to  prove  that  it 
is  poisonous  in  large  doses.  (Banking's  Abstract,  No.  29,  p.  286.) 

The  vapoury  from  roasted  coffee  appear  to  have  a  powerful  deodoriz- 
ing effect,  not  merely  by  covering  the  offensive  smell,  but  by  decompos- 
ing the  effluvia  in  which  it  originates.  (See  Am.  Journ.  of  Pharm., 
xxviii.  183.)  They  appear  also,  when  largely  inhaled,  to  be  capable  of 
producing  very  serious  effects  on  the  nervous  system.  The  cases  of  two 
soldiers  are  recorded  by  Dr.  L.  Traver,  U.  S.  N.,  who,  in  consequence  of 
smoking  coffee  as  a  substitute  for  tobacco,  for  a  period  of  about  ten  days, 
were  seized  with  a  species  of  insanity.  They  either  wandered  about 
seemingly  unconscious  of  what  was  going  on  around  them,  or  sat  as  if 
in  ruminating  silence,  starting  with  surprise  when  spoken  to,  staring  at 
the  speaker  with  a  vacant  and  dejected  look,  and  trembling  with  ap- 
parent apprehension  of  some  evil  to  come.  In  consequence  of  their 
removal  from  the  regiment,  Dr.  Traver  lost  sight  of  them,  and  was  igno- 
rant of  the  result.  (Med.  and  Surg.  Reporter,  April  1,  1865,  p.  406.) 

Tea  differs  in  its  effects  from  coffee  mainly  in  degree.  It  is  less  stim- 
ulant to  the  nervous  system,  less  apt  to  oppress  the  stomach,  probably 
quite  as  efficient  as  a  tonic  to  the  digestive  organs,  and  more  astringent 
in  consequence  of  the  amount  of  tannic  acid  it  contains.  Certain  it  is 
that  tea,  especially  black  tea,  may  be  drank  habitually  with  impunity  by 
persons  who  cannot  use  coffee  without  suffering,  and  that  it  sits  more 
lightly  on  the  stomach.  In  febrile  diseases,  a  cup  of  tea  is  often  not 
only  tolerated,  but  agreeable  to  the  patient,  and  refreshing  in  its  effects ; 
while  coffee,  however  much  it  may  be  relished  in  health,  is  usually  re- 
pulsive to  the  patient  in  a  fever,  and  not  well  accepted  by  the  stomach 
or  the  system. 

Therapeutic  Application.  Coffee  and  tea  came  into  use  in  Western 
Europe  about  the  middle  of  the  seventeenth  century.  Unfortunately, 
their  habitual  use  as  articles  of  diet  limits  very  much  their  therapeutic 
application.  The  system  is  so  much  accustomed  to  them,  that  their 
remedial  influence  can  scarcely  be  felt,  in  ordinary  doses.  • 

There  can  be  no  doubt  that,  under  other  circumstances,  they  would 
be  very  serviceable  in  dyspepsia,  the  very  disease  of  which,  through 
their  abuse,  they  are  among  the  most  frequent  causes.  Occasionally 


620  GENERAL    STIMULANTS.  [PART  II. 

used,  they  would  serve  as  agreeable  tonics  in  these  cases,  in  which  they 
would  also  l)e  recommended  by  their  cheering  influence  upon  the  spirits, 
ordinarily  so  much  depressed  in  that  complaint.  If,  instead  of  using 
them  at  the  morning  meal,  when  the  stomach  and  system  are  most  ex- 
citable, we  should  restrict  their  employment  to  the  close  of  dinner,  as 
is  done  with  coffee  in  France,  they  might  prove  serviceable  by  facilita- 
ting the  digestion  of  the  food,  and  rendering  it  less  oppressive  to  the 
stomach,  while  their  injurious  influence  on  the  nervous  centres  would  be 
less  felt. 

Thus,  too,  to  those  who  do  not  habitually  abuse  them,  they  would  be 
found  an  admirable  restorative  in  the  exhaustion  of  excessive  labour, 
mental  or  physical,  and  an  excellent  corrective  of  mental  disquietude 
arising  from  morbid  states  of  the  system,  or  the  vicissitudes  of  life. 

In  attacks  of  nervous  headache,  or  of  sick-headache,  they  often  afford 
great  relief  to  patients  not  insensible  by  habit  to  their  effects;  and  even 
in  those  who  have  brought  on  habitual  headache  and  nervous  disorder 
by  their  abuse,  they  will  often  control  temporarily  the  paroxysm  of  those 
affections  if  given  very  freely;  just  as  ardent  spirit  will  relieve,  for  a 
time,  the  horrors  which  have  originated  in  its  continued  excess. 

Their  influence  in  producing  wakefuluess  may  sometimes  be  taken 
advantage  of,  in  lethargic  and  soporose  conditions  of  the  system,  with 
good  effect.  They  have,  with  this  view,  been  recommended  in  the  stupor 
of  low  fevers;  and  a  cup  of  tea  occasionally  given  may  prove  useful  in 
that  condition;  but  coffee  is  usually  too  heavy  upon  the  stomach,  and 
might  be  injurious  by  disturbing  that  organ. 

In  narcotic  poisoning,  these  medicines  are  obviously  indicated.  The 
stupor  from  this  cause  may  depend  either  upon  a  direct  sedative  influ- 
ence on  the  nervous  centres,  as  from  chloroform,  or  upon  active  conges- 
tion, as  from  opium,  alcohol,  belladonna,  etc.  In  either  case,  coffee,  as 
the  stronger  of  the  two  medicines  in  its  stimulant  powers,  may  lie  use- 
fully employed.  In  both  cases,  it  relieves  by  its  general  diffusive  stimu- 
lation of  the  nervous  centres,  causing  a  more  equable  distribution  of  the 
nervous  force,  thus  supplying  the  deficiency  in  the  one  instance,  and 
unloading  the  overwhelmed  centres  in  the  other.  Experience  has  proved 
it  to  possess  considerable  efficacy  in  obviating  the  stupefying  effect  from 
poisonous  doses  of  opium.  Though  it  should  never  be  relied  on  exclu- 
sively in  cases  of  this  kind,  it  may  be  used  conjointly  with  other  methods ; 
and,  after  the  evacuation  of  the  poison,  is  among  the  best  means  not 
only  of  preventing  stupor,  but  also  generally  of  supporting  the  system 
in  its  tendency  to  collapse.  It  must,  however,  be  given  strong  and 
freely  to  produce  much  effect.  In  the  same  way,  it  proves  useful  in  dis- 
sipating slight  effects  from  alcoholic  liquors ;  and  the  habitual  use  of  it, 
at  the  close  of  dinner,  is  sometimes  advantageous  in  other  methods  than 
by  promoting  the  digestion  of  the  food. 


CHAP.  I.]          NERVOUS   STIMULANTS. — COFFEE    AND    TEA.  621 

In  the  paroxysm  of  spasmodic  asthma,  strong  coffee  often  affords  con- 
siderable relief.  It  should  be  given  quite  saturated,  and  in  the  dose  of 
a  cupful  every  twenty  or  thirty  minutes. 

In  hooping-cough,  too,  it  has  been  highly  recommended,  given  at  the 
close  of  each  meal.  It  is  only  in  children  unaccustomed  to  its  use  that  it 
could  be  expected  to  be  beneficial ;  and  in  these  it  may  at  least  be  tried 
with  the  hope  of  advantage.  The  editors  of  the  Boston  Medical  and 
Surgical  Journal  (May  16,  1861,  p.  333)  say  that  they  have  used  it  in 
several  instances,  with  marked  advantage.  In  one  case,  that  of  a  girl 
six  years  old,  the  hooping  ceased  entirely  after  she  had  begun  with  the 
prepared  coffee,  of  which  she  took  a  tablespoonful  and  a  half,  made  very 
strong,  three  times  daily. 

I  have  heard  of  a  case  of  ordinary  catarrhal  or  spasmodic  croup,  in 
which  it  relaxed  the  spasm,  and  seemed  to  be  the  cause  of  cure. 

In  attacks  of  nervous  dyspncea  and  palpitation  of  the  heart,  coffee  is 
said  to  have  proved  highly  useful ;  and,  though  it  might  be  deemed  in- 
adequate to  the  cure  of  so  serious  an  affection  as  angina  pectoris,  it  might 
be  employed  along  with  other  measures,  given  as  above  recommended 
in  spasmodic  asthma. 

It  is  asserted  to  have  proved  very  useful  in  strangulated  hernia. 
(British  Hed.  Journ.,  Nov.  1857,  p.  926.) 

Coffee  has  been  found  effectual  in  many  cases  of  intermittent  fever. 
Its  strong  influence  upon  the  nervous  centres,  through  which  each  par- 
oxysm of  an  intermittent  disease  probably  makes  its  approach,  might  be 
expected  to  endow  it  with  a  certain  amount  of  antiperiodic  power.  In 
some  parts  of  Greece,  it  is  said  by  Dr.  Pouqueville  to  be  very  success- 
fully used  in  connection  with  lemon-juice.  At  least  an  ounce  of  the 
powder  must  be  employed,  in  the  form  of  decoction  or  infusion,  between 
the  paroxysms. 

Other  complaints  in  which  it  has  been  recommended  are  cholera  in- 
fantum,  diarrhoea,  calculous  affections,  and  ameuorrhoea. 

It  has  also  been  used  to  cover  the  taste  of  sulphate  of  magnesia,  castor 
oil,  sulphate  of  quinia.  etc..  which  maybe  administered  in  it  as  a  vehicle  ; 
but  it  is  said  not  to  be  effectual  for  this  purpose,  unless  the  mixture  is 
heated  for  a  time  to  the  boiling  point. 

Administration.  Coffee  may  be  used  in  medicine  in  the  form  of  pow- 
der, decoction,  or  infusion.  Of  the  powder,  a  drachm  or  two  may  be  taken 
for  a  dose ;  but  it  is  very  seldom  used  in  this  way.  The  decoction  may 
be  made  by  boiling  an  ounce  of  the  coarse  powder  in  a  pint  of  water  for 
a  short  time,  and  then  clarifying  by  the  white  of  an  egg.  The  infusion 
is  best  prepared  by  the  process  of  percolation.  A  cupful  of  either  may 
be  given  for  a  dose,  and  repeated,  if  necessary. 

Caffein,  in  the  form  of  citrate,  has  been  recommended  as  a  remedy  or 
preventive  of  sick-headache,  in  the  dose  of  a  grain  every  hour,  before 


622  GENERAL    STIMULANTS.  [PART  II. 

or  during  the  paroxysm.  Caffein  itself,  in  doses  varying  from  two  to 
ten  grains,  was  found  by  Lehmann  to  produce  vehement  excitement  of 
the  nervous  and  circulatory  systems,  with  palpitations,  oppression  of 
chest,  headache,  perversion  of  hearing  and  sight,  sleeplessness,  erec- 
tions, and  delirium.  Prof.  II.  T.  Campbell,  of  Georgia,  administered 
twenty  grains  of  it,  dissolved  in  infusion  of  cofi'ee,  by  enema,  in  a  case  of 
poisoning  by  laudanum  in  which  the  patient  could  not  swallow,  with  the 
apparent  effect  of  rescuing  him  from  impending  death.  (Am.  Journ.  of 
Pharm.,  xxxii.  321,  from  South.  Med.  and  Surg.  Journ.  for  May,  1860.) 
Tea  is  always  given  in  infusion.  It  is  probably  preferable  to  coffee, 
especially  the  green  variety,  when  given  very  strong,  as  a  preventive  or 
cure  of  sick-headache.  As  a  refreshing  drink  in  febrile  diseases  it  is  also 
preferable,  being  much  more  agreeable  to  the  patient  and  acceptable  to 
the  stomach.  In  diarrhoea,  too,  it  might  be  expected  to  prove  more  effec- 
tual than  coffee,  through  its  astringency.  In  consequence  of  the  tannic 
acid  it  contains,  it  might  be  used  as  an  antidote  to  tartar  emetic;  and  I 
have  often  employed  it,  on  the  same  account,  as  a  gargle  in  mercurial 
sore-mouth. 


There  are  several  other  substances  which  merit  a  brief  notice  here,  either 
from  former  reputation,  or  from  their  greater  or  less  efficiency,  though  at 
present  not  much  employed  as  nervous  stimulants,  at  least  in  this 
country. 

1.  RECTIFIED  OIL  OF  AMBER — OLEUM  SUCCINI  RECTIFICATUM. 

U.S. 

Oil  of  Amber  (OLEUM  SUCCINI,  U.  £),  in  its  impure  commercial 
form,  is  obtained  from  amber  by  subjecting  it,  mixed  with  sand,  to  dry 
distillation.  A  sour  liquid  comes  over,  on  the  surface  of  which  a  very 
dark-coloured  oil  floats,  which  is  removed,  and  constitutes  the  crude  oil 
of  commerce.  The  rectified  oil  is  obtained  from  this  by  distillation 
with  water. 

Rectified  oil  of  amber  thus  obtained  is  of  a  light  yellowish-brown  or 
amber  colour,  a  strong,  peculiar,  disagreeable  odour,  and  a  hot  acrid 
taste.  It  is  insoluble  in  water,  but  is  dissolved  by  alcohol  and  the  fixed 
oils.  Exposed  to  the  air,  it  absorbs  oxygen,  and  gradually  darkens  and 
thickens,  until  at  last  it  becomes  black  and  solid.  It  consists,  when 
pure,  of  carbon  and  hydrogen,  but  contains  oxygen  as  found  in  the 
shops. 

Medical  Properties  and  Uses.  Oil  of  amber  is  locally  and  generally 
stimulant,  exciting  both  the  circulation  and  the  nervous  system,  and 
sometimes  promoting  the  secretions.  It  has  been  employed  in  most  of 
the  diseases  to  which  this  class  of  medicines  are  considered  applicable  ; 


CHAP.  I.]      NERVOUS  STIMULANTS. — DRACONTIUM.          623 

as  tetanus,  epilepsy,  hysteria,  hooping-cough,  and  the  convulsive  affec- 
tions of  children.  It  has  also  been  given  in  amenorrhoaa.  The  dose  is 
from  five  to  fifteen  drops,  which  may  be  most  agreeably  given  in  emul- 
sion, made  with  gum  arabic,  sugar,  and  one  of  the  aromatic  waters. 

The  oil  has  been  used  locally,  as  an  antispasmodic  liniment,  rubbed 
on  the  skin  along  the  whole  length  of  the  spine,  in  hooping-cough,  and 
infantile  convulsions.  It  has  also  been  employed  in  chronic  rheumatism 
and  palsy,  as  a  rubefacient.  In  the  convulsions  of  children,  connected 
with  intestinal  spasm,  the  late  Dr.  Joseph  Fairish  was  in  the  habit  of- 
using  a  liniment  composed  of  equal  parts  of  this  oil  and  laudanum, 
mixed  with  three  or  four  parts  of  olive  oil  and  brandy.  It  was  rubbed 
freely  along  the  spine.  It  is  said  to  be  a  very  efficient  remedy  for  piles, 
applied  locally  to  the  tumours.  (Prof.  Procter,  Am.  Journ.  of  Pharm., 
May,  1866,  p.  21 T.) 

2.  DRACONTIUM.  U.S. 

This  is  the  root  of  Symplocarpus  fcetidus,  or  common  skunk  cabbage, 
an  indigenous  plant,  with  broad  cabbage-like  leaves,  and  a  very  fetid 
odour,  growing  in  low  meadowy  or  swampy  places,  throughout  the 
northern  and  middle  sections  of  the  United  States.  The  root  should  be 
collected  twice  a  year,  if  possible,  early  in  the  spring  and  late  in  the 
autumn,  should  be  carefully  dried  without  heat,  and  then  kept  in  closely- 
stopped  bottles.  It  should  not  be  kept  in  powder. 

Properties.  There  are  two  parts  of  the  root,  the  body  and  the  radicles 
or  rootlets,  which  are  separated  when  collected.  The  body,  as  kept  in 
the  shops,  is  either  whole  or  in  slices.  In  the  former  state,  it  is  two  or 
three  inches  long  by  an  inch  thick,  dark-brown  and  rough  externally, 
and  white  and  starchy  within ;  in  the  latter,  it  is  in  circular  pieces,  which 
are  transverse  sections  of  the  root.  The  radicles  are  of  various  lengths, 
about  as  thick  as  a  hen's  quill,  flattened  and  wrinkled,  white  within,  and 
invested  by  a  light  brownish-yellow  epidermis. 

The  root  has  a  peculiar,  extremely  fetid  odour,  which  is  strongest  in 
the  recent  state,  is  retained,  however,  in  drying,  but  gradually  lessens, 
and  at  length  disappears.  The  taste  is  acrid,  and  in  like  manner  is  in- 
jured by  time.  A  boiling  heat  deprives  the  root  both  of  smell  and  taste. 
These  sensible  properties  are  connected  with  one  or  more  highly  fugitive 
principles,  which  it  has  been  found  impossible  to  isolate,  probably  be- 
cause they  are  destroyed  in  the  process.  Dr.  Bigelow  found  that  water 
distilled  from  the  root  was  but  feebly  impregnated  with  the  odorous 
principle,  but  was  somewhat  acrid,  if  the  process  were  carefully  con- 
ducted. It  lost  its  acrimony,  however,  on  standing  a  short  time.  (Ned. 
Bot.,  ii.  46.)  The  root  is  said  to  yield  its  virtues  to  water  and  alcohol. 
It  should  not  be  kept  longer  than  a  year  for  use. 

Medical  Uses.  Pracontium  is  locally  irritant,  and,  in  its  effects  on  the 
system,  stimulant  both  to  the  circulation  and  nervous  centres;  and  it  is 


624  GENERAL   STIMULANTS.  [PART  II. 

thought  also  by  some  to  be  expectorant.  The  Rev.  Dr.  Cutler,  of  Mas- 
sachusetts, introduced  it  to  the  notice  of  the  profession  as  a  remedy  or 
palliative  in  the  paroxysms  of  spasmodic  asthma,  in  which  he  had 
found  benefit  from  it  in  his  own  person.  Many  practitioners  have  con- 
firmed the  statements  of  Dr.  Cutler.  Dr.  Bigelow  has  seen  a  number  of 
instances  in  which  it  proved  useful  in  the  catarrhal  affections  of  old 
people;  and  Dr.  Eberle  gives  similar  testimony,  from  his  own  expe- 
rience, of  its  effects  in  chronic  cough  "attended  with  a  cold  phlegmatic 
habit  of  body."  (Mat.  Med.  and  Therap.,  4th  ed.,  ii.  154.)  It  is  prob- 
ably useful  in  these  catarrhal  affections  mainly  by  its  stimulant  influence 
on  the  nervous  centres  of  respiration.  Dr.  Thacher,  in  his  Dispensa- 
ton~,  states  that  it  has  been  found  useful  in  hysteria,  hooping-cough, 
spasmodic  pains,  chronic  rheumatism,  and  dropsy.  Dr.  Heintzelman 
has  used  it,  "with  unequivocal  benefit,"  in  hooping-cough,  in  the  spas- 
modic stage ;  finding  it,  when  not  successful  in  completely  eradicating 
the  disease,  almost  always  to  mitigate  the  severity  of  the  symptoms. 
(N.  J.  Med.  Reporter,  iv.  310.)  He  has  also  used  it  advantageously  in 
phthisis.  There  can  be  little  doubt  that  it  is  a  very  efficacious  nervous 
stimulant,  when  used  in  sufficient  doses,  and  before  its  virtues  have  been 
impaired  by  time.  As  kept  in  the  shops,  it  is  often  nearly  or  quite 
inert;  and  its  great  disadvantage  is  that,  in  the  uncertainty  as  to  its 
strength,  it  is  impossible  properly  to  graduate  the  dose  unless  it  be 
quite  recent.  The  practitioner  in  the  country  can  always  command 
it  of  full  strength;  for  it  is  almost  everywhere  abundant  in  the  low 
grounds. 

The  dose  of  the  recently  dried  root  in  powder,  to  begin  with,  is  from 
ten  to  twenty  grains,  three  or  four  times  a  day.  Dr.  Bigelow  found 
thirty  grains  of  it  to  occasion  vomiting,  vertigo,  headache,  and  dimness 
of  vision.  But  it  has  been  given  in  larger  doses  with  entire  impunity; 
and  the  probability  is  that  different  individuals  are  affected  by  it  with 
different  degrees  of  facility.  The  dose  above  recommended,  if  it  produce 
no  obvious  effect,  should  be  gradually  increased  till  it  does  so,  in  order 
to  determine  the  degree  of  its  activity.  It  may  be  given  also  in  strong 
cold  infusion,  in  tincture,  or  syrup.  The  infusion  should  be  made  by 
percolation  with  cold  water,  in  the  proportion  of  an  ounce  of  the  recently 
dried  root  to  the  pint,  and  given  in  the  commencing  dose  of  half  a  fluid- 
ounce  to  an  adult.  An  infusion,  prepared  in  the  same  way,  but  of  four 
times  the  strength,  may  be  formed  into  a  syrup  with  twice  its  weight  of 
sugar,  and  given  in  half  the  dose.  The  dose  of  a  saturated  tincture  is 
stated  at  one  or  two  flnidrachms. 

3.  CYPRIPEDIUM.  U.  S. 

Under  this  title,  has  been  introduced  into  the  U.  S.  Pharmacopeia 
the  root  of  Cypripedium  pubescens,  one  of  several  species,  which, 


CHAP.  I.]  NERVOUS    STIMULANTS. — SAFFRON.  625 

with  the  common  name  of  ladies1  slipper  or  moccasin  plant,  inhabit  the 
woods  in  different  parts  of  the  United  States.  They  are  small  perennial 
herbs,  with  beautiful  and  conspicuous  flowers,  which,  from  their  peculiar 
shape,  have  given  rise  to  the  name  by  which  the  plants  are  commonly 
designated.  The  medical  virtues  of  the  different  species  are  probably 
identical  or  nearly  so,  and  several  of  them  are  indiscriminately  employed. 
The  root  of  the  officinal  species  consists  of  numerous  somewhat  contorted 
radicles,  four  or  five  inches  long,  which  unite  in  a  common  head  or  caudcx. 
It  has  an  aromatic  odour,  and  a  peculiar,  sweetish,  pungent,  and  bitter 
taste,  and  imparts  its  virtues  to  water  and  alcohol.  These  appear  to 
consist  in  a  moderate  stimulant  power,  directed  especially  to  the  nervous 
system,  which  renders  the  root  useful  in  various  nervous  diseases,  as 
hysteria,  hypochondriasis,  morbid  sensitiveness,  neuralgia,  etc.  The 
dose  of  the  powder  is  about  fifteen  grains  three  times  a  day.  A  resinoid 
matter  obtained  by  precipitating  the  tincture  with  water,  improperly 
called  cypripedin,  has  been  given  in  doses  varying  from  half  a  grain  to 
three  grains.  The  medicine  may  be  administered  also  in  infusion ;  and 
a  fluid  extract  would  probably  be  an  eligible  preparation  were  the  remedy 
much  used. 

4.  SAFFRON.  — CROCUS.  U.  S.,  Br. 

The  term  saffron  is,  in  common  language  as  well  as  officinally,  used  to 
designate  a  product  of  the  Crocus  sativus,  or  common  cultivated  saffron, 
consisting  of  the  convoluted  stigmas  and  a  portion  of  the  attached  style, 
separated  from  other  parts  of  the  flower.  The  plant  is  a  native  of  Greece 
and  Asia  Minor,  and  is  cultivated  in  most  of  the  temperate  regions  of 
Europe,  as  well  as  in  Egypt,  Persia,  and  Cashmere.  It  is  cultivated 
also  in  the  United  States,  not  only  in  our  gardens  as  an  ornamental 
plant,  but  to  some  extent,  moreover,  for  medical  use.  The  saffron,  how- 
ever, used  in  this  country  is  generally  imported;  and  most  of  it  is  brought 
from  Gibraltar,  Trieste,  and  other  Mediterranean  ports.  As  a  medicine, 
it  is  so  little  valued  as  hardly  to  merit  a  place  in  a  Materia  Medica  cata- 
logue ;  yet  it  is  still  much  used  as  an  ingredient  in  various  officinal  pre- 
parations, especially  tinctures,  in  which  it  was  formerly  supposed  to  per- 
form an  active  part  remedially,  but  in  which  it  is  now  retained,  partly 
because  it  adds  a  certain  richness  of  appearance  to  these  preparations, 
and  partly  from  an  unwillingness  to  disturb  long  established  formulas. 
It  is,  therefore,  an  object  of  interest  much  more  to  the  pharmaceutist  than 
the  physician ;  and  I  must  content  myself  with  referring,  for  its  sensible 
and  chemical  properties,  to  the  U.  S.  Dispensatory ;  merely  stating  here 
that  it  has  a  rich  deep-orange  colour,  a  sweetish,  aromatic  odour,  and 
a  warm,  bitter,  somewhat  pungent  taste,  and  yields  all  its  virtues  to 
water  and  alcohol. 

It  was  formerly  very  highly  esteemed  as  a  medicine,  and  was  sup- 

VOL.  i. — 40 


626  GENERAL    STIMULANTS.  [PART  II. 

posed  to  possess  extraordinary  powers  as  an  anodyne,  antispasmodic, 
emmenagogue,  etc.;  but  it  is  believed  at  present  to  have  little  remedial 
power  of  any  kind.  The  most,  probably,  that  can  be  said  of  it  is,  that 
it  is  a  moderate  nervous  stimulant,  and  may  possibly  add  somewhat  to 
the  efficiency  of  other  remedies,  with  which  it  is  combined  chiefly  in 
reference  to  its  sensible  properties.  In  domestic  practice,  it  is  sometimes 
used  in  the  form  of  hot  infusion,  to  hasten  the  appearance  of  the  erup- 
tion, in  certain  exanthematous  fevers,  as  measles  and  scarlatina,  when 
from  any  cause  delayed,  or  to  restore  it  if  suppressed. 

An  officinal  Tincture  (TINCTURA  CROCI,  Br.)  may  be  used  internally 
in  the  dose  of  one  or  two  fluidrachms  ;  but  is  employed  mainly  to  give 
flavour  and  colour  to  other  liquid  preparations. 

The  dose  of  saffron  itself  is  stated  at  from  ten  to  thirty  grains. 

5.  COCHINEAL.  — Coccus  CACTI.  U.S.,Br. 

This,  like  the  substance  just  treated  of,  is  much  more  used  for  its  sen- 
sible than  for  its  remedial  properties.  Little,  therefore,  need  be  said  of 
it  here  ;  but  the  reader  will  find  it  described,  in  relation  to  all  its  prop- 
erties, in  the  U.  S.  Dispensatory.  Cochineal  is  a  dried  insect,  desig- 
nated as  the  Coccus  Cacti,  because  it  inhabits  different  species  of  the 
genus  Cactus  and  allied  genera,  especially  the  Opuntia  cochinillifera, 
or  Nopal  plant  of  Mexico.  It  is  from  that  country  that  cochineal  is 
chiefly  imported,  though  it  and  the  plant  on  which  it  feeds  are  now  cul- 
tivated in  other  countries,  and  especially  the  Canary  Islands.  The  mass 
of  cochineal  consists  of  grains,  which  are  the  whole  dried  insect,  irregu- 
larly round  or  oval,  convex  on  one  side,  convex  or  flat  on  the  other, 
about  one-eighth  of  an  inch  in  diameter,  marked  with  transverse  wrinkles, 
and  either  of  a  reddish-gray  or  blackish  colour.  It  has  a  faint  heavy 
odour,  a  bitter  acidulous  taste,  and  in  powder  a  purplish  carmine  colour. 
When  chewed,  it  stains  the  saliva  intensely  red;  and  it  owes  its  chief 
value  to  a  colouring  principle,  denominated  cochinilin,  which  is  of  a  bril- 
liant purple-red,  and  imparts  its  colour  to  water,  alcohol,  and  ether,  all  of 
which  dissolve  it.  It  is  precipitated  from  its  watery  solution  by  various 
metallic  salts,  with  the  bases  of  which  it  forms  insoluble  compounds,  of 
a  rich  red  colour.  The  pigment  called  lake  is  a  compound  of  cochinilin 
and  alumina.  Carmine  is  the  colouring  principle  precipitated  by  the 
salts  of  tin. 

In  relation  to  its  medicinal  properties,  cochineal  may  be  slightly  stim- 
ulant to  the  nervous  system,  and  has  been  recommended  in  hooping- 
cough  and  neuralgia.  In  the  former  of  these  complaints,  a  liquid  mix- 
ture containing  cochineal  and  carbonate  of  potassa,  was  highly  recom- 
mended by  the  late  Prof.  Chapman, -of  the  University  of  Pennsylvania. 
It  is  more  used,  however,  as  a  colouring  agent  than  as  a  remedy.  The 
dose  for  an  infant  is  one-third  of  a  grain  three  times  a  day. 


CHAP.  I.]  NERVOUS    STIMULANTS. — COCA.  627 

The  Tincture  (TiNCTURA  Cocci,  Br.),  which,  as  directed  in  the  Brit- 
ish Pharmacopoeia,  contains  the  virtues  of  two  and  a  half  avoirdupois 
ounces  in  an  Imperial  pint  (twenty  fluidounces)  of  spirit,  maybe  given 
in  a  dose  of  from  twenty  drops  to  a  fluidrachm,  but  is  chiefly  used  to 
give  colour  to  liquid  preparations. 

6.  COCA. 

Though  not  recognized  by  the  Pharmacopoeias,  and  scarcely  known  in 
this  country  except  as  an  imported  curiosity,  the  substance  thus  named 
exercises  over  the  system  an  influence  so  extraordinary,  that  it  would  be 
scarcely  justifiable  to  pass  it  wholly  unnoticed.  It  consists  of  the  dried 
leaves  of  Erythroxylon  Coca,  a  South  American  shrub,  extensively  cul- 
tivated in  Peru,  Bolivia,  and  other  neighbouring  countries,  where  its 
produce  was  in  common  use  before  the  Spanish  conquest.  The  leaves 
bear  a  considerable  resemblance  in  size  and  form  to  those  of  the  Chinese 
tea  plants,  and  when  dried'iiave  a  somewhat  similar  odour.  Their  taste 
is  peculiar,  with  some  bitterness  and  astringency  in  decoction.  Water 
and  alcohol  extract  their  virtues.  Besides  the  ordinary  constituents  of 
vegetables,  they  have  been  found  to  contain  a  concrete  odorous  principle, 
tannic  acid,  and  a  peculiar  crystallizable  alkaloid,  called  cocaina,  on 
which  their  virtues  probably  depend. 

The  effects  of  coca  on  the  system  appear  to  be  of  the  same  character 
as  those  of  tea  and  coffee,  though  more  powerful.  It  has  an  excitant  influ- 
ence on  the  nervous  system,  induces  wakefulness,  and  supports  the  strength 
under  an  amount  of  physical  exertion  which  would  be  impossible  without 
it.  The  natives  of  Peru  employ  it  habitually  to  invigorate  them  on 
the  occasion  of  any  unusual  exertion,  as  in  long  foot-journeys  in  the 
mountains,  where  they  act  as  porters,  in  the  labour  of  the  mines,  etc.; 
and,  while  under  its  influence,  they  can  support  fatigue  whole  days,  even 
without  food,  except  at  night.  They  carry  with  them,  on  such  occasions, 
a  bag  of  the  dried  leaves,  which  they  chew  continually.  They  who  are 
accustomed  to  its  use,  like  tobacco-chewers,  suffer  greatly  from  the 
want  of  it,  and  find  it  difficult,  if  not  impossible,  to  break  the  habit  when 
once  formed ;  yet  experience  has  not  shown  that  it  causes  any  great 
injury  to  the  health,  or  in  any  appreciable  degree  shortens  life.  The 
amount  consumed  by  an  Indian  daily,  under  the  circumstances  men- 
tioned, is  said  by  Dr.  Reis  (Bulletin  Gen.  de  Therap.,  Fev.  28,  1866) 
to  be  from  fifteen  to  twenty-five  grammes  (about  four  to  six  drachms). 
From  the  accounts  of  intelligent  persons  who  have  used  the  coca,  it  ap- 
pears to  exhilarate  the  spirits,  invigorate  the  faculties  both  mental  and 
physical,  inspire  courage,  and,  in  fact,  to  be  a  powerful  nervous  stimu- 
lant, as  this  term  is  defined  in  the  present  work.  In  excessive  doses,  as 
thirty  or  forty  grammes,  for  example,  it  excites  the  circulation,  and  in- 
duces a  febrile  condition,  often  attended  with  hallucination  and  delirium. 


628  GENERAL    STIMULANTS.  [PART  II. 

As  a  medicine,  it  would  probably  be  found  useful  in  most  of  the  affections 
to  which  the  nervous  stimulants  are  applicable,  and  especially  such  as 
are  benefited  by  the  use  of  tea  and  coffee.  In  South  America  it  has 
been  employed  successfully  in  the  treatment  of  intermittent  fever.  An 
apothecary  of  La  Paz  has  prepared  a  sulphate  of  cocaina,  which  is  said 
to  be  analogous  in  antiperiodic  powers  to  sulphate  of  quinia.  (Fuentes, 
Journ.  de  Pharm.  et  de  Chim.,  Oct.  1866,  p.  268.)  Coca  is  most  con- 
veniently used  in  the  form  of  infusion,  made  in  the  proportion  of  an 
ounce  to  the  pint  of  boiling  water,  of  which  one-third  or  one-half,  repre- 
senting the  virtues  of  three  or  four  drachms  of  the  leaves,  may  be  taken 
daily. 


CHAP.  I.]  CEREBRAL   STIMULANTS.  629 


III. 
CEREBRAL  STIMULANTS. 

Syn.   Stimulant  Narcotics. 

THESE  are  medicines  which,  to  a  stimulant  influence  over  the  circula- 
tion and  nervous  system  generally,  add  a  peculiar  power  over  the  special 
functions  of  the  brain,  as  evinced,  in  their  higher  grades  of  action,  by  de- 
lirium and  stupor.  Prom  their  stupefying  property,  they  have  been 
called  narcotics,  derived  from  the  Greek  verb  vapxsut,  which  signifies  to 
be  or  become  torpid,  dull,  or  stupid.  But  I  do  not  think  that  the  pos- 
session of  this  property  is  a  sufficient  basis  for  the  formation  of  a  class; 
for  it  belongs  to  medicines  quite  different  and  even  opposite  in  their 
modes  of  operation,  and  therapeutic  character.  Thus,  both  opium  and 
digitalis  are  capable  of  producing  stupor ;  but  the  former  is  directly  stim- 
ulant, and  the  latter  directly  sedative;  and  so  opposite  are  they  in  their 
effects  upon  the  system,  that  the  former  is  one  of  the  best  instruments 
for  controlling  the  excessive  action  of  the  latter.  Besides,  certain  medi- 
cines, as  alcohol  and  ether,  have  been  generally  excluded  from  the  narcotics. 
though  they  act  upon  the  brain  with  an  energy  scarcely  inferior  to  that 
of  any  acknowledged  substance  of  the  class,  and  are  both  jpwerfully  stu- 
pefying agents.  I  have  thought  it  best,  therefore,  to  abandon  the  old 
class  of  narcotics,  and  to  arrange  the  medicines  composing  it  according 
to  their  more  important  affinities ;  placing  in  separate  categories  the  stim- 
ulating and  the  sedative,  and  merely  retaining  the  word  narcotic  to  ex- 
press a  quality,  as  we  employ  the  terms  anodyne,  soporific,  etc. 

The  only  properties  in  which  all  the  medicines  of  this  class  agree  are 
those  stated  in  the  definition.  In  all  other  respects  they  differ  among 
themselves,  and  some  of  them  very  greatly.  In  the  first  place,  they  dif- 
fer very  much  in  the  degree  of  their  general  stimulant  power.  In  this 
respect,  alcohol  and  ether  may  be  placed  at  one  end  of  the  scale,  and 
henbane  at  the  other;  the  two  former  medicines  being  among  the  most 
powerful  stimulants  in  our  possession,  the  latter  having  no  more  of  this 
property  than  barely  sufficient  to  justify  its  position  in  the  class.  Sec- 
ondly, they  differ  in  the  degree  in  which  they  relatively  affect  different 
organs  or  functions.  Thus,  if  we  compare  alcohol  and  opium,  we  shall 
find  that  the  former  has  a  greater  proportional  influence  in  stimulating 
the  heart  aud  arteries,  the  latter  in  stupefying  the  brain.  Thirdly,  they 


630  GENERAL   STIMULANTS.  [PART  II. 

differ  in  the  manner  in  which  they  affect  precisely  the  part  or  organ  upon 
which  they  operate.  The  symptoms  of  cerebral  disturbance  produced 
by  alcohol  are  unlike  those  resulting  from  the  use  of  opium ;  and  both 
differ  materially  in  this  respect  from  belladonna.  Fourthly,  there  is,  for 
the  most  part,  in  each  one  of  them,  a  characteristic  mode  of  affecting 
some  function  apart  from  their  general  action  as  cerebral  stimulants. 
Thus,  opium  produces  constipation  of  the  bowels,  hyoscyamus  often  acts 
as  a  laxative,  and  belladonna  occasions  a  characteristic  dryness  and  irri- 
tation of  the  fauces. 

In  some  measure,  this  difference  of  action  may  be  accounted  for  by 
supposing,  that  the  influence  of  the  several  articles  of  the  class  is  di- 
rected more  especially  to  some  one  portion  of  the  brain  rather  than  to 
another,  though  all  parts  may  be  more  or  less  affected.  Thus  alcohol, 
from  its  peculiar  influence  on  the  voluntary  movements,  and  the  power- 
ful stimulation  it  exercises  upon  the  sexual  propensities,  may  be  sup- 
posed to  operate  more  especially  on  the  cerebellum ;  opium,  from  its 
great  stupefying  power,  to  act  on  the  cerebral  lobes  with  peculiar  en- 
ergy; belladonna,  from  its  property  of  impairing  vision,  to  have  a  more 
immediate  influence  on  the  optic  thalami  or  corpora  striata.  But  too 
little  is  yet  known  of  the  precise  functions  of  different  portion's  of  the 
encephalon,  or  of  the  phenomena  by  which  influences  upon  them  respect- 
ively could  be  recognized,  to  justify  any  very  decided  opinion  upon  the 
affinity  which  the  several  cerebral  stimulants  may  have  for  particular 
parts  of  that  structure. 

The  difference  in  the  effects  of  cerebral  stimulants  on  the  pupils  is  a 
striking  point  of  diversity  between  them,  which  has  attracted  much  at- 
tention, but  winch  only  recent  discoveries  in  relation  to  uervous  action 
enable  us  partially  to  explain.  Thus,  while  opium  often  contracts  the 
pupil,  belladonna  much  more  strikingly  produces  dilatation.  This  has 
been  considered  as  evincing  an  essential  antagonism  between  those  two 
narcotics.  It  only  proves  that,  in  reference  to  this  particular  effect,  t.h«-y 
either  act  differently  on  a  special  nervous  centre,  or  in  like  manner  on 
different  nerve  centres  with  which  these  phenomena  are  connected  ; 
while,  as  regards  their  general  action,  there  may  be  no  antagonist 
whatever.  Thus,  supposing  the  radiating  fibres  of  the  iris  to  be  excited 
by  the  sympathetic  nerve,  and  the  circular  by  nerves  from  near  the  bat>e 
of  the  brain,  as  the  third  or  fifth  pair,  and  these  forces  to  balance  each 
other  in  the  normal  state,  it  follows  that  whatever  excites  the  sympa- 
thetic centre  in  the  medulla  oblongata,  or  paralv/.cs  the  basic  centres 
referred  to,  will  produce  dilatation  of  the  iris,  while  a  paralyzing  influ- 
ence on  the  sympathetic  centres,  or  one  of  an  excitant  character  on  the 
others,  will  equally  produce  contraction ;  so  that,  while  two  cerebral 
stimulants  differ  in  their  mode  of  affecting  these  special  centres,  they 
may  correspond  in  their  effects  on  the  remainder  of  the  cerebro-spinal 


CHAP.  I.]  CEREBRAL  STIMULANTS.  631 

axis,  or  while  one  acts  on  one  of  the  centres,  and  the  other  on  the  other, 
they  may  both  act  in  the  same  manner,  and  with  the  same  effect,  that 
is,  may  both  be  excitant,  or  both  depressing. 

Though  differing  so  much  among  themselves,  there  are  affinities  be- 
tween certain  articles  of  the  class,  which  might  serve  to  arrange  them 
in  subdivisions,  having,  to  a  considerable  extent,  a  common  therapeutic 
basis.  They  might  thus  be  arranged  in  groups,  of  which  one  would 
contain  alcohol  and  ether,  another  opium,  extract  of  hemp,  lactucarium, 
and  hyoscyamus,  and  a  third  belladonna  and  stramonium ;  the  other  in- 
dividuals of  the  class  remaining  isolated.  By  considering  them  succes- 
sively according  to  these  relations,  we  may,  sufficiently  for  practical  pur- 
poses, fix  in  the  recollection  of  the  student  the  resemblances  referred  to. 

Before  proceeding  to  a  general  account  of  the  mode  of  operation,  and 
therapeutic  properties  of  the  class,  it  will  serve  to  prepare  the  way,  if 
we  dwell  for  a  short  time  on  certain  peculiarities  in  cerebral  pathology, 
which,  if  not  understood,  will  inevitably  lead  into  great  confusion.  It 
is  a  well-established  fact,  that  opposite  morbid  conditions  of  the  brain, 
or  parts  of  it,  express  themselves  by  similar  phenomena;  and  the  law 
probably  holds  true  of  the  nervous  centres  universally.  Pain  and  other 
morbid  sensations,  spasm  and  other  forms  of  irregular  muscular  action, 
delirium  partial  or  complete,  mild  or  severe,  chronic  or  acute,  and  every 
grade  of  stupor,  from  slight  drowsiness  to  the  deepest  coma,  may  all 
arise,  and  frequently  do  arise,  from  the  two  opposite  affections  of  irrita- 
tion and  depression  of  the  cerebral  centres.  For  proofs  of  this,  and 
for  an  explanation,  which,  in  the  opinion  of  the  author,  may  serve  to 
reconcile  the  apparent  contradiction,  readers  are  referred  to  the  article  on 
functional  diseases  of  the  brain  in  his  work  on  the  Practic§  of  Medicine. 
It  would  occupy  more  space  than  could  be  spared  to  repeat  them  here. 
But  the  application  of  this  fact  to  the  subject  now  before  us  is  of  great 
practical  importance.  From  a  certain  similarity  in  their  obvious  effects, 
medicines  essentially  different  in  character  have  been  associated  together 
in  the  minds  of  writers  and  practitioners,  and  been  considered  as  nearly 
identical  in  nature,  so  that  they  might  be  interchangeably  employed 
under  the  same  circumstances,  without  disadvantage.  !Now,  as  opposite 
morbid  causes,  acting  on  the  same  cerebral  centres,  may  produce  the 
same  morbid  phenomena ;  as,  for  example,  insufficiency  and  excess  of 
blood  in  the  brain  may  either  of  them  produce  delirium,  coma,  and  con- 
vulsions; it  follows  necessarily  that  medicines,  which  in  excess  are  al- 
ways morbid  causes,  may  also,  though  really  opposite  in  character,  give 
rite  to  closely  resembling,  if  not  identical  symptoms.  Thus,  of  the  medi- 
cines usually  ranked  together  as  narcotic,  because  they  produce  the 
common  effect  of  stupor,  some  operate  as  direct  stimulants,  others  as 
direct  sedatives  to  the  nervous  centres ;  and  it  will  be  readily  understood 
that,  if  such  medicines  are  used  remedially,  under  the  impression  that 


632  GENERAL    STIMULANTS.  [PART  II. 

they  are  identical  in  character,  the  most  serious  consequences  might 
ensue.  Opium  is  stimulant  to  the  nervous  centres,  aconite  is  sedative  : 
but  both  in  over-doses  are  capable  of  producing  coma.  In  a  case  of 
active  congestion  of  the  brain,  in  which  the  latter  may  be  useful,  the 
former  could  do  only  injury;  and  vice  versa.  To  administer  them,  there- 
fore, indiscriminately,  because  of  their  common  stupefying  effect,  would 
be  a  grievous  error.  But  a  case  more  in  point,  because  there  is  reason 
to  think  that  attention  has  not  yet  been  sufficiently  called  to  it,  is  that  of 
ether  and  chloroform.  Both  of  these  are  powerful  anesthetic  agents; 
and,  under  the  impression  that  their  mode  of  action  is  essentially  iden- 
tical, they  have  been  used  and  recommended  in  similar  cases,  with  little 
discrimination.  The  one  is,  in  fact,  a  most  energetic  cerebral  stimulant. 
the  other  an  equally  powerful  cerebral  sedative  :  is  it,  therefore,  surpris- 
ing that,  used  indiscriminately,  one  of  them  at  least  should  have  occa- 
sioned so  fearful  an  amount  of  mortality  ?  The  importance  of  guarding 
against  such  a  therapeutic  error  is,  it  appears  to  me,  an  irrefragable 
argument  in  favour  of  the  division  I  have  made  of  the  narcotic  medi- 
cines into  classes,  founded  not  on  phenomena  which  are  readily  misin- 
terpreted, but  on  their  real  physiological  influence  on  the  brain,  and  the 
general  system. 

Effects  on  the  System.  The  first  effect  of  a  cerebral  stimulant,  given 
in  doses  calculated  to  bring  its  characteristic  influence  into  operation,  is 
more  or  less  to  excite  the  stomach.  In  a  short  time,  its  influence  extends 
to  the  general  system,  showing  itself  usually,  in  the  beginning,  by  a 
moderate  increase  in  the  activity  of  the  sensorial  functions,  and  in  the 
movements  of  the  heart.  But  very  quickly  more  obvious  cerebral  phe- 
nomena are  ^hibited  ;  while  the  circulation  may  or  may  not  be  propor- 
tionably  excited.  The  sensorial  functions  are  now  perverted.  Abnormal 
sensations  are  felt  in  the  head,  such  as  fulness,  pressure,  confusion,  swim- 
ming, giddiness,  singing  in  the  ears,  perhaps  pain;  the  mind  wanders 
more  or  less ;  the  voluntary  movements  are  apt  to  become  irregular ;  and 
intoxication  or  delirium  may  supervene.  Jsext  succeeds  a  gradual  dimi- 
nution of  the  sensorial  functions.  Heaviness  and  languor,  or  a  feeling 
of  general  and  pleasing  calmness,  soon  deepens  into  drowsiness,  and  this 
at  length  into  stupor,  which  more  or  less  closely  resembles  natural  sleep, 
according  to  the  character  of  the  narcotic  used.  All  these  are  the  direct 
eiVects  of  the  medicine.  The  stupor  continues  for  a  length  of  time  vary- 
ing from  one  or  two  to  twelve  hours  or  more,  according  to  the  particular 
article  used,  gradually  diminishing  from  its  greatest  intensity,  till  the 
patient  at  length  becomes  fully  awake,  when  the  direct  operation  of  the 
medicine  is  passed.  But  now  a  condition  of  depression  takes  place,  moiv 
or  less  corresponding  with  the  previous  excitement,  and  the  strength  of 
the  direct  impres.-idii.  This  is  characterized  by  feelings  of  languor  and 
dejection,  often  with  more  or  less  general  or  local  uneasiness,  especially 


CHAP.  I.]  CEREBRAL    STIMULANTS.  633 

headache,  by  a  pale,  cool,  and  relaxed  state  of  the  surface,  and  feeble- 
ness of  the  pulse,  and  by  a  depressed  state  of  the  gastric  functions,  as 
indicated  by  want  of  appetite,  nausea,  and  perhaps  vomiting.  These 
symptoms  may  be  so  slight  as  to  be  scarcely  noticed,  or  they  may  be 
severe  and  extremely  uncomfortable  to  the  patient,  but  from  appropriate 
doses  ate  seldom  serious.  After  a  few  hours  they  gradually  pass  away, 
under  healthy  vital  influences,  and  the  previous  state  of  system  returns 
with  little  or  no  appreciable  change. 

From  larger  doses  of  the  medicine,  the  primary  excitant  impression 
is  stronger,  but  shorter,  the  succeeding  period  of  stupefaction  deeper  and 
more  lasting,  and  the  secondary  depression  greater,  more  protracted,  and 
more  serious. 

In  very  large  quantities  these  medicines  become  poisonous.  The  symp- 
toms of  excitement  and  exhilaration,  though  sometimes  intense,  are  very 
brief,  and  the  subsequent  stupor  profound  and  alarming.  Instead  of 
being  confined  mainly  to  the  cerebral  centres,  the  influence  of  the  poison 
extends  to  the  centre  of  respiration  in  the  medulla  oblongata,  which  may 
be  overwhelmed  by  the  force  of  the  poison,  and  death  may  result  from 
this  cause.  Or  the  direct  effects  of  the  narcotic  may  pass  over  without 
fatal  consequences,  and  the  patient  may  lapse  into  the  secondary  condi- 
tion, and  perish  from  the  universal  prostration  of  his  functions.  If  the 
dose  of  the  poison  has  not  been  quite  sufficient  to  destroy  life,  he  rises 
slowly  and  with  difficulty  from  the  profound  depression,  and  may  not  for 
several  days  recover  his  previous  state  of  health,  perhaps  even  for  a  much 
longer  time,  if  any  organic  lesion  shall  have  taken  place. 

The  course  of  the  symptoms  has  been  given  above ;  but  they  require 
explanation.  First,  it  may  be  proper  to  observe  that  the  description  is 
applicable  only  as  a  general  rule.  Special  phenomena  are  sometimes 
exhibited  by  the  individual  narcotics,  which  it  will  be  most  convenient 
to  treat  of  along  with  their  other  properties  and  effects. 

The  first  impression  on  the  stomach  is  due  to  the  direct  contact  of  the 
medicine,  which  operates  both  on  the  nervous  and  vascular  tissue  of  the 
organ,  exciting  it  to  an  increase  of  function,  which  is  followed  by  the 
same  stupor,  locally,  if  we  may  so  express  ourselves,  as  that  experienced 
by  the  general  system.  It  is  not  impossible  that  the  original  gastric  ex- 
citation may  be  sympathetically  propagated  to  the  cerebral  centres, 
giving  rise  to  the  first  phenomena  of  general  stimulation,  and  afterwards 
increasing  the  direct  influence  of  the  medicine  when  it  reaches  the  brain 
through  absorption ;  but  we  have  no  positive  evidence  to  this  effect;  nor 
indeed  have  we,  in  relation  to  some  of  the  narcotics,  any  demonstrative 
proof  that  they  are  absorbed  at  all.  But,  as  some  of  them  are  known 
to  be  so,  the  inference  is  quite  allowable  that  they  are  all  taken  into  the 
circulation,  or  at  least  their  active  prin^ples  ;  and  it  is  most  probable  that 


634  GENERAL    STIMULANTS.  [PART  II. 

their  constitutional  effects  are  chiefly,  if  not  exclusively,  produced  in  this 

way. 

The  impression  of  the  medicine  on  the  cerebral  centres  is  probably 
throughout,  so  long  as  its  direct  influence  remains,  of  a  stimulating  char- 
acter. That  it  is  so  at  first,  is  rendered  obvious  by  the  symptoms.  Some 
have  ascribed  the  stupefaction  which  ensues  to  a  sedative  operation.  I 
cannot  agree  with  them.  I  cannot  conceive  that  a  medicine,  in  its  direct 
influence  on  an  organ,  shall  pass  so  speedily  from  a  stimulant  to  a  seda- 
tive action.  A  true  sedative  condition  will  result,  but  that  is  after  the 
medicine  has  ceased  to  act  directly.  It  is  not  difficult  to  explain  the  oc- 
currence of  intoxication  and  stupor  upon  the  principle  of  continued  stim- 
ulation. I  have  demonstrated  elsewhere  that,  in  the  continuous  opera- 
tion of  an  excitant  directly  upon  any  organ,  the  first  effect  is  an  increase, 
the  next  a  derangement,  and  the  last  a  depression  or  suspension  of  its 
function.  These  results  probably  follow  the  gradually  increasing  amount 
of  blood  drawn  into  the  organ  by  the  irritation,  at  first  in  quantities 
merely  sufficient  for  the  support  of  the  increased  function,  afterwards 
sufficient  to  derange  it,  though  still  increased,  and  lastly  congesting  the 
organ  to  a  point  at  which  its  function  is  embarrassed  and  impaired,  or 
quite  overwhelmed.  Applying  this  general  rule  to  the  operation  of  the 
cerebral  stimulants,  we  have  first  the  simple  excitation,  as  shown  by  the 
obvious  phenomena;  next,  the  perverted  excitation,  exhibited  in  the  men- 
tal confusion,  or  intoxication;  and  thirdly,  the  overwhelming  congestion, 
as  evinced  by  the  drowsiness  and  stupor.  But  when  the  immediate  ope- 
ration of  the  medicine  has  ceased,  either  in  consequence  of  its  decompo- 
sition or  elimination,  the  stimulated  organ  is  left  to  its  own  powers.  Its 
excitability  having  been  exhausted  by  the  previous  over-action,  it  is  in- 
susceptible to  the  ordinary  healthful  influences  of  the  blood  and  other 
vital  agents,  and  consequently  acts  feebly,  or  for  a  time  ceases  to  act. 
Hence  the  prostration  which  follows  the  cessation  of  the  direct  opera- 
tion of  the  medicine.  The  exhausted  organ,  however,  if  not  fatally 
depressed,  recovers  its  excitability  by  rest,  and,  being  again  able  to  feel 
and  respond  to  its  healthy  stimuli,  returns  to  its  normal  state  of  action. 
When  poisonous  quantities  have  been  taken,  death  occurs  in  one  of  two 
ways.  Either  a  nervous  centre  essential  to  life,  as  the  respiratory  centre 
in  the  medulla  oblongata,  is  so  far  overwhelmed  by  the  active  congestion 
as  to  be  unable  longer  to  perform  its  office,  in  which  case  the  function  of 
respiration  ceases  as  a  necessary  consequence;  or  the  general  depression 
following  the  enormous  preceding  excitement  of  the  cerebral  centres 
generally,  and  of  the  whole  system,  is  too  great  for  reaction,  and  tin- 
patient  dies  completely  prostrated.  In  the  former  ease,  which  is  l>y  far 
the  most  common,  the  respiration  ceasing,  the  blood  is  no  longer  oxygen- 
ated in  the  lungs ;  the  capillariea^onsequently  refuse  to  carry  it  forward  ; 
the  heart,  failing  to  receive  a  supply  necessary  to  the  support  of  its 


CHAP.  I.]  CEREBRAL  STIMULANTS.  635 

function,  now  in  its  turn  ceases  to  act;  and  death  takes  place  finally 
because  the  blood  no  longer  circulates.  In  proof  that  the  above  is  the 
true  explanation  of  the  operation  of  the  cerebral  stimulants,  dissection 
after  death  always  shows  congestion  of  the  brain,  when  the  patient  has 
not  died  of  pure  prostration  after  the  poison  has  ceased  to  act. 

Death,  then,  from  the  cerebral  stimulants  is  usually  an  example  of 
asphyxia.  The  heart,  as  in  the  same  affection  from  other  causes,  con- 
tinues to  beat  for  a  short  time  after  respiration  has  ceased,  sometimes  in 
a  greater  or  less  degree  for  five  minutes,  thus  affording  the  opportunity 
for  the  employment  of  recuperative  measures,  even  after  apparent  death. 
Brodie  first  proved,  by  experiments  on  the  lower  animals,  that,  after 
apparent  death  from  a  narcotic  poison,  life  might  be  saved  by  artificial 
respiration.  The  blood,  being  thus  supplied  with  oxygen,  begins  again 
to  move  onward;  and  the  heart,  which  has  not  yet  quite  ceased  to  beat, 
receiving  a  due  supply,  resumes  its  normal  action,  and  the  phenomena 
of  life  return.  All  that  is  necessary  now  is  to  continue  the  artificial  res- 
piration, until  the  nervous  centres  shall  be  in  a  condition  to  resume  their 
function,  and  to  support  the  strength  of  the  patient  against  the  secondary 
prostration.  In  several  instances,  these  measures  have  been  successful 
in  the  preservation  of  human  life. 

The  cerebral  stimulants  are  capable  of  producing  their  characteristic 
constitutional  effects,  to  whatever  part  of  the  body  they  may  be  applied; 
a  fact  which  strongly  corroborates  the  idea  of  their  operation  through 
absorption.  Of  the  ordinary  avenues  by  which  they  are  introduced  into 
the  system,  with  a  view  to  remedial  effect,  they  operate  most  speedily 
through  the  subcutaneous  areolar  tissue  or  lungs,  next  through  the 
stomach,  and  after  this  through  the  rectum,  or  the  skin  deprived  of  the 
epidermis;  and  the  duration  of  their  effect  is  usually  inversely  propor- 
tionate to  the  rapidity  with  which  it  is  induced. 

The  local  effects  of  the  cerebral  stimulants  upon  the  surface  of  appli- 
cation arc  analogous  to  their  general  effects,  probably  through  their 
direct  action  upon  the  vessels  and  nerves  of  the  part.  They  first  excite 
the  actions  of  the  part,  then  diminish  its  sensibility,  and  lastly  leave  it, 
upon  their  removal,  in  a  somewhat  depressed  condition;  unless,  indeed, 
their  first  stimulant  impression  shall  have  been  sufficient  to  induce  a 
positive  inflammation,  which  will  complicate  the  result. 

This  class  of  medicines,  more  rapidly  than  perhaps  any  other,  lose 
their  effect  upon  repetition.  Each  successive  stimulant  impression  serves, 
in  some  degree,  to  lessen  the  excitability  of  the  organs  acted  on ;  and,  if 
time  is  not  allowed  for  the  system  to  recover  its  normal  state  before  a 
renewal  of  the  impression,  this  diminution  of  the  excitability  must  be 
constantly  and  steadily  continued.  To  produce  a  given  effect,  the  dose 
of  the  medicine  must  be  increased  pajt  passu  with  the  diminution  of 
the  excitability;  and  there  are  no  fixed  limits  within  which  this  augmen- 


636  GENERAL    STIMULANTS.  [PART  II. 

tut  ion  is  restrained.  As  the  medicines  have  no  corrosive  effect,  and 
therefore  do  not  directly  destroy  the  organization  of  the  parts  on  which 
they  act,  the  quantity  which  an  individual  may  attain  the  ability  to  sup- 
port, with  present  impunity,  is  enormous.  In  Dr.  Chapman's  Therapeu- 
tics the  case  of  a  woman  is  mentioned,  affected  with  cancer  of  the  uterus, 
who  took  three  pints  of  laudanum,  besides  a  considerable  quantity  of 
opium  daily,  enough  probably  to  kill  from  fifty  to  one  hundred  healthy 
individuals.  (2d  ed.,  ii.  236.) 

But  the  protracted  use  of  the  cerebral  stimulants  in  excess  is  often 
attended  with  the  most  deplorable  consequences  in  the  end.  As  before 
explained,  under  the  head  of  the  Tonics,  there  are  two  great  evils  flow- 
ing from  this  abuse;  the  one,  a  gradual  wearing  out  of  the  excitability  of 
the  system,  and  a  consequent  gradual  depression  of  its  functions  and 
powers;  the  other,  the  production  finally,  in  some  one  or  more  of  the 
organs  upon  which  the  stimulant  specially  acts,  of  a  low  chronic  inflam- 
mation, the  result  of  the  incessantly  repeated  irritation.  This  complica- 
tion of  general  debility  Avith  local  disease  almost  necessarily  destroys 
life  in  the  end,  if  it  be  not  previously  cut  short  by  the  occurrence  of 
some  accidental  affection,  which  the  exhausted  frame  is  unable  to  sup- 
port. More  will  be  said  on  this  point  when  the  particular  cerebral  stim- 
ulants are  treated  of,  which  are  most  liable  to  be  thus  abused. 

When  the  system  has  become  habituated  to  one  of  these  stimulants 
in  great  excess,  its  sudden  withdrawal  is  sometimes  followed  by  the 
most  alarming  prostration;  and  this  is  a  fact  which  it  is  highly  import- 
ant to  bear  in  mind,  in  the  treatment  of  the  diseases  of  individuals  who 
are  the  victims  of  such  self-indulgence.  Even  in  their  inflammatory 
affections,  when  depletion  may  be  necessary  to  save  life,  though  the 
habitual  stimulant  may  be  lessened,  it  should  not  be  altogether  withheld. 

When  called  to  a  patient  suffering  under  the  effects  of  the  abuse  here 
referred  to,  the  only  remedy  is  the  total  abandonment  of  the  evil  habit. 
But  this  should,  if  possible,  be  effected  gradually.  Should  the  patient 
be  under  his  own  control,  and  unable  or  unwilling  to  persist  in  such  a 
course  of  gradual  reduction,  the  best  substitute  is  to  throw  aside  the 
particular  stimulant  abused  at  once  and  completely,  and  to  support  the 
strength  by  other  stimulants  of  analogous  powers,  but  less  injurious  in 
their  effects,  and  possessing  less  attractions  for  the  patient;  then  grad- 
ually to  diminish  the  amount  of  this  support,  and  ultimately  withdraw 
it  altogether. 

Therapeutic  Application.  The  therapeutics  of  this  class  of  medicines 
will  be  most  conveniently  treated  of  under  the  several  individual  articles; 
as  there  is  so  much  specialty  in  their  uses,  that  few  general  observations 
would  be  applicable  to  the  whole,  or  even  the  greater  number.  There 
are,  however,  a  few  consideral^ns  which  it  may  be  proper  to  present 


CHAP.  I.]  CEREBRAL  STIMULANTS.  637 

in  this  place,  to  spare  inconvenient  explanations  and  useless  repetition 
hereafter. 

General  Stimulation.  Among  the  cerebral  stimulants  are  medicines 
which  are  most  powerful  and  most  relied  on  under  circumstances  calling 
for  the  most  vigorous  support  to  the  depressed  or  exhausted  system.  In 
consequence  of  the  universality  of  their  stimulant  power,  and  especially 
of  their  influence  over  the  functions  of  the  brain,  the  due  maintenance  of 
which  is  essential  to  life,  they  are  better  adapted  than  any  other  class  of 
medicines  to  diseases  of  debility,  in  which  these  functions  may  partici- 
pate in  the  general  prostration.  The  only  circumstance  which  centra- 
indicates  their  use,  and  which  might  preferably  direct  the  attention  to 
other  stimulants,  is  the  existence  at  the  moment,  or  the  probable  occur- 
rence at  the  period  of  reaction,  of  active  congestion  or  inflammation  of 
the  brain. 

Relief  of  Pain,  Spasm,  etc.  Besides  general  stimulation,  they  are 
much  employed  for  the  relief  of  pain,  the  relaxation  of  spasm,  and  the 
composure  of  nervous  irritation  generally.  All  these  effects  they  pro- 
duce by  rendering  the  nervous  centres  insensible  to  impressions  of  an  irri- 
tant character,  and  incapable  of  radiating  influence  from  themselves.  It 
must  be  remembered,  however,  that,  in  thus  operating,  they  stimulate  the 
centres  instead  of  depressing  them.  Their  influence  comes  under  the 
general  law  already  referred  to  in  these  preliminary  remarks,  namely, 
that  irritation  of  an  organ,  in  its  highest  grade,  diminishes  or  depresses 
the  function  of  that  organ,  probably  by  overloading  it  with  blood. 
When  the  sensorial  centres  are  thus  stimulated,  the  impression  sent  to 
them  from  the  suffering  part  is  no  longer  felt,  and  pain  of  course  ceases. 
Or,  if  the  pain  originated  in  disordered  function  of  the  centre  itself,  the 
feeling  is  equally  abolished ;  because  the  function  itself  is  temporarily 
supprcssed.  The  same  explanation  applies  to  spasm  and  other  forms  of 
nervous  derangement.  If  they  originate  in  external  irritation  transmit- 
ted to  the  sensorium,  they  are  relieved  when  the  sensorium  can  no 
longer  feel  the  irritation ;  if  in  disorder  of  the  seusoriuin  itself,  they 
cease  temporarily  with  the  cessation  of  its  function.  But  it  frequently 
happens  that  pain,  spasm,  and  other  nervous  disorder,  originate  in  a  de- 
pressed condition  of  the  nervous  centre ;  perhaps  in  a  deficiency  of  its 
supply  of  good  blood.  The  centre,  under  these  circumstances,  becomes 
a  negative  point  towards  which  nervous  force  may  be  supposed  to  flow 
from  the  periphery  corresponding  with  it,  which  suffers  from  the  loss, 
and  exhibits  that  suffering  in  one  of  the  modes  alluded  to.  The  cerebral 
stimulants  meet  the  indication  here  precisely.  They  sustain  the  de- 
pressed centre  by  a  direct  excitation,  and  by  supplying  it  with  good  blood, 
when  this  is  to  be  had,  and  sometimes  even  when  it  may  happen  to 
be  wanting ;  for  they  often  serve,  by  stimulating  the  blood-producing 
functions,  to  improve  its  character,  and  increase  its  quantity.  But  of 


638  GENERAL    STIMULANTS.  [PART  II. 

course  the  cerebral  stimulants  are  altogether  unsuited  for  the  relief  of 
disordered  nervous  phenomena,  when  dependent  on  active  congestion  or 
inflammation  of  the  brain  itself.  No  one  but  a  homreopathist  would 
think  proper  to  prescribe  alcohol  or  opium  in  acute  cerebritis  or  recent 
apoplexy ;  and  the  homoeopathist  himself,  in  doing  so,  escapes  the  crime 
of  manslaughter  only  by  the  absolute  nothingness  of  the  dose. 

The  term  anaesthesia  has  been  applied  to  the  loss  of  sensation  under 
the  influence  of  narcotic  medicines,  and  anaesthetics  to  the  substances 
capable  of  producing  it.  By  some  writers  the  anaesthetics  have  been 
raised  to  the  dignity  of  a  class ;  and  if  we  regard  symptoms  or  obvious 
effects  simply  as  the  basis  of  classification,  such  an  association  would  be 
altogether  proper ;  but  I  have  elsewhere  given  my  reasons  for  consider- 
ing such  a  plan  as  very  defective,  of  which  the  strongest  is  that  similar 
symptoms  are  often  produced  by  medicines  wholly  different  in  their  es- 
sential mode  of  action,  and  a  class  founded  on  this  basis  must  often  include 
medicines  which  are,  in  other  respects,  wholly  different,  and  consequently 
endanger  serious  errors  in  practice.  Thus,  anesthesia  may  result  from 
cerebral  stimulants  or  cerebral  sedatives,  from  excess  of  cold,  from  me- 
chanical compression,  and  various  other  agencies,  directly  or  indirectly, 
which  could  not,  I  think,  be  thrown  together  on  any  just  basis  of  arrange- 
ment. After  considering,  however,  the  different  agents  used  for  their 
anaesthetic  effects  in  the  several  classes  to  which  they  properly  belong, 
it  may  not  be  amiss  to  enumerate  them  together,  and  thus  recall  them  to 
the  mind  of  the  student  in  relation  to  their  very  important  practical  pur- 
pose ;  and  I  shall  probably  pursue  this  course  before  dismissing  their 
consideration  altogether. 

Production  of  Sleep.  This  is  another  purpose  which  some  of  the  ce- 
rebral stimulants  are,  beyond  all  other  medicines,  calculated  to  fulfil. 
They  produce  the  effect,  in  all  probability,  simply  by  so  congesting  the 
sensorial  centres  as  temporarily  to  suspend  their  sensibility  to  impres- 
sions, and  their  power  of  action.  Sleep  necessarily  ensues,  and  is  more 
or  less  profound,  according  as  the  centres  are  more  or  less  deeply  affected. 
It  will  be  remembered  that  the  congestion  is,  in  these  cases,  merely  the 
result  of  a  stimulation  of  the  centres  inviting  the  blood  into  them,  and 
may  occupy,  therefore,  only  the  minute  portions  of  cerebral  matter  of 
which  the  proper  centres  may  possibly  consist;  differing  altogether  from 
the  universal  congestion  caused  by  forces  driving  the  blood  into  the 
brain,  or  by  obstruction  preventing  its  return.  Sleep  may  equally  be 
produced  by  influences  on  these  same  centres,  depressing  them  below  the 
point  of  impressibility  or  of  action,  as  is  probably  the  case  with  chloro- 
form. This,  too,  is  probably  the  source  of  sleep  in  health  ;  the  centres 
ceasing  for  a  time  to  act,  under  the  loss  of  excitability,  temporarily  ex- 
hausted by  their  activity  in  the  waking  state. 

But  several  of  the  cerebral  stimulants  produce  the  therapeutic  effects 


CHAP.  I.]  CEREBRAL    STIMULANTS. — ALCOHOL.  639 

referred  to  in  the  last  two  paragraphs,  in  the  manner  of  the  nervous  stim- 
ulants or  antispasmodics,  and  in  doses  too  small  to  give  rise  to  their 
characteristic  effects  upon  the  brain.  Pain,  spasm,  etc.  are  thus  relieved 
by  them,  not  by  rendering  the  nervous?  centres  insensible  to  impression, 
but  probably  by  equalizing  the  excitement,  the  disturbance  in  the  balance 
of  which  has  occasioned  the  disorder.  In  producing  sleep,  their  effect, 
thus  given,  is  wholly  different  from  their  ordinary  and  characteristic  ope- 
ration. It  is  only  when  rest  is  prevented  by  nervous  disturbance,  that 
they  are  capable  of  acting  in  these  small  doses.  The  patient  sleeps  be- 
cause the  disorder  which  interrupted  his  rest  has  been  relieved,  not  from 
the  direct  impression  of  the  medicine  on  his  nervous  centres.  A  little 
paregoric,  two  or  three  grains  of  camphor  in  solution,  or  half  ateaspoon- 
ful  of  Hoffmann's  anodyne  ;  doses  which  would  have  scarcely  an  observ- 
able effect  in  health,  will  often  have  this  composing  influence  in  disease. 
Different  names  have  been  conferred  upon  articles  of  this  class,  ex- 
pressive of  certain  effects  produced  by  them  ;  as  narcotics  because  they 
stupefy,  anodynes  because  they  relieve  pain,  anaesthetics  from  producing 
insensibility  in  general,  and  soporifics  or  hypnotics  from  causing  sleep. 


I.  ALCOHOL. 

I  propose  first  to  give  a  general  account  of  alcohol,  its  effects,  and 
medical  uses,  and  afterwards  to  treat  of  the  forms  in  which  it  is  used, 
and  of  what  may  be  peculiar  to  each. 

Alcohol  is  the  product  of  a  chemical  process  denominated  vinous  fer- 
mentation, by  which,  at  a  temperature  between  60°  and  90°  Fahr.,  and 
with  the  aid  of  a  nitrogenous  material  called  yeast  or  ferment,  sugar, 
either  contained  in  certain  vegetable  juices  or  infusions,  or  dissolved  in 
water,  is  converted  into  alcohol  and  carbonic  acid,  the  latter  of  which 
escapes  with  effervescence.  The  liquids  thus  prepared,  containing  the 
newly-formed  alcohol,  are  called  fermented  liquors.  Many  of  them  are 
employed  in  medicine,  especially  wines  and  malt  liquors.  When  these 
are  submitted  to  distillation,  the  alcohol  conies  over  mixed  with  a  con- 
siderable proportion  of  water,  and  a  small  proportion  of  other  volatiliza- 
ble  matter  contained  in  the  liquid  employed.  The  liquids  thus  distilled 
are  called  ardent  spirits,  of  which  there  are  numerous  forms,  varying 
with  the  character  of  the  fermented  liquor  from  which  they  are  prepared. 
Among  them  are  brandy,  rum,  gin,  and  whisky,  all  of  which  are  oc- 
casionally used  in  medicine.  By  subjecting  the  ardent  spirits  to  another 
distillation,  or  as  the  process  has  been  called,  to  rectification,  the  alcohol 
comes  over  with  much  less  water,  and  a  smaller  amount  of  other  impu- 
rity, and  now  constitutes  rectified  spirit,  or,  as  it  is  named  in  the  U.  S. 


640  GENERAL    STIMULANTS.  [PART  II. 

Pharmacopoeia,  simply  ALCOHOL.  It  must  be  noticed,  however,  that  this 
is  not  pure  chemical  alcohol,  but  still  contains  water,  and  has  the  sp.  gr. 
0.835.  It  is  the  strongest  alcoholic  liquid  recognized  in  our  officinal 
code  prior  to  the  last  revision,  when  a  more  concentrated  preparation 
was  introduced,  with  the  title  of  ALCOHOL  FORTIUS,  or  Stronger  Alcohol, 
for  use  in  certain  pharmaceutical  processes.  This  has  the  sp.  gr.  0.817, 
and  is  still  far  from  being  pure  alcohol ;  but  there  is  little  or  no  occasion 
for  anything  stronger,  for  the  use  of  the  apothecary.  As  a  chemical 
agent,  however,  it  is  sometimes  necessary  to  have  a  still  purer  alcohol, 
which  can  be  procured  by  further  distillation  ;  and,  if  quicklime  be  added 
to  the  liquid  before  it  is  distilled,  all  the  water  is  retained,  and  alcohol 
comes  over  quite  free  from  that  liquid.  This  is  called  pure,  absolute,  or 
anhydrous  alcohol. 

Of  pure  alcohol  it  is  only  necessary  to  say  that  it  is  a  colourless,  vol- 
atile, inflammable  liquid,  of  the  sp.  gr.  0.794  at  60°  Fahr.,  of  an  agreea- 
ble pungent  odour,  and  a  burning  taste,  capable  of  combining  in  all  pro- 
portions with  water  and  ether,  and  composed  of  4  equivalents  of  carbon, 
6  of  hydrogen,  and  2  of  oxygen.  The  latest  view,  and  the  one  now 
generally  received,  of  its  precise  chemical  constitution,  is  that  it  is  a 
hydrated  oxide  of  a  compound  radical  called  ethyl;  in  other  words,  con- 
sists of  1  equivalent  of  ethyl  (C4H5)  and  1  of  oxygen,  combined  with  1 
eq.  of  water. 

1.  Effects  on  the  System. 

The  following  observations  have  reference  to  alcoholic  beverages  in 
general,  and  not  to  any  one  distinct  form ;  but  the  effects  described  are  to 
be  understood  as  exclusively  those  of  the  alcoholic  ingredient.  When 
any  particular  fermented  or  distilled  liquor  has  peculiar  properties,  inde- 
pendently of  the  alcohol  it  may  contain,  these  will  be  mentioned  when 
the  liquor  itself  is  treated  of. 

Alcohol  appears  to  be  a  universal  stimulant.  It  excites  the  part  to 
which  it  is  applied,  the  circulatory  and  nervous  systems,  the  digestive, 
nutritive,  and  reproductive  functions,  and,  under  favourable  circum- 
stances, the  various  secretions;  but  its  most  powerful  and  character- 
istic effects  are  those  produced  upon  the  brain.  Bernard  has  shown  that 
it  increases  the  formation,  by  the  liver,  of  the  material  out  of  which 
sugar  is  generated  in  that  organ.  (Arch.  Gen..  Juin,  1850,  p.  735.) 

Local  Effects.  When  applied,  sufficiently  concentrated,  to  the  skin  or 
mucous  membranes,  its  immediate  effect  is  to  induce  paleness,  with  imnv 
or  less  pain,  according  to  the  sensitiveness  of  the  part :  alter  which  the 
blood-vessels  expand,  heat  and  redness  are  produced,  and  sometimes  in- 
flammation. If  the  application  be  continued  for  some  time,  the  tissue 
shrinks,  and  becomes  wrinkled  and  hardened,  in  consequence,  as  some 
suppose,  of  the  affinity  of  the  alcohol  for  moisture,  which  it  is  thought  to 


CHAP.  I.]        CEREBRAL  STIMULANTS. — ALCOHOL.  641 

abstract  from  the  part,  or  of  its  property  of  coagulating  albumen  and 
fibrin,  which  are  thus  solidified  in  the  tissue.  It  certainly  has  been 
proved  by  Orfila,  when  thrown  in  considerable  quantity  into  the  veins  of 
the  lower  animals,  to  coagulate  the  blood  ;  and,  when  injected  into  the  cel- 
lular tissue,  to  produce  the  same  effect  in  the  neighbouring  blood-vessels. 
But,  in  the  former  instance,  it  is  brought  into  direct  contact  with  the 
blood,  so  as  to  exercise  all  its  chemical  influence  upon  the  albumen  and 
fibrin  of  that  fluid;  and,  in  the  cellular  tissue,  it  easily  penetrates  the 
extremely  tenuous  walls  of  the  capillaries,  and  is  in  like  manner  enabled 
to  act,  in  a  concentrated  state,  directly  upon  the  blood.  Its  influence  in 
these  cases  is  chemical ;  and,  in  general,  death  in  the  one  case,  and 
local  death  in  the  other  are  the  consequences.  But  in  its  condensing  or 
solidifying  action  upon  the  skin,  we  have  no  proof  of  any  chemical 
agency.  It  probably  simply  increases  the  vital  contractility  of  the 
tissues,  in  the  same  manner  as  the  astringents.  The  surface  is  thus 
rendered  more  capable  of  resisting  injury,  which  would  scarcely  happen 
if  its  organization  were  impaired.  It  is  a  common  mode  of  preventing 
bed-sores,  to  wash  frequently  the  parts  liable  to  pressure  with  brandy, 
or  other  form  of  ardent  spirit. 

General  Effects.  When  taken  into  the  stomach,  alcoholic  drinks  pro- 
duce a  feeling  of  warmth  in  the  epigastrium,  which  is  soon  followed  by 
increased  frequency  and  force  of  the  pulse,  heat  and  flushing  of  the  face, 
brilliancy  of  the  eyes,  and  a  characteristic  sensation  in  the  head ;  a  sort 
of  slight  swimming  or  giddiness,  which  serves  as  a  warning  to  the  pru- 
dent not  to  allow  the  effects  of  the  stimulant  to  proceed  further.  The 
spirits  are  at  the  same  time  exhilarated;  there  is  a  more  rapid  flow  of 
thought  and  fancy  ;  and  increased  energy  is  given  to  any  emotion  or 
passion  that  may  predominate.  There  is,  too,  in  general,  a  greater  dis- 
position to  give  expression  to  the  thoughts  and  feelings  of  the  moment; 
the  restraints  of  modesty  or  timidity  are  removed;  the  tone  of  voice  be- 
comes louder  and  more  energetic;  and  the  limits  have  been  approached, 
which  cannot  be  transgressed  without  hazard.  Beyond  this  point,  if  the 
drinking  be  continued,  the  control  over  the  judgment  is  lost,  and  latent 
feelings  are  betrayed,  or  new  ones  arise,  which  are  by  no  means  always 
creditable.  Persons,  however,  are  very  differently  affected.  Some  are 
cheerful  and  good  natured,  others  disposed  to  a  fondling  friendliness  of 
manner,  others,  again,  positive,  domineering,  or  disputatious;  and  ex- 
pressions are  often  used,  or  offence  taken,  in  the  excitement  of  the  mo- 
ment, which  not  unfrequently  lead  to  the  most  sad  results.  The  thoughts 
can  now  no  longer  be  commanded.  The  ideas  become  confused,  fancies 
are  changed  into  realities,  and  various  delusions  are  apt  to  occur,  which 
often  lead  to  corresponding  acts.  It  is  in  this  state  that  the  absurd  fol- 
lies, or  deplorable  violences  are  perpetrated,  with  which  the  annals  of 
drinking  teem.  The  species  of  delirium  entitled  intoxication  has  now 

VOL.  I. — 41 


642  GENERAL    STIMULANTS.  [PART  II. 

come  on.  In  common  English,  the  individual  is  drunk.  Not  unfre- 
quently  the  senses  are  perverted  in  this  condition  ;  and  double  vision  is 
one  of  its  well-known  characteristics.  With  all  this  cerebral  disturb- 
ance, there  is  continued  vascular  excitement,  the  secretion  of  urine  is 
generally  much  augmented,  and  the  sexual  propensities  often  powerfully 
stimulated,  especially  in  the  earlier  stage.  At  the  commencement  of  in- 
toxication, the  control  of  the  will  over  the  muscles  begins  to  be  impaired ; 
and,  after  a  time,  it  is  quite  lost.  Each  muscle  may  contract  regularly ; 
but  the  associated  action  necessary  for  the  attainment  of  any  particular 
object  cannot  be  commanded.  Hence  the  staggering  of  drunkards,  their 
zigzag  movements,  the  frequent  tumbles,  and  often  vain  efforts  to  regain 
their  feet.  At  length,  the  disordered  functions  gradually  subside  into 
insensibility ;  first  heaviness  and  vacancy  of  expression  come  on,  then 
drowsiness,  and  lastly  deep  sleep  or  a  sort  of  coma,  from  which,  how- 
ever, the  patient  may  generally  be  roused  more  or  less  completely.  If 
he  cannot  be  roused,  he  is  vulgarly  said  to  be  dead  drunk.  The  pulse 
subsides  along  with  the  nervous  excitement,  but,  though  slow,  remains 
often  full,  and  of  a  certain  strength,  such  as  characterizes  compression 
of  the  brain.  The  sleep  or  insensibiHty  continues  for  several  hours, 
perhaps  from  six  to  ten  on  the  average;  and,  during  this  period,  the 
pulse  gradually  declines  in  strength,  the  skin  relaxes,  and  not  unfre- 
quently  copious  perspiration  takes  place.  The  awakening  is  attended 
with  headache,  general  uneasiness,  and  feelings  of  languor  and  depres- 
sion; the  pulse  is  feeble,  and  the  skin  cool  and  relaxed;  and  a  want  of 
appetite,  often  nausea  and  vomiting,  clamminess  of  the  mouth,  and  a 
furred  tongue  evince  depression  of  the  digestive  organs  following  their 
great  excitement.  This  condition  passes  off  gradually;  and,  under  the 
influence  of  cool  water,  fresh  air  and  exercise,  and  the  usual  appliances 
of  health,  the  system  recovers  its  tone ;  and,  in  the  course  of  a  day  or 
two,  no  traces  of  the  debauch  may  remain,  except,  perhaps,  the  feeling 
of  degradation. 

Now  and  then,  instead  of  the  series  of  phenomena  above  presented, 
nausea  and  vomiting  come  on  at  some  period  in  the  progress  of  the  de- 
bauch, and  the  further  development  of  the  symptoms  is  prevented.  The 
patient  goes  to  bed,  and  sleeps  off  the  effects  of  the  stimulant. 

If  the  drinker  have  the  prudence  to  cease  before  other  cerebral  dis- 
turbance is  produced  than  the  slight  swimming  of  head  alluded  to,  the 
excitement  of  system  will  gradually  subside,  perhaps  with  a  copious 
diuresis,  and  there  will  be  little  observable  depression  afterwards.  Should 
he,  however,  repeat  the  potation  every  day.  he  will,  after  a  time,  begin 
to  find  that,  as  the  period  approaches  for  recurring  to  the  stimulant,  there 
are  feelings  of  uneasiness  and  of  a  want  to  be  supplied,  which  are  the 
inevitable  penalty  of  over-indulgence ;  and  there  is  always  some  danger, 
under  these  circumstances,  of  the  formation  of  a  very  pernicious  habit 


CHAP.  I.]  CEREBRAL   STIMULANTS. — ALCOHOL.  643 

Every  day,  more  and  more  will  be  required  to  relieve  the  uneasiness, 
and  produce  feelings  of  exhilaration ;  and,  if  the  temptation  to  increase 
the  quantity  is  yielded  to,  the  power  of  resistance  gradually  diminishes, 
and  confirmed  intemperance  ensues.  The  only  preventive  of  this  course 
of  deterioration,  when  once  entered  upon,  is  to  break  off  the  use  of  the 
drink  altogether,  or  to  fix  positive  limits  for  the  quantity  daily  used, 
which  shall  not  be  exceeded  ;  and  this  quantity  should  not  be  large 
enough  to  produce  sensible  exhilaration.  The  former  plan  is  much  the 
safer. 

The  moderate  use  of  these  drinks,  when  a  certain  limit  is  never  ex- 
ceeded, and  this  falls  short  of  obvious  cerebral  excitement,  may  be  con- 
tinued by  many  persons  for  a  lifetime  without  serious  injury.  The  sys- 
tem accommodates  itself  to  the  stimulus,  which  enters  into  the  regular 
means  of  life,  and  no  observable  difference  will  be  noticed  between  such 
an  individual  and  another  of  the  same  natural  constitution  who  is  abste- 
mious, except  that  the  former,  when  from  any  cause  diseased,  has  prob- 
ably somewhat  diminished  powers  of  resistance,  and  stands  more  in  need 
of  artificial  support. 

But,  if  carried  to  the  borders  of  intemperance  or  beyond  them,  the 
stimulant  soon  makes  itself  felt,  in  an  individual  before  healthy,  by  an 
increased  vigour  or  at  least  activity,  of  the  digestive,  assimilative,  and 
nutritive  functions.  More  and  perhaps  richer  blood  is  made  out  of  the 
same  quantity  of  food,  and  the  system  passes  into  a  plethoric  condition, 
as  shown  by  the  fuller  and  stronger  pulse,  and  the  general  redness  of  the 
surface,  especially  of  the  face.  At  the  same  time,  the  increased  fulness 
of  habit,  and  weight  of  body,  prove  that  the  nutrition  has  been  promoted 
equally  with  the  other  processes ;  and  in  fact  all  the  functions  of  the  or- 
ganic life  are  in  a  higher  state  of  activity.  This  condition  of  things  may 
continue  long,  in  a  constitution  originally  well  balanced,  without  serious 
injury ;  and  the  individual  may  think  himself  in  a  high  state  of  health. 
He  is,  however,  on  the  brink  of  disease,  and  the  slighest  accident  may 
precipitate  him  into  it.  If  a  considerable  excess  is  maintained,  the  coun- 
tenance, instead  of  the  ruddy  hue  and  fulness  of  health,  assumes  a  deeper 
tint  and  a  bloated  appearance;  and  the  signs  of  an  excessive  indulgence 
become  obvious  even  to  the  most  unobservant. 

Poisoning  by  Alcohol.  Every  serious  injury  to  the  health,  resulting 
either  from  a  temporary  debauch,  or  from  the  habit  of  drinking  alcoholic 
liquids  to  excess,  I  consider  as  falling  strictly  under  this  head.  First  I 
shall  treat  of  the  acute,  and  secondly  of  the  chronic  poisoning. 

Acute  alcoholic  poisoning  is  that  in  which  life  is  endangered  by  large 
quantities  of  the  stimulant  taken  at  once,  or  in  successive  portions  at 
short  intervals,  so  that  the  conjoint  eifect  is  felt  at  the  same  time. 

Sometimes,  in  such  cases,  death  is  almost  instantaneous.  Ortila,  m  his 
Toxicology,  mentions  two  instances  of  this  kind.  Two  soldiers  drank. 


644  GENERAL    STIMULANTS.  [PART  II. 

each,  four  litres  (eight  pints)  of  brandy.  One  died  immediately,  the 
other  while  they  were  bearing:  him  to  the  hospital.  It  is  probable  that, 
in  such  cases,  death  results  from  an  overwhelming  impression  on  the 
stomach,  affecting  the  brain  sympathetically;  and  that  the  symptoms  are 
those  of  great  prostration  from  the  first. 

But  such  instances  are  extremely  rare.  Generally  there  is  a  brief  ex- 
citement, followed  speedily  by  coma,  from  which,  when  the  result  is  fatal, 
death  usually  takes  place  at  a  period  varying  from  twelve  to  twenty-four 
hours.  The  symptoms  differ  considerably  in  different  cases.  In  some, 
the  coma  is  so  profound  that  the  patient  can  be  made  to  show  no  signs 
of  sensibility  or  intelligence;  in  others,  he  can  be  partially  and  tempora- 
rily roused.  The  pulse  is  usually  slow  and  full,  sometimes  natural  as 
to  frequency,  but  towards  the  close  extremely  feeble,  and  at  length  im- 
perceptible. The  respiration  is  also  slow.  The  face  may  be  flushed, 
with  a  venous  hue,  or  may  be  pale.  The  pupils,  though  occasionally 
contracted,  are  more  commonly  dilated.  Complete  immovability  of  the 
pupil  is  an  unfavourable  sign.  Convulsions  are  rare.  Death  results 
from  the  suspension  of  the  respiratory  process,  either  through  the  direct 
alcoholic  congestion,  or  the  secondary  prostration  of  the  nervous  ivnm-s 
in  the  encephalon.  When  recovery  takes  place,  as  the  affection  was 
functional,  the  patient,  upon  the  disappearance  of  the  coma,  returns  to 
health,  after  a  short  period  of  secondary  depression,  with  an  aggravation 
of  the  symptoms  already  mentioned  as  characterizing  the  same  stage  in 
an  ordinary  debauch. 

Another  mode  of  acute  alcoholic  poisoning  is  by  the  supervention  of 
apoplexy.  This  generally  occurs  in  persons  predisposed  to  that  affection. 
In  such  cases,  even  a  comparatively  moderate  indulgence  may  produce 
'this  effect  by  determining  blood  to  the  brain.  It  is  no  very  uncommon 
event  for  persons  thus  predisposed  to  be  attacked  at  the  table.  But  <><•- 
casionally  the  result  is  to  be  ascribed  purely  to  the  alcohol.  The  quan- 
tity of  blood  thrown  into  the  brain  produces  a  general  congestion  of  the 
organ,  and  sometimes  positive  sanguineous  effusion  takes  place.  The 
patient  may  recover  from  either  of  these  conditions;  but,  in  the  latter, 
paralytic  symptoms  will  be  apt  to  remain. 

A  third  mode  of  poisoning  is  by  the  superinduction  of  inflammation  of 
the  brain  or  its  meninges.  This  condition  is  either  left  behind  after 
the  disappearance  of  the  coma,  or  the  symptoms  of  the  two  conditions 
are  commingled.  Whenever,  with  more  or  less  stupor,  there  are  de- 
lirium, convulsions,  tonic  contraction  of  the  flexor  muscles,  and  local  or 
partial  palsy,  the  existence  of  the  inflammatory  complication  may  be  con- 
sidered as  pretty  certain.  This  condition  of  things,  however,  is  more 
apt  to  accrue  from  a  continued  debauch  of  several  days,  or  weeks,  than 
from  one  hard  drinking  spell,  unless  there  may  have  been  a  predispo- 


CHAP.  I.]  CEREBRAL   STIMULANTS. — ALCOHOL.  645 

sition  to  the  affection.  It  is  a  very  dangerous  condition,  and  many  die  of 
it;  often  sinking  into  a  state  resembling  typhoid  fever  before  death. 

Still  another  mode  of  poisoning  is  by  acute  inflammation  of  the  stom- 
ach and  bowels.  Gastritis,  in  a  greater  or  less  degree,  I  have  fre- 
quently witnessed,  in  the  Pennsylvania  Hospital,  among  patients  brought 
in  while  labouring  under  the  effects  of  strong  drink.  But  it  is  very  sel- 
dom fatal.  Instances,  however,  are  on  record,  in  which  this  seems  to 
have  been  the  immediate  cause  of  death. 

The  accidental  deaths  resulting,  in  the  coma  of  drunkenness,  from  ex- 
posure to  cold,  from  drowning,  or  from  various  kinds  of  violence,  as 
when  the  body  is  run  over  by  a  locomotive  on  railroads,  do  not  properly 
fall  into  this  category ;  though  they  are  useful  warnings,  and  may  be 
appropriately  enumerated  in  the  list  of  evils  consequent  upon  this  terri- 
ble vice. 

Chronic  Poisoning.  A  great  diversity  of  evils  arise  from  the  habitual 
use  of  alcoholic  drinks.  I  shall  treat  of  them  in  the  order  of  their  suc- 
cessive occurrence. 

1.  The  stimulant  influence  of  alcohol  renders  the  system  at  all  times 
more  liable  to  inflammatory  attacks'  from  ordinary  causes,  especially  in 
the  earlier  stages  of  its  habitual  use,  or  in  those  persons  who  employ  it 
in  such  a  manner  as  not  materially  to  impair  the  energies  of  their  sys- 
tem.    It  has  this  effect,  first,  by  inducing  a  plethoric  state  of  the  blood, 
which  predisposes  to  inflammation,  and,  secondly,  by  stimulating  the 
circulation,  and  thereby  acting  as  an  exciting  cause  when  a  predisposi- 
tion already  exists,  or  aiding  other  irritant  influences. 

2.  Conjointly  with  the  use  of  rich  food  and  stimulating  condiments,  it 
contributes  to  the  development  of  gout.     In  persons  predisposed  to  this 
disease  from  inheritance,  it  hastens  its  appearance;  and,  in  those  not 
predisposed,  it  is  quite  sufficient,  in  conjunction  with  the  other  agencies 
mentioned,  to  originate  the  diathesis.  But,  of  those  who  abuse  alcoholic 
liquors,  only  a  comparatively  small   number  are  attacked  with   gout. 
This  demands  explanation.     The  origination  of  the  gouty  diathesis  re- 
quires the  co-operation  of  causes  which,  without  materially  impairing  the 
vital  forces,  shall  produce  and  sustain  an  habitual  state  of  plethora  and 
excitement.     In  great  excess,  alcoholic  drinks  rapidly  wear  out  the  ex- 
citability of  the  system,  and  induce  an  indirect  debility,  which  leads  to 
various  other  disorders,  but  is  incompatible  with  the  generation  of  the 
gouty  constitution.     More  moderately  used,  however,  and  with  rich  food, 
they  stimulate  the  blood-making  functions,  without  so  rapid  an  exhaus- 
tion of  the  excitability.     A  greater  amount  of  food,  therefore,  is  con- 
verted into  blood  than  without  the  aid  of  the  stimulant,  and  a  state  of 
plethora  is  produced,  which  the  continuance  of  the  same  habit  sustains. 
The  abuse,  consequently,  of  wines  and  malt  liquors  is  more  apt  to  cause 
gout  than  that  of  ardent  spirits ;  and  hence  the  prevalence  of  this  dis- 


646  GENERAL   STIMULANTS.  [PART  II. 

ease  among  the  rich  and  luxurious.  But  the  amount  of  exercise  taken 
has  also  much  influence  over  the  result  of  alcoholic  stimulation.  By 
vigorous  exercise  the  plethora  induced  by  wine-drinking  and  a  rich  diet 
is  repressed,  the  excess  of  blood  is  consumed  by  the  excess  of  the  excited 
functions,  and  the  equilibrium  of  health  is  preserved.  Hence,  a  person 
of  somewhat  luxurious  habits  of  eating  and  drinking  may  counteract 
their  effects  by  proportionally  vigorous  exercise.  It  is  from  a  conjunc- 
tion of  the  moderately  luxurious  with  sedentary  habits  that  we  are  to 
look  for  the  development  of  gout.  Again,  an  excess  in  the  use  of  alco- 
hol which  would  soon  indirectly  wear  out  the  powers  of  a  sedentary  man, 
if  counterbalanced  by  violent  bodily  exertion,  may  tend  to  sustain  the 
system  at  a  point  of  elevation  favourable  to  this  disease.  An  individual 
may  become  intoxicated  at  his  table  every  evening,  and  yet,  if  he  spend 
all  the  morning  in  some  active  exercise,  as  on  horseback  in  the  chase, 
may  ward  off  the  prostrating  influences  of  the  poison,  and  escape  with 
only  the  penalty  of  gout.  It  is  not  so  much,  therefore,  the  particular 
quality  of  the  liquor  drank,  whether  it  be  wine,  or  whether  rum,  which 
determines  the  occurrence  of  gout  preferably  to  general  debility,  as 
it  is  the  quantity  of  the  stimulus  used,  and  the  other  attendant  circum- 
stances. 

3.  Another  evil  arising  from  the  abuse  of  alcohol  is  the  direct  produc- 
tion of  inflammation  in  the  organs  upon  which  its  stimulant  agency  is 
most  strongly  exerted.  Sometimes  this  inflammation  is  acute ;  but  much 
more  frequently  it  is  chronic,  and  the  necessary  result  of  a  long-sustained 
irritation.  The  organs  upon  which  alcohol  especially  expends  its 
force  are  the  stomach,  the  brain,  and,  secondarily,  the  lungs  and  the 
liver.  These,  therefore,  are  most  frequently  affected ;  but  the  bowels, 
kidneys,  heart,  and  arteries  sometimes  participate  in  the  disease.  Evi- 
dence of  this  is  exhibited  not  only  by  the  symptoms  during  life,  but  by 
the  appearances  upon  dissection.  Every  physician  is  familiar  with  the 
chronic  gastritis  of  drunkards.  Inflammation  of  the  brain  or  its  mem- 
branes is  scarcely  less  common,  though,  in  the  acute  state,  often  con- 
founded with  delirium  tremens,  and,  in  the  chronic,  masked  by  the 
disorder  in  the  cerebral  functions  incident  to  habitual  intoxication. 
Reference  is  often  made,  in  the  records  of  insane  asylums,  to  intemper- 
ance as  one  of  the  causes  of  insanity.  There  are  some  persons  who 
always  have  an  attack  of  this  disease,  when  they  indulge  in  the  use  of 
alcoholic  drinks.  The  duty  is  devolved  upon  the  lungs,  partly  at  least, 
to  throw  off,  in  the  form  of  vapour,  the  portion  of  alcohol  not  expended 
in  the  nutritive  process.  Hence,  bronchitis  is  a  common  disease  of 
drunkards;  and  other  pectoral  inflammations  arc  not  unfrequent.  The 
liver  is  another  of  the  emunctories  through  which  the  superfluous  alco- 
hol is  thrown  off,  probably  in  the  form  of  fatty  matter.  This  organ, 
therefore,  is  kept  constantly  in  a  state  of  undue  excitation,  and,  as  a  re- 


CHAP.  I.]  CEREBRAL   STIMULANTS. — ALCOHOL.  647 

suit,  is  not  unfrequently  inflamed.  Disease  of  the  liver  is  among  the 
most  common  complaints  of  habitual  drunkards ;  and  though,  as  will 
be  seen  directly,  it  is  not  exclusively  inflammation  that  occurs,  yet  this 
does  take  place  in  a  considerable  proportion  of  cases.  Out  of  seventy-three 
cases  of  drunkards  examined  after  death  by  Dr.  P.  Ogston,  of  Aberdeen, 
Scotland,  the  liver  was  found  generally  hypertrophied  in  nine,  and  par- 
tially in  two  cases ;  and,  though  this  hypertrophy  may  possibly  have 
been  in  some  instances  the  pure  effect  of  a  sustained  over-excitement, 
yet  much  more  probably  there  was  in  all  an  admixture  at  least  of  inflam- 
mation during  life.  It  is  not  necessary  to  refer  more  particularly  to  the 
other  organs  mentioned.  In  all  of  them  lesions  are  frequently  found, 
which  may  be  best  explained  by  the  supposition  of  the  previous  exist- 
ence of  chronic  inflammation. 

4,  From  the  constant  stimulation  of  the  whole  system,  and  especially 
of  the  brain,  the  excitability  is  so  far  exhausted  that,  on  the  withdrawal 
of  the  stimulus,  a  condition  of  extreme  prostration  takes  place,  which 
often  ends  fatally,  unless  counteracted.  The  brain,  left  without  its  ha- 
bitual support,  exhibits  its  suffering  in  a  peculiar  kind  of  delirium,  called 
delirium  tremens  or  mania  a  potu,  the  characteristics  of  which  are  sin- 
gular hallucinations,  the  fear  of  some  present  or  impending  evil,  sleep- 
lessness, and  muscular  tremors.  This  has  been  considered  by  some  as 
inflammation  of  the  brain.  But,  in  its  pure  form,  it  has  nothing  to  do 
with  inflammation.  It  is  the  simple  result  of  the  withdrawal  of  the 
alcoholic  stimulus,  and  is  a  condition  of  real  depression  in  the  cerebral 
centres,  showing  itself  by  the  irregularities  referred  to.  It  is,  moreover, 
relieved  by  restoring  the  stimulant  impression  by  means  of  alcoholic 
drinks  or  opium.  In  the  Pennsylvania  Hospital,  I  have  had  frequent 
opportunities  of  watching  the  attack  and  removal  of  this  affection.  I 
have,  in  numerous  instances,  seen  it  coming  on  more  or  less  completely 
when  the  wonted  stimulus  has  been  withheld,  and  have  almost  as  con- 
stantly seen  it  yield  to  a  renewal  of  the  stimulus.  It  will  be  observed 
that  I  am  now  speaking  of  pure  delirium  tremens.  But  there  are  often 
mixed  cases  of  a  very  different  character.  In  these,  some  inflammatory 
and  febrile  attack  has  rendered  the  patient  careless  of  the  stimulant,  or 
averse  to  it.  The  cerebral  centres,  left  unsupported,  fall  into  the  abnor- 
mal state  ucder  consideration,  and  there  is  now  a  mixture  of  local  inflam- 
mation with  delirium  tremens.  Not  unfrequently  the  inflammation  is 
the  direct  result  of  the  alcoholic  stimulus.  The  patient,  goaded  by  his 
insatiable  thirst  for  the  poison,  gives  himself  up  for  a  period  to  the  most 
frantic  indulgence,  until  he  is  at  length  brought  up  by  an  attack  of  in- 
flammation of  the  brain  or  the  stomach,  the  direct  result  of  the  excessive 
quantity  of  alcohol  taken.  Then  the  debauch  ends,  and,  the  drink  being 
suspended,  delirium  tremens  along  with  the  meningitis  or  gastritis  seizes 
on  its  victim.  These  attacks,  unless  promptly  and  efficiently  treated, 


648  GENERAL    STIMULANTS.  [PART  II. 

especially  the  rneningeal  cases,  are  very  apt  to  terminate  fatally,  and 
sometimes  do  so  even  under  judicious  treatment;  while  the  simple  deli- 
rium tremens,  which  constitutes  the  vast  majority  of  cases,  is  curable 
almost  certainly,  if  the  patient  be  prevented  from  sinking  into  a  fatal 
prostration  from  the  want  of  support. 

But  it  is  not  only  upon  the  withdrawal  of  the  wonted  stimulus  that 
the  effects  of  depressed  function  are  experienced.  With  the  constant 
repetition  of  the  excitement,  there  is  as  constant  a  diminution  of  the 
excitability,  so  that  the  stimulated  functions  can  be  sustained  only  by  a 
steady  increase  in  the  quantity  of  the  stimulus,  until  the  time  at  last 
comes  when  no  quantity  that  can  be  taken  is  sufficient  to  support  the 
working  of  the  exhausted  organs.  It  is  surprising  how  much  ardent 
spirit  the  system  can  be  brought  to  bear.  Two  or  three  pints  of  raw 
spirit  are  consumed  daily  by  some  confirmed  rum-drinkers.  But,  as  just 
stated,  even  should  no  organic  mischief  happen  in  the  mean  time,  the 
functions  must  at  last  fail.  In  relation  to  the  stomach,  dyspepsia;  to  the 
bowels,  constipation  ;  to  the  liver,  insufficient  secretion,  are  ordinary 
results.  The  circulatory  and  respiratory  functions  are  also  enfeebled  ; 
the  generative  function  is  impaired;  and  even  nutrition,  at  first  over- 
stimulated,  now  fails,  and  the  patient  becomes  either  emaciated,  or  pale 
and  bloated.  The  cerebral  functions  also  suffer  greatly.  The  intellect 
is  enfeebled,  the  power  of  self-command  is  lost,  and  the  predominant 
propensities  or  passions,  whatever  they  may  happen  to  be,  are  scarcely 
resisted.  The  influence  of  the  will  over  the  muscles  is  greatly  impaired, 
and  the  patient  is  subject  to  habitual  tremors  when  not  under  the  fullest 
action  of  the  stimulus.  These  tremors  sometimes  deepen  into  positive 
paralysis,  though  there  is  reason  to  think  that,  by  this  time,  the  brain 
has  become  organically  deranged. 

5.  The  last  stage  of  physical  degradation  is  now  reached.  The  failure 
of  the  functions  both  organic  and  nervous  leads  inevitably  to  degenerate 
organization.  The  blood  is  depraved,  nutrition  suffers,  and  different 
parts  of  the  frame  undergo  various  degradation ;  those  being  most  af- 
fected the  functions  of  which  have  been  previously  most  stimulated,  and 
consequently  most  exhausted.  In  many  instances,  the  vital  forces  have 
been  so  prostrated,  in  particular  organs,  that  chemical  influences  predom- 
inate, and  the  tissue  is  converted  more  or  less  into  oil.  This,  is  the  fatty 
degeneration.  In  other  instances,  the  disorganization  is  less  complete; 
and  abnormal  tissues  bearing  some  resemblance  to  the  fibrous,  cartilagi- 
nous, or  bony,  take  the  place  of  the  healthy  structure.  The  brain,  the 
stomach,  the  liver,  the  kidneys,  and  the  heart  and  blood-vessels  are  pe- 
culiarly the  seats  of  this  organic  degradation ;  and  their  great  vital  func- 
tions suffer  accordingly.  The  most  diversified  forms  of  functional  or 
organic  disease  are  presented  in  different  cases,  most  of  them  tending  to 
a  dropsical  condition,  in  which  the  patient  is  at  last  apt  to  perish,  if  he 


CHAP.  I.]  CEREBRAL   STIMULANTS. — ALCOHOL.  649 

has  escaped  the  numerous  dangers  which  have  beset  him  almost  from 
the  beginning,  and  which  cause  vast  numbers  to  be  carried  to  a  prema- 
ture grave.  The  cirrhosed  or  fatty  liver,  the  granulated  kidney,  the 
hypertrophied  or  dilated  heart  with  its  various  valvular  disease,  the 
ossified  blood-vessels,  and  the  depraved  blood,  deficient  in  red  cor- 
puscles, but  abounding  in  oil  and  carbon,  are  the  most  frequent  causes 
of  the  dropsy. 

Dr.  Magnus  Huss,  Professor  of  Clinical  Medicine  in  Stockholm,  has 
described  a  paralytic  affection,  which  he  denominates  alcoholism  us  chron- 
icus,  and  which  he  ascribes  solely  to  the  poisonous  influence  of  alcohol. 
It  is  very  common  in  Sweden,  where  intemperance  is  said  to  prevail  to 
a  fearful  extent.  The  affection  shows  itself  first  in  tremors  and  unstead- 
iness of  the  voluntary  muscles,  usually  commencing  in  the  upper  ex- 
tremities, then  extending  to  the  lower,  and  at  length  involving  the 
muscles  of  the  trunk.  The  trembling  is  often  violent,  particularly  on  the 
occasion  of  any  voluntary  effort,  and  is  greatest  in  the  mornings  before 
the  patient  has  had  recourse  to  his  accustomed  stimulus.  Sensation 
after  a  time  begins  to  be  affected ;  formication  occurs  here  and  there ; 
and  at  last  both  sensation  and  the  power  of  motion  are  lost  over  a  greater 
or  less  extent  of  the  body,  the  special  senses  being  not  unfrequently  in- 
volved. Instead  of  this  paralytic  condition,  the  poisoning  may  assume 
the  spasmodic  or  convulsive  character,  marked  at  first  by  twitchings, 
and  afterwards  various  irregular  muscular  contractions,  terminating  in 
positive  epileptic  paroxysms.  All  these  phenomena  are  readily  explica- 
ble. The  first  failure  of  muscular  power  is  probably  the  result  of  mere 
exhausted  function  in  the  brain ;  but  the  more  serious  subsequent  results 
must  be  ascribed  to  the  organic  changes  which  have,  in  the  mean  time, 
been  going  on  in  the  cerebral  tissue. 

6.  Another  and  not  the  least  evil  of  the  abuse  of  alcoholic  liquors,  is 
the  increased  danger  given  by  it  to  other  diseases ;  partly  through  the 
impaired  state  of  the  constitution,  which  renders  it  less  able  to  resist 
them ;  partly  through  the  impossibility,  under  which  it  places  the 
physician,  of  using  that  energy  in  the  treatment  which  the  diseases 
may  require ;  and,  in  some  degree  also,  in  consequence  of  the  relative 
•inertness  of  alcoholic  remedies  in  the  intemperate,  in  whom  they  are 
most  needed. 

I  have  purposely  avoided  the  consideration  of  the  moral  aspect  of  in- 
temperance, which,  even  if  we  confine  our  views  to  this  world,  presents 
an  amount  of  evil,  far  exceeding  the  physical,  terrible  as  this  must  be 
acknowledged  to  be. 

Appearances  on  Dissection.  When  death  has  occurred  suddenly  from, 
enormous  quantities  of  the  poison,  no  pathological  appearance  need  be 
expected  after  death ;  the  stomach  and  brain  being  at  once  overwhelmed 
by  the  violence  of  the  shock.  In  the  more  protracted  cases  of  acute 


650  GENERAL    STIMULANTS.  [PART  II. 

poisoning,  the  signs  of  inflammatory  congestion  of  the  stomach  are 
sometimes,  though  not  always  presented;  but  there  is  usually  congestion 
of  the  brain,  with  occasional  effusion  into  the  ventricles,  which  has  the 
odour  of  alcohol,  and  in  one  instance  is  said  to  have  been  inflammable. 
Congestion  of  the  lungs  is  also  an  occasional  result  of  acute  alcoholic 
poisoning;  and,  in  the  case  of  a  child  recorded  by  Dr.  John  Ashhurst, 
appeared  to  btj  the  cause  of  death,  through  the  copious  effusion  into  the 
air-passages.  (Am.  Journ.  of  Med.  Set.,  July,  1863,  p.  128.) 

In  cases  of  habitual  drunkards,  dying  either  directly  from  the  effects 
of  the  poison,  from  suicide,  or  other  forms  of  violent  death,  and  from 
accidental  diseases,  there  is  almost  always  some  lesion  discoverable, 
which  may  be  fairly  ascribed  to  the  poison;  sometimes  the  direct  conse- 
quence of  constant  irritation,  as  hypertrophy ;  sometimes  of  pure  defi- 
ciency of  action,  as  atrophy;  very  frequently  of  inflammation,  and  still 
more  frequently  of  various  degeneration. 

Out  of  117  cases  examined  by  Dr.  Ogston,  only  one  was  without 
some  discoverable  lesion.*  The  lesions  were  most  numerous  in  the 
brain  and  its  appendages,  and  after  this,  successively,  in  the  respiratory 
organs,  the  liver,  the  circulatory  organs,  the  kidneys,  and  the  alimentary 
canal.  That  the  smallest  number  should  have  been  found  in  the  stom- 
ach and  bowels  is  not  what  might  have  been  anticipated;  but  the  prob- 
ability is  that  more  of  the  lesions  in  this  structure  were  to  be  ascribed  to 
the  alcohol  exclusively  than  in  the  others,  unless  the  brain  be  excepted. 
It  will  of  course  be  understood  that  many  of  the  morbid  appearances 
would  have  been  found  in  temperate  persons;  but  assuredly  in  greatly 
less  proportion.  In  the  brain  the  most  frequent  changes  were  thicken- 
ing of  the  arachnoid,  effused  serum,  injection  of  the  pia  mater,  and  indu- 
ration or  softening  of  the  cerebral  substance ;  in  the  respiratory  organs, 
pleural  adhesion  and  partial  emphysema;  in  the  heart  and  its  append- 
ages, hypertrophy  and  dilatation,  obesity,  valvular  disease,  pericardial 
adhesion  or  thickening,  and  atheromatous  or  osseous  deposition  or 
degeneration  in  the  large  vessels ;  in  the  stomach,  extraordinary  diminu- 
tion of  size  or  atrophy,  congestion,  softening  of  the  mucous  membrane, 
and  hypertrophy  or  thickening  of  the  walls,  which,  however,  was  seen  in 
three  only  out  of  the  whole  number  of  cases;  in  the  liver,  fatty  degen- 
eration, hypertrophy,  cirrhosis,  and  the  nutmeg  appearance ;  jn  the  kid- 
neys, hypertrophy,  congestion,  and  fatty  degeneration.  (Brit,  and  For. 
Med.'Chir.  Rev.,  April  and  October,  1854.) 

*  Of  the  different  organs,  the  brain  and  its  appendages  were  affected  in  108  of  the 
cases,  or  92.3  per  cent.;  the  respiratory  organs  in  74,  or  63.24  per  cent.;  the  liver 
in  66,  or  66.4  per  cent.;  the  heart  and  its  appendages,  including  the  aorta  and  pul- 
monary artery,  in  56,  or  47.86  per  cent.;  the  kidneys  in  51,  or  43.58  per  cent.;  and 
the  intestinal  tube  in  48,  or  41  per  cent.  (Brit,  and  For.  Med.-chirury.  Rev.,  July, 
1*55,  Am.  ed.,  p.  145.) 


CHAP.  I.]  CEREBRAL  STIMULANTS. — ALCOHOL.  651 

• 

Treatment  of  Alcoholic  Poisoning.  In  the  acute  cases,  the  prominent 
indication,  in  the  earlier  stage,  is  to  evacuate  the  stomach;  for  which 
purpose  recourse  may  be  had  to  emetics  or  the  stomach-pump.  The 
latter  is  the  most  effectual  method,  though,  in  the  absence  of  the  neces- 
sary implements,  the  former  should  not  be  neglected.  At  the  same  time, 
cold  water  should  be  freely  and  steadily  applied  to  the  head,  and  sina- 
pisms or  other  rubefacients,  or  hot  pediluvia  to  the  lower  extremities. 
Pouring  cold  water  into  the  ear  has  been  recommended,  in  order  to  rouse 
the  patient  from  stupor;  and,  with  the  same  view,  in  its  first  application, 
it  may  be  poured  from  a  height  on  the  head  or  shoulders.  Bleeding, 
either  general  or  local,  or  both,  should  be  used  when  the  pulse  is  full  and 
strong,  and  organic  mischief  in  the  brain  is  apprehended.  Should  respi- 
ration be  suspended  or  nearly  so,  it  should  be  supported  artificially,  until 
nature  may  be  able  to  maintain  the  function,  or  undoubted  death  shall 
have  taken  place.  In  the  stage  of  prostration,  after  the  direct  action  of 
the  stimulant  has  ceased,  and  nothing  remains  but  the  depression  conse- 
quent on  the  previous  excitement,  the  system  should  be  supported  by 
external  and  internal  stimulation.  When  the  patient  cannot  swallow, 
the  stimulant  should  be  injected  into  the  stomach  or  rectum.  Carbonate 
of  ammonia,  or  aromatic  spirit  of  ammonia  may  be  used,  so  far  diluted  as 
not  to  injure  the  mucous  membrane ;  and  even  brandy  may  be  resorted 
to,  especially  in  the  form  of  milk-punch  by  the  stomach.  It  is  not  now 
the  presence  of  the  alcohol  that  is  endangering  life.  It  is  the  prostra- 
tion; and  that  may  be  very  properly  counteracted  by  a  smaller  amount 
of  the  stimulus,  so  as  to  cause  the  system  to  subside  gradually  from  its 
previous  state  of  exaltation.  This  treatment,  however,  should  not  be 
employed  until  the  skin  becomes  cool,  the  pulse  feeble,  and  the  danger 
from  prostration  obvious. 

In  chronic  poisoning,  the  only  remedy  is  abstinence.  It  is  rarely  that 
the  affection  has  proceeded  so  far,  that  a  cure  may  not  be  effected,  or  the 
state  of  the  system  very  much  ameliorated,  by  this  measure.  Unless 
some  essentially  fatal  disorganization  has  taken  place,  as  in  cirrhosis  of 
the  liver,  the  system  may  be  gradually  led  back  to  health  by  a  reversal 
of  the  process  which  has  brought  it  into  the  diseased  state.  A  sudden 
withdrawal  of  the  stimulus,  without  the  substitution  of  something  of  a 
similar  character,  is  dangerous.  Death  frequently  results  from  this 
cause.  Delirium  tremens  is  an  almost  constant  consequence,  when  the 
habitual  excess  has  been  great  and  long  continued.  The  chief  difficulty 
lies  in  the  want  of  co-operation  upon  the  part  of  the  patient.  The  same 
infirmity  of  will  that  led  to  the  evil,  is  in  the  way  of  its  removal.  I 
have  often,  however,  had  patients  under  my  care  in  the  Pennsylvania 
Hospital,  who  have  been  willing  to  submit  to  the  requisite  restraints,  and 
invariably  they  have  been  dismissed  without  evil  consequences,  and 
cured  for  the  present  of  the  evil  habit.  The  simple  measure  is  to  allow 


652  GENERAL   STIMULANTS.  [PART  II. 

them  at  first  somewhat  less  than  their  ordinary  amount  of  stimulus, 
preferring  the  milder  kinds  when  they  will  answer,  as  wines  and  the 
malt  liquors,  and  daily  to  diminish  the  quantity,  always  endeavouring 
to  sustain  them  above  the  point  of  sleeplessness  or  delirium.  Opium 
often  comes  in  very  happily  as  an  adjuvant,  to  obviate  nervous  disorder 
and  produce  sleep;  but  this  also  must  be  withheld,  as  the  system  is 
found  capable  of  doing  without  it.  Sometimes  there  is  an  advantage 
in  partially  substituting  for  the  pure  stimulus  one  of  the  bitter  tinctures, 
especially  that  of  hops;  and  recourse  may  be  had  to  the  nervous  stimu- 
lants, as  assafetida,  valerian,  and  Hoffmann's  anodyne,  when  nervous 
irregularities  may  seem  to  call  for  them.  When  the  health  has  been  ma- 
terially impaired  by  the  long  continuance  of  the  habit,  it  is  necessary,  as 
the  original  stimulus  is  withdrawn,  to  address  remedies  to  the  system  in 
order  to  correct  the  diseased  functions,  or  repair  the  diseased  organs ; 
such  as  the  bitter  tonics  and  aromatics  for  dyspepsia,  rhubarb  and  aloes 
for  constipation,  the  chalybeates  to  improve  the  blood,  and  nitromuriatic 
acid  or  the  blue  pill  to  obviate  hepatic  disease. 

When  the  patient  cannot  or  will  not  summon  resolution  enough  for  a 
steady  perseverance  in  the  above  plan,  it  is  better  for  him  to  break  off  at 
once,  and  take  the  risk  of  the  evil  consequences,  than  to  incur  certain 
destruction  from  continuance  in  the  vicious  habit.  Under  proper  medi- 
cal superintendence,  even  should  delirium  occur,  the  case  may  almost 
always  be  conducted  to  a  safe  issue. 

Of  the  management  of  delirium  tremens  I  do  not  propose  to  treat  in 
this  place,  as  I  have  already  fully  considered  the  subject  in  my  work  on 
the  Practice  of  Medicine.  I  would  simply  observe  that,  on  the  whole, 
I  prefer  the  opiate  plan  of  treatment  moderately  conducted,  giving  only 
so  much  alcoholic  drink  as  may  be  sufficient  to  obviate  prostration,  and 
gradually  withdrawing  both. 

There  is  one  important  practical  point,  however,  to  which  I  would 
especially  invite  the  attention  of  the  student.  He  is  not  to  consider  cases 
of  meningeal  inflammation  or  acute  gastritis,  when  brought  on  by  in- 
temperance, and  then  mingled  with  delirium  tremens,  as  instances  purely 
of  the  latter  disease.  In  these  cases,  he  must  deplete  for  the  inflam- 
mation, while  he  supports  the  actions  of  the  nervous  centres  by  alcoholic 
stimulation,  which,  in  drunkards,  when  given  in  less  than  the  habitual 
amount,  acts  as  a  real  sedative.  The  same  rule  holds  in  regard  to  in- 
flammatory affections,  which  may  come  on  accidentally  in  the  intemper- 
ate, and,  in  consequence  of  the  suspended  use  of  the  stimulant,  become 
complicated  with  their  peculiar  delirium. 

Dr.  Marcet,  of  London,  recommends  the  use  of  oxide  of  zinc  in  chronic 
alcoholic  poisoning,  beginning  with  two  grains,  twice  daily,  an  hour  after 
ineals,  and  increasing  by  two  grains  every  three  days,  until  th«;  last  dose 
amounts  to  six  or  eight  grains.  (London  Lancet,  April,  1859,  p.  346.) 


CHAP.  I.]  CEREBRAL   STIMULANTS. — ALCOHOL.  653 

2.  Mode  of  Operating. 

The  operation  of  alcohol  as  a  stimulant  is  probably  dynamic,  that  is, 
the  result  of  its  influence  on  the  vital  properties  of  the  tissues,  and  inde- 
pendent of  any  chemical  action  exerted  upon  those  tissues.  At  least,  we 
have  as  yet  no  proof  of  chemical  change  produced  in  the  organs  which 
it  stimulates ;  and  all  theories  based  upon  such  a  change  are,  in  the 
present  state  of  our  knowledge,  conjectural.  It  is  true  that,  in  its  more 
concentrated  form,  its  affinity  for  water,  and  its  disposition  to  coagulate 
albumen,  may  cause  disorganization  of  the  tissues,  as  any  other  chemical 
escharotic  may  do;  but  this  is  not  its  ordinary  medicinal  operation,  to 
procure  which  it  is  always  given  much  diluted.  The  theory  that  the 
excitement  it  occasions  is  a  vital  reaction  against  its  chemical  affinities, 
is,  therefore,  gratuitous.  It  may  possibly  be  true ;  but  we  have  no  proof 
of  it ;  and  the  safest  conclusion  is  that,  like  any  other  stimulant,  it  pro- 
duces its  characteristic  effects  simply  through  its  relation  to  the  vital 
properties,  which  determines  that,  when  it  is  brought  into  contact  with 
the  living  tissues,  these  should  take  on  an  increase  of  action. 

Its  first  effects  on  the  brain  may  possibly  result,  in  part  at  least,  from 
the  sympathy  of  that  organ  with  the  stomach.  Indeed,  so  close  is  this 
relation,  that  any  strong  impression  in  one  is  very  apt  to  make  itself 
sensible  in  the  other.  The  fact  stated  by  Orfila,  that  alcoholic  liquors 
act  with  less  energy  when  injected  into  the  cellular  tissue  than  when 
taken  into  the  stomach,  seems  to  favour  this  view.  -But,  whether  the 
cerebral  effects  have  or  have  not  their  commencement  in  sympathy  with 
the  gastric  impression,  they  are  chiefly  attributable,  throughout  their 
course,  to  the  direct  action  of  the  alcohol  circulating  through  the  brain. 
That  this  principle  is  absorbed,  when  liquids  containing  it  are  swallowed, 
is  beyond  all  doubt.  Its  rapid  disappearance  from  the  stomach,  and  its 
odour  in  the  breath  are  sufficient  proofs  of  the  fact.  But  it  has  been 
found  also  in  the  urine,  bile,  liquors  of  the  serous  cavities,  brain,  liver, 
and  the  blood  itself;  and  especially  abundant  in  the  brain,  in  the  ven- 
tricles of  which  it  is  asserted  sometimes  to  have  existed  in  an  inflamma- 
ble state.  Dr.  Ogston  in  one  instance  "found  about  four  ounces  of  fluid 
in  the  ventricles,  having  all  the  physical  qualities  of  alcohol "  (Pcreira's 
Mat.  Med.,  3d  ed.,  p.  1987);  and,  in  another  instance,  while  heating  over 
a  candle,  three  or  four  drachms  of  urine  taken  from  the  bladder  of  a  man 
who  was  drowned  while  intoxicated,  he  observed  that  its  vapour  was  set 
on  fire  by  the  flame.  (Brit,  and  Fur.  Med.-chir.  Rev.,  July,  1855,  Am. 
ed.,  p.  148.)  Coming  then  into  direct  contact  with  the  nervous  centres, 
the  alcohol  stimulates  them  into  excessive  action,  and  thus  gives  rise  to 
the  phenomena  of  excitement  which  characterize  the  early  stage  of  its 
operation.  Every  excitation  of  a  part  is  attended  with  an  increased  flow 
of  blood  into  it,  and  the  active  congestion  increases  with  the  excitation. 


654  GENERAL   STIMULANTS.  [PART  II. 

By  the  continued  operation  of  the  alcohol,  the  congestion  is  continually 
increased  in  the  cerebral  centres,  which,  after  their  brief  exhilaration, 
become  disturbed,  and  at  length  embarrassed  or  overwhelmed,  all  through 
the  direct  and  continued  irritation  of  the  same  agent.  Hence  the  intoxi- 
cation, and  ultimate  stupor  which  follow  the  primary  excitement.  But 
at  length,  the  alcohol  ceasing  to  act,  the  cerebral  centres  become  de- 
pressed in  proportion  to  their  previous  elevation ;  and  general  prostra- 
tion of  the  system  results.  The  wearing  out  of  the  excitability,  the 
ultimate  general  debility,  and  the  consequent  degradation  of  the  organs, 
resulting  from  long-continued  intemperance,  have  been  sufficiently 
noticed. 

The  influence  of  alcohol  upon  the  brain  has  been  ascribed  to  the 
altered  and  more  highly  carbonized  state  of  the  blood.  Of  this  there  is 
no  proof  whatever ;  nor,  except  in  the  single  fact  of  stupor,  is  there  any 
resemblance  between  the  effects  of  this  substance  and  the  condition  of 
the  blood  referred  to.  From  the  experiments  of  Dr.  Bocker,  it  would 
seem  that  alcohol  diminishes  the  amount  of  the  solid  and  fluid  excretions 
by  the  urine,  and  the  quantity  of  carbonic  acid  exhaled  in  respiration, 
without  increasing  the  fecal  discharges,  the  perspiration,  or  the  loss  of 
water  by  the  lungs.*  Hence  it  has  been  inferred  that  it  lessens  the 
rapidity  of  the  normal  disintegration  of  the  solids,  and  consequently 
diminishes  the  general  activity  of  the  functions ;  for  the  measure  of  their 
activity  is  the  quantity  of  effete  matter  thrown  out  of  the  system.  Hence, 
too,  the  practical  inference,  that  it  enables  the  body  to  be  sustained  by  a 
less  amount  of  food.  But  these  are  conclusions  much  too  large  for  the 
basis  on  which  they  rest.  We  need  many  more,  and  much  more  va- 
riously repeated  experiments,  before  they  can  be  justified.  Xo  facts  of 
observation  seem  more  obvious  than  that  alcohol  stimulates  the  func- 
tions of  the  stomach  and  brain  to  increased  activity;  that  it  for  a  time 
invigorates  digestion,  promotes  nutrition,  increases  the  action  of  the  kid- 
neys or  the  skin,  according  as  it  is  directed  to  one  or  to  the  other,  and 
elevates  the 'intellectual  and  emotional  functions.  How  it  can  effect  all 
these  ends,  without  a  more  rapid  disintegration  and  renewal  of  the  struc- 
ture, is  inconceivable  to  one  who  considers  such  disintegration  as  a 

*  The  experiments  of  Dr.  Bocker  have  been  confirmed  by  those  of  Dr.  Hammond, 
of  the  U.  S.  ArmyA  (See  Am.  Journ.  of  Med.  Sri.,  xxxii.  313  )  It  may  be  admitted 
that,  in  the  long  run,  alcohol  diminishes  the  metamorphosis  of  the  tissues,  as  it  does 
all  the  vital  functions,  through  the  diminution  of  excitability  and  the  production  of 
debility ;  but  I  cannot  admit  that  this  result  takes  place  during  its  stimulant  ac- 
tion; and,  if  the  amount  of  excretion  of  all  kinds  be  diminished,  during  its  direct 
action,  I  should,  as  before  stated,  be  disposed  to  ascribe  the  result  to  a  more  thor- 
ough appropriation  and  assimilation  of  the  food,  which  prevent  the  useless  portion 
of  it  that  may  reach  the  blood,  from  passing  off  in  the  shape  of  urea,  the  phos- 
phates, sulphates,  etc.  (Note  to  the  second  edition.) 


CHAP.  I.]  CEREBRAL   STIMULANTS. — ALCOHOL.  655 

necessary  attendant  of  every  vital  action.  That,  when  taken  in  ex- 
cess, it  will  overwhelm  and,  in  some  measure,  paralyze  the  functions 
after  the  first  excitement  is  past,  and  that,  in  this  way,  it  may  on  the. 
whole  diminish  the  amount  of  the  excretions;  and  that  by  the  wearing 
influence  of  its  long-continued  abuse,  the  functions  come  at  last  to  be 
in  great  measure  prostrated,  is  readily  intelligible.  But  that,  during  its 
stimulant  operation,  it  should  not  promote  a  more  rapid  change  of  the 
tissues  which  it  stimulates,  is  quite  incompatible  with  the  present  views 
of  the  connection  between  the  actions  and  the  wear  and  tear  of  the  system. 
But  it  is  an  undoubted  fact  that  the  habitual  use  of  alcohol  lessens 
the  desire  and  apparent  necessity  for  food ;  and  it  seems  to  be  well  proved, 
that  a  labourer  can  do  a  certain  amount  of  work  with  less  ordinary  ali- 
ment, if  freely  supplied  with  beer  or  wine,  than  when  water  alone  is  al- 
lowed for  drink.  But  this  fact  is  explained,  at  least  in  the  early  stage 
of  the  action  of  alcohol,  not  by  the  diminished  integral  change  in  the  tis- 
sues, but  by  the  double  fact,  that  it  promotes  the  more  perfect  digestion 
of  the  food  taken,  and  at  the  same  time  supplies  food  itself.  If  the  usual 
amount  of  food  is  swallowed,  alcohol  favours  its  digestion  and  conversion 
into  blood,  and  hence  produces  a  plethoric  state.  This  reacts  on  the 
stomach,  diminishing  the  desire  for  food;  and  hence  less  is  taken.  But, 
as  stated,  alcohol  is  itself  in  all  probability  assimilated.  What  else  be- 
comes of  it?  Assuredly,  but  a  very  small  portion  of  that  taken  into  the 
body  leaves  it  unchanged.  It  is  certainly  decomposed  in  the  system. 
If,  as  some  suppose,  it  were  merely  oxidized  into  water  and  carbonic 
acid,  there  would  be  a  vast  increase  of  the  excretions  of  these  products 
by  the  lungs,  which,  from  the  experiments  of  Dr.  Bocker  and  some  others, 
would  seem  not  to  be  the  case.  It  is  probably  converted  into  some  one 
or  more  of  the  proximate  constituents  of  the  body ;  and  I  am  among 
those  who  believe  that  it  may,  through  the  agency  of  the  vital  forces, 
and  in  the  presence  of  organized  nitrogenous  matter,  be  converted  into 
any  one  or  all  of  those  constituents,  excepting  only  the  mineral.  The 
one,  however,  which  most  obviously  results,  is  oil ;  and  this  is  often  gen- 
erated with  great  rapidity.  It  is  not  only  visible  in  the  increase  of  the 
adipose  tissue,  and  in  the  promotion  of  obesity  in  certain  individuals, 
but  it  exists  also  in  abiiounal  proportion  in  the  blood;  and  the  oleaginous 
change  is  probably  the  first  step  of  the  conversion  of  alcohol  into  mate- 
rials fit  for  organization.  And  why  should  not  alcohol  be  capable  of 
digestion  ?  It  is  generally  admitted  that  many  of  the  organic  acids  are 
so,  as  vinegar,  citric  acid,  etc.  Now,  by  a  very  easy  change,  alcohol 
itself  is  convertible  into  acetic  acid.  The  inference  seems  to  me  inevita- 
ble, that  it  also  is  capable  of  being  digested  and  assimilated.  It  is  food, 
therefore,  as  well  as  a  stimulant ;  and  this  view  certainly  best  explains 
the  plethoric  condition,  and  increased  weight  and  fulness  of  the  body, 
often  so  strikingly  observable  under  its  use,  while  the  amount  of  other 


656  GENERAL   STIMULANTS.  [PART  II. 

kinds  of  food  taken  is  diminished.  But  this  fact  in  no  degree  justifies  its 
abuse.  The  various  evils  to  which  its  excess  gives  rise  are  neither  les- 
sened in  themselves,  nor  do  they  constitute  a  less  unanswerable  argu- 
ment against  the  abuse  of  alcohol,  from  the  fact  that  it  may  contribute 
to  the  nourishment  of  the  body.  In  opposing  an  enemy,  it  is  useless  if 
not  dangerous  to  shut  our  eyes  against  his  good  qualities,  and  bad  policy 
to  put  ourselves  into  a  position  in  which  we  cannot  avail  ourselves  of 
them. 

3.    TJierapeutic  Application. 

The  first  great  question  in  the  therapeutics  of  alcohol  is  how  far  its 
habitual  use  is  favourable  or  unfavourable  to  health.  In  the  greater 
number  of  cases,  judging  from  the  experience  of  the  world  since  the  be- 
ginning of  history,  it  is  of  little  consequence  to  the  health  of  the  indi- 
vidual, whether  he  drink  it  or  not,  provided  he  do  not  exceed  the  limits 
of  temperance,  and  especially  if  he  confine  himself  to  the  pure  fermented 
liquors.  But  there  are  two  classes  of  individuals  to  whom  this  remark 
does  not  apply.  In  one  of  these  classes,  the  possession  of  a  peculiarly 
sanguine  or  nervous  temperament,  renders  them  strongly  susceptible  to 
injury  from  substances  calculated,  in  the  one  instance,  to  favour  the  over- 
production of  blood,  and,  in  the  other,  to  stimulate  the  unduly  excitable 
nervous  centres.  In  tfrese  persons,  the  habitual  use  of  alcoholic  drinks, 
which  have  in  a  high  degree  both  the  properties  mentioned,  is  hazardous 
to  health,  and  should,  therefore,  be  avoided.  It  endangers  inflammation, 
hemorrhage,  and  serious  cerebral  disease.  In  the  second  of  the  classes 
referred  to,  the  contrary  of  this  proposition  is  true.  Nature,  while 
planting  in  so  large  a  proportion  of  the  human  family  a  disposition  to 
scrofulous  or  tuberculous  complaints,  seems  to  have  provided,  in  the  fer- 
mented liquors,  what,  if  properly  used,  may  be  considered  as  in  some 
degree  a  counteracting  agent.  Physicians  have  often  noticed  that  drunk- 
ards seldom  die  of  phthisis.  In  this  respect,  my  own  observation  coin- 
cides with  that  of  others.  During  my  tours  of  hospital  duty  in  the 
winter,  I  have  met  with  great  numbers,  both  of  drunkards  and  of  tuber- 
culous individuals;  but  it  is  very  seldom  that  I  have  seen  the  two  classes 
coincide.  This  is  A  singular  fact,  and  not  exactly  what  might  have  been 
anticipated ;  for  the  tuberculous  constitution  belongs  to  the  same  ca- 
chectic category  with  that  which  gives  a  tendency  to  fatty  degenera- 
tion, cirrhosis  of  the  liver,  granular  disease  of  the  kidney,  etc.,  and  is 
not  unfrequently  associated  with  it.  A  priori,  it  would  have  been  im- 
agined that  the  exhausted  state  of  general  health,  characterizing  the  ad- 
vanced stages  of  intemperance,  would  favour  tuberculous  deposition  ;  and 
the  discovery  of  the  opposite  truth  has  been  something  like  a  surprise  to 
the  profession.  This  result  of  observation  has  been  singularly  confirmed 
by  recent  pathologico-anatomical  investigations.  Out  of  117  cases  of 


CHAP.  I.]       CEREBRAL  STIMULANTS. — ALCOHOL.  657 

confirmed  drunkards,  whose  bodies  were  examined  after  death  by  Dr. 
Ogston,  there  were  only  two  who  exhibited  any  evidence  of  tuberculous 
disease  of  the  lungs.  In  one  of  these  there  were  some  latent  tubercles, 
and  in  the  other  a  single  tuberculous  cavity  in  the  right  lung;  and  in 
neither  was  this  affection  the  cause  of  death.  (Brit,  and  For.  Med.- 
chir.  Rev.,  April  and  October,  1854.)  In  the  same  number  of  temperate 
persons,  of  different  sexes  and  ages,  examined  after  death  from  other 
causes,  the  same  result  would  assuredly  not  have  been  obtained.*  How 
alcoholism  acts  adversely  to  the  development  of  tubercle  may  be  conjec- 
tured, but  is  not  certainly  known.  In  its  earlier  stages,  it  may  be  sup- 
posed to  sustain  a  grade  of  elevation  in  the  vital  functions,  and  richness 
of  the  blood,  above  that  at  which  there  is  a  tendency  to  the  deposition 
of  tuberculous  matter.  But  this  is  certainly  not  the  case  in  the  latter 
stages,  during  which,  so  long  as  the  stimulus  continues  to  be  used,  there 
appears  to  be  the  same  exemption.  Perhaps,  as  many  suppose,  it 
is  the  more  highly  carbonated  state  of  the  blood  in  the  inebriate  that 
protects  him  against  tuberculosis.  Possibly,  the  large  proportion  of  oil 
contained  in  it  may  have  some  preservative  tendency,  similar  to  that  ex- 
ercised by  cod-liver  oil.  It  would  be  a  perverse  reason  that  would  deduce 
from  the  fact  here  stated  an  argument  in  favour  of  intemperance.  As- 
suredly, of  the  two,  even  admitting  that  the  security  afforded  is  com- 
plete, which  it  is  very  far  from  being,  death  from  pulmonary  consump- 
tion is  infinitely  preferable  to  death  from  drunkenness,  or  even  to  the  life 
of  a  drunkard.  But  a  just  inference  is,  that  they  who  may  be  predis- 
posed to  phthisis  or  scrofula,  or  may  be  labouring  under  the  disease,  may, 
with  propriety,  and  probably  with  advantage,  employ  the  fermented 
liquors  habitually,  though  always  in  moderation.  By  adhering  to  the 
rule,  never,  under  any  circumstances  of  ordinary  health,  to  use  any  one 
of  the  forms  of  ardent  spirit,  but  to  adhere  exclusively  to  the  fermented 
liquors,  they  may  avoid  the  danger  of  intemperance,  and  yet  obtain  all 
the  immunity  which  alcohol  can  confer. 

In  giving  the  above  general  rules  in  relation  to  the  habitual  use  of 
alcoholic  liquors,  it  will  be  perceived  that  I  confine  myself  wholly  to  the 
medical  aspect  of  the  question.  How  far  an  individual  may  feel  himself 
bound  to  forego  a  harmless  gratification,  or  to  sacrifice*  in  some  instances, 
a  positive  good,  for  the  sake  of  an  example  to  others  of  weaker  will,  or 
of  a  constitution  more  susceptible  to  injury  from  alcoholic  drinks  than 
himself,  is  a  moral  question  upon  which  there  is  no  occasion  to  express 
an  opinion  in  this  place.  One  point,  however,  I  would  urge,  with  what- 

*  See  an  elaborate  paper,  by  Dr.  John  Bell,  of  N.  York,  on  the  effects  of  alcoholic 
drinks  in  tuberculous  disease,  in  the  Am.  Journ.  of  Med.  Sci.,  Oct.  1859,  p.  407,  in 
which  much  evidence  has  been  collected  upon  the  subject  referred  to.  The  tendency 
of  this  evidence  appears  to  uie  decidedly  to  confirm  the  views  given  in  the  text. 
(Note  to  the  second  edition.) 
VOL.  I. — 42 


658  GENERAL    STIMULANTS.  [PART  II. 

ever  weight  of  authority  a  life  of  observation  may  have  given  me,  and 
\vith  all  the  strength  of  expression  I  possess,  that,  whenever  an  indi- 
vidual discovers  in  himself  the  least  tendency  to  excess  in  these  drinks, 
or  the  least  deficiency  of  power  to  restrain  himself  within  due  limits  when 
slightly  under  their  influence,  he  should  promptly  abandon  them  alto- 
gether, and  permit  no  sophistry  of  inclination  to  overcome  his  resolution 
of  entire  abstinence  for  the  future. 

In  low  febrile  diseases  the  alcoholic  liquors  are  a  most  valuable  re- 
source, and,  indeed,  often  indispensable.  At  least,  I  have  very  frequently 
met  with  conditions  in  these  fevers,  in  which  I  should  have  quite  de- 
spaired of  a  cure  without  their  aid.  They  are  not  so  well  adapted  to  the 
prostration  or  collapse  which  sometimes  occurs  in  the  cold  stage,  at  the 
commencement  of  the  fever,  as  to  the  debility  coming  on  in  its  course. 
The  continuance  of  their  stimulant  influence  into  the  stage  of  reaction, 
and  their  special  tendency  to  the  head,  might  possibly,  under  the  former 
circumstances,  injuriously  increase  the  fever  and  cerebral  disturbance; 
and  they  should,  therefore,  be  employed  only  when  the  arterial  stimu- 
lants may  prove  inadequate  to  the  end  in  view.  But  to  the  latter  con- 
dition, the  debility,  namely,  which  so  often  supervenes  in  febrile  diseases, 
and  not  un frequently  constitutes  their  greatest  danger,  they  are  adapted, 
beyond  all  other  medicines,  by  the  universality  as  well  as  energy  of  their 
stimulant  property.  Operating  specially  upon  the  brain,  they  rouse  it 
from  the  torpor  by  which  it  is  apt  to  be  overwhelmed  in  the  advanced 
stage  of  fevers  of  the  typhoid  character,  and  prove  much  more  efficient 
in  sustaining  life  than  the  arterial  or  nervous  stimulants.  They  are  in- 
dicated when  the  pulse  is  feeble,  and  the  skin  cool,  and  particularly 
when,  with  these  evidences  of  debility,  are  associated  the  dark  tongue, 
the  sordes  about  the  teeth,  and  the  stupor  or  low  delirium  of  the  typhous 
state,  indicating  a  depraved  condition  of  the  blood.  Even  when  the 
skin  is  hot,  if  the  other  symptoms  appear  to  call  for  their  use,  they  should 
be  tried.  I  believe  they  not  only  stimulate  in  these  cases,  but  prove 
useful  also  by  directly  contributing,  through  their  nutritive  properties,  to 
the  improvement  of  the  blood.  Unless  the  prostration  is  sudden  and 
alarming,  the  mildest  form  of  these  stimulants  should  be  first  employed, 
and  recourse  be  had  to  the  stronger  only  as  th%  increasing  debility  may 
in  to  require  them.  Thus,  it  is  usually  advisable  to  begin  with  wine- 
whey,  then,  if  necessary,  to  advance  to  pure  wine,  and  ultimately  to  ar- 
dent spirit.  Should  the.  skin  become  hotter  and  dryer,  the  pulse  more  fre- 
quent, and  the  patient  more  restless  and  delirious  under  the  stimulant,  it 
should  be  diminished  or  discontinued ;  but,  should  the  contrary  condition 
occur,  should  the  skin  heroine  soft  or  moist,  the  pulse  slower,  fuller,  and 
stronger,  and  the  patient  more  comfortable  and  less  disposed  to  delirium, 
it  may  be  taken  for  granted  that  the  remedy  is  operating  favourably,  and 
should  be  continued.  It  is  in  typhus,  enteric  or  typhoid,  and  petevhial 


CHAP.  I.]  CEREBRAL   STIMULANTS. — ALCOHOL.  659 

fevers,  that  the  alcoholic  remedies  generally  prove  most  useful ;  but  most 
other  febrile  affections  sometimes  assume  the  same  low  character,  and 
require  the  same  treatment.  The  alcoholic  liquids  may  often  be  advan- 
tageously used  in  scarlatina,  diphtheria,  smallpox,  and  erysipelatous 
fever,  and  occasionally  in  bilious  remittent  and  yellow  fevers,  when  they 
present  typhoid  symptoms.  Even  the  existence  of  inflammation,  under 
these  circumstances,  does  not  positively  contraindicate  them  Active  alco- 
holic stimulation  is  often  necessary  in  typhoid  or  typhous  pneumonia. 

In  the  advanced  stage  of  inflammation,  when  copious  suppuration 
has  taken  place,  and  the  patient  is  sinking  under  it,  the  alcoholic  stimu- 
lants are  often  called  for,  to  aid  in  supporting  the  strength  until  the 
exhausting  influences  shall  have  ceased,  or,  when  the  case  is  hopeless,  to 
render  the  patient  more  comfortable,  and  protract  his  life.  Such  a  con- 
dition is  presented  in  the  suppurative  stage  of  pneumonia,  abscess  of 
tin;  lungs  and  kidneys,  purulent  phlebitis,  lumbar  and  psoas  abscess, 
suppuration  of  the  large  joints,  extensive  caries  of  the  bones,  and  very 
large  or  numerous  ulcers  upon  the  surface.  To  this  category  may  be 
added  various  constitutional  affections  attended  with  suppurative  or 
ulcerative  conditions,  as  erysipelas  affecting  the  cellular  tissue,  conflu- 
ent smallpox  after  the  maturation  of  the  pustules,  all  scrofulous  affec- 
tions including  phthisis,  syphilis  in  the  ulcerative  stage,  and  several  of 
the  cutaneous  affections,  particularly  rupia  and  ecthyma. 

Precisely  the  same  indication  is  offered  by  gangrene,  whether  result- 
ing from  inflammation,  from  purely  depressing  agencies,  or  from  a  vitia- 
ted state  of  the  blood.  The  system  requires  support  against  the  directly 
depressing  influence  of  the  gangrene,  and  of  the  processes  requisite  for 
the  separation  of  the  slough,  and  also  to  enable  it  to  repair  the  injury 
done.  It  is  unnecessary  to  enumerate  all  the  affections  in  which  this 
condition  may  occur.  In  severe  internal  inflammations,  there  is  occa- 
sionally an  abrupt  cessation  of  the  pain,  with  symptoms  of  great  pros- 
tration, which  have  been  supposed  to  indicate  the  occurrence  of  mortifi- 
cation, and  often  perhaps  truly,  even  though  certain  evidence  may  not 
be  exhibited  by  putrefaction  after  death.  Strangulation  of  the  bowels, 
whether  concealed  as  in  invaginalion,  or  obvious,  as  in  hernia,  very  often 
ends  in  mortification.  Other  examples  of  this  affection  we  have  in  gan- 
grene of  the  lungs  and  of  the  mouth,  that  which  attends  malignant  ery- 
sipelas, carbuncle,  and  the  malignant  pustule,  and  lastly  that  arising 
from  severe  burns,  injuries  of  the  blood-vessels,  arterilis,  the  poison  of 
ergot,  etc. 

In  the  above  suppurative  and  gangrenous  affections,  and  all  others 
of  a  similar  character,  alcoholic  stimulation  is  very  frequently  indicated, 
and  sometimes  strongly  so.  But  it  must  be  remembered  that  they  are 
usually  attended  with  more  or  less  remaining  inflammatory  or  systemic 
excitement,  which  requires  caution  in  the  use  of  the  stimulant;  and,  as 


660  GENERAL   STIMULANTS.  [PART  II. 

a  general  rule,  the  fermented  liquors  will  be  preferable  to  the  spirituous. 
Most  frequently,  in  these  conditions,  there  is  also  an  indication  for  the 
use  of  opium  and  sulphate  of  quinia  or  other  preparation  of  Peruvian 
bark. 

There  is  a  state  of  system,  essentially  one  of  debility,  in  which  the 
blood  is  poisoned  by  noxious  matter  absorbed  into  it,  and  which  does 
not  come  exactly  into  either  of  the  preceding  divisions.  To  this  belongs 
the  condition  denominated  purulent  infection,  metastatic  abscess,  and 
pyogenic  fever.  It  is  a  condition  in  which,  probably,  disintegrated  pus, 
or  other  sanious  secretion  from  vitiated  sores,  is  absorbed  into  the  blood, 
and  depraves  its  character.  Analogous  to  it  is  the  state  of  system  aris- 
ing from  dissecting  wounds.  Alcoholic  stimulation  is  often  indicated  in 
this  condition. 

Considerable  attention  has  recently  been  attracted  to  the  asserted  effi- 
cacy of  this  remedy  in  the  state  of  system  resulting  from  the  bites  of 
poisonous  serpents;  and  cases  have  been  recorded  which  go  far  to  prove 
that  it  really  possesses  no  inconsiderable  curative  powers.*  The  pros- 
tration of  system  which  attends  the  operation  of  the  poison  would  appear 
to  indicate  stimulation ;  and  the  ammoniacal  preparations  have  long 
been  in  repute  as  antidotes.  To  produce  the  desired  effect,  the  alcoholic 
remedy,  it  is  said,  must  be  given  very  freely;  and,  in  most  of  the  cases, 
it  has  been  pushed  to  intoxication.  It  seems,  however,  that  the  system, 
when  strongly  under  the  influence  of  the  poison,  resists  its  influence,  as 
tetanus  is  known  to  do.  In  a  case  recorded  by  Dr.  T.  A.  Atchinson  in 
the  Southern  Journal  of  the  Medical  and  Physical  Sciences  for  March, 
1853  (vol.  i.  p.  108),  in  which  the  patient,  a  young  woman  of  seventeen, 
was  found  almost  moribund  two  hours  and  a  half  after  the  bite  of  a  rat- 
tlesnake, three  pints  of  whisky,  given  in  doses  of  a  glassful  every  hour, 
though  it  produced  reaction,  and  apparently  saved  the  life  of  the  patient, 
occasioned  not  the  slightest  intoxication.  During  the  same  time,  how- 
ever, eighty  grains  of  carbonate  of  ammonia  were  given,  which  has  been 
supposed  to  have  some  power  of  obviating  the  inebriating  effects  of  alco- 
hol. A  young  medical  friend  of  mine  informed  me  that,  while  upon  an 
excursion  in  Texas,  he  was  bitten  by  a  poisonous  serpent,  and  had 
already  begun  to  experience  alarming  local  as  well  as  constitutional 
effects,  when  the  progress  of  the  poisoning  seemed  to  be  arrested  by 


*  For  accounts  of  cases,  see  a  paper  read  by  Dr.  Edward  Ilullowell,  before  the 
College  of  Physicians  of  I'hihidophia,  Dec.  1,  l^oL',  in  the  Transactions  <f  the  Col- 
lege, N.  S.,  i.  394;  the  New  Jersey  Medical  Reporter  for  March,  1853  (vol.  vi.  p.  195), 
in  which  a  case  is  recorded  credited  to  the  Southern  Medical  and  Surgical  Journal; 
the  Southern  Journal  of  the  Medical  and  Physical  Sciences  for  March,  1853  (vol.  i. 
p.  108);  and  the  Boston  Medical  and  Sury.  Journ.  for  January,  1854  (vol.  xlix. 
p.  606). 


CHAP.  I.]  CEREBRAL   STIMULANTS. — ALCOHOL.  661 

ardent  spirit,  given  until  it  rendered  him  insensible.  So  many  instances 
occur,  in  which  spontaneous  cures  of  snake-bites  take  place  after  the 
exhibition  of  threatening  symptoms,  and  so  many  others  in  which  the 
effects  of  the  bite  are  simply  those  of  a  shock  produced  by  fright  upon 
the  nervous  system,  that  it  is  very  difficult  to  determine  how  much  value 
can  be  attached  to  any  remedy,  which  may  be  recommended  on  the 
ground  of  experience.  In  the  St.  Louis  Medical  and  Surgical  Journ. 
(xii.  26)  is  a  communication  from  Dr.  J.  Oilman,  in  which,  as  the  result 
of  numerous  experiments  directly  with  the  poison  of  different  serpents 
upon  plants  and  animals,  he  found  that  alcohol,  "if  brought  in  contact 
with  the  venom,  is,  to  a  certain  extent,  an  antidote;"  while  the  poison 
mixed  with  the  solution  of  ammonia  and  various  other  agents  "seemed 
to  act  with  uudiminishcd  energy." 

In  some  nervous  diseases,  alcohol  possesses  considerable  powers.  In 
tetanus  it  has  been  given  very  freely,  in  the  form  of  wine  and  ardent 
spirit,  and  is  among  the  remedies  upon  which  most  reliance  has  been 
placed.  The  most  suitable  time  for  giving  it  is  at  the  first  appearance 
of  the  characteristic  symptoms,  and  before  the  disease  has  become  fully 
established;  and  it  should  be  so  exhibited  as  to  give  obvious  proofs  of 
affecting  the  system.  It  has  been  much  used  also  as  a  preventive, 
when  serious  apprehensions  have  been  entertained  of  an  attack.  The 
disease,  when  fully  formed,  resists  the  influence  of  alcohol  strongly ;  and 
it  is  very  difficult  to  obtain  its  characteristic  effects.  In  the  trembling 
palsy,  alcoholic  stimulation  is  sometimes  temporarily  beneficial ;  and  it 
may  be  used  with  great  advantage  in  those  cases  of  delirium  from  ex- 
haustion which  imitate  delirium  tremens.  Of  its  employment  in  the 
latter  affection  enough  has  been  said  already. 

Finally,  alcoholic  liquors  may  be  used  in  the  debility  arising  from 
excessive  secretion  or  hemorrhage,  in  that  of  convalescence,  and  in  that 
which  attends  the  advanced  stages  of  most  incurable  diseases  before  the 
fatal  issue.  In  epidemic  cholera,  it  is  highly  recommended,  in  large 
doses,  by  M.  Gaillard,  who  has  found  great  advantage  from  it  in  that 
affection,  which,  according  to  his  statement,  is  characterized  by  a  strong 
insusceptibility  to  its  intoxicating  effects.  Of  the  different  forms  of  alco- 
holic liquor  he  prefers  rum,  of  which  a  bottle  or  more  may  be  given  in 
the  day.  This  quantity  was  borne  by  a  delicate  woman,  wholly  unac- 
customed to  alcoholic  stimulation,  without  the  least  sign  of  intoxication. 
(Ann.  de  Thcrap.,  A.D.  1865,  p.  127.)  In  the  acute  diseases  of  intem- 
perate persons,  it  is  generally  necessary  to  have  recourse  to  these  liquors, 
in  order  to  sustain  life,  even  when  there  might  be  otherwise  no  indica- 
tion, or  a  positive  contraindication ;  care  being  taken  to  give  them  in 
as  small  a  quantity  as  the  circumstances  of  the  case  will  admit,  while 
efficient  methods  are  employed  to  combat  the  disease,  such  as  would  be 
used  in  cases  without  this  complication. 


b'62  GENERAL    STIMULANTS.  [PART  II. 

In  the  use  of  these  drinks,  a  preference  should  always  be  given  to  the 
weaker,  whenever  sufficient  to  answer  the  intended  purpose;  and,  from 
the  weakest  up  to  the  strongest,  there  should  be  a  graduation  directly  in 
proportion  to  the  debility,  and  at  the  same  time  the  insusceptibility  of 
the  system. 

Alcohol  has  lately  been  employed  as  a  dressing  for  wounds  by  sev- 
eral French  surgeons,  imitating  a  practice  as  old  as  the  times  of  Hippo- 
crates, who  recommended  wine  for  this  purpose.  In  favour  of  the  plan, 
it  is  asserted  to  promote  union  by  the  first  intention,  and  to  prevent  va- 
rious unpleasant  accidents  which  are  apt  to  follow,  especially  in  hospitals, 
such  as  purulent  infection,  hospital  gangrene,  angioleucitis,  and  erysipe- 
las. Alcohol  is  sometimes  used  in  its  purer  forms,  of  the  sp.  gr.  0.835 
for  example,  as  in  gangrenous  wounds  ;  sometimes  in  the  form  of  ardent 
spirit,  as  brandy,  whisky,  camphorated  spirit  of  0.923  sp.  gr.,  tincture 
of  aloes,  etc.  It  is  applied  on  compresses,  steeped  in  the  spirit,  care 
being  taken  always  to  keep  the  wounded  part  sufficiently  moist.  (Arch. 
Gen.,  Dec.  1864,  p.  725.) 

Another  local  use  of  alcohol,  suggested  by  Dr.  Luton,  of  Rheims,  is 
by  means  of  subcutaneous  injection,  for  the  relief  of  obstinate  neuralgia. 
Twenty  drops  may  be  thrown  into  the  areolar  tissue,  as  near  the  affected 
nerve  as  possible.  The  operation  is  attended  by  a  rather  severe  pain, 
followed  by  swelling;  but  this  soon  subsides,  ([bid.,  Oct.  1863,  p.  285.) 

Contraindications.  In  chronic  debility,  the  alcoholic  liquors  should  be 
employed  with  great  reserve,  from  the  fear  of  originating  habits  of  in- 
temperance. They  are  contraindicated  in  plethora,  in  fever  and  acute 
inflammation  with  a  sthenic  state  of  system,  in  acute  gastric  and  cerebral 
inflammations  under  almost  any  circumstances  except  in  drunkards,  and 
in  cases  of  special  sanguineous  determination  to  the  brain. 

4.  Forms  in  which  Alcohol  is  used. 
a.  Fermented  Liquors. 

1.  WINES. — VINA. 

The  U.  S.  Pharmacopoeia  recognizes  only  two  kinds  of  wine ;  1.  Sherry 
Wine,  VINUM  XERICUM,  U.  S.  (ViNUM  ALBUM,  U.  S.  1850,  White  Wine); 
and  2.  Port  Wine,  VINUM  PORTENSE,  U.  S.  (VINUM  RUBRUM,  U.  S.  1850, 
Red  Wine). 

The  wines  used  in  medicine  are  exclusively  the  fermented  juice  of  the 
grape.  The  same  name  has  been  given  to  the  fermented  juice  of  various 
other  fruits,  as  the  currant,  gooseberry,  elderberry,  etc.;  but  these  are 
not  admitted  into  the  Materia  Medica,  and  should  never  be  employed 
medicinally  in  the  place  of  genuine  wine,  when  the  latter  can  be  obtained. 

Wines  have  been  differently  classified,  according  to  their  qualities  and 


CHAP.  I.]  CEREBRAL   STIMULANTS. — WINES.  663 

origin.  The  most  important  distinction  for  the  physician  is  into  the  light 
and  the  strong  wines;  the  former  including  those  which  consist  exclu- 
sively or  nearly  so  of  the  fermented  grape-juice;  the  latter,  those  to  which 
brandy  or  other  form  of  ardent  spirit  has  been  added,  to  increase  their 
body,  and  enable  them  to  keep  better.  Among  the  former  are  sauterne, 
claret,  champagne,  the  Rhine  and  Moselle  wines,  and  burgundy ;  among 
the  latter,  madeira,  ieneriffe,  sherry,  and  port.  It  will  be  noticed  that 
the  distinction  between  the  two  kinds  is  not  only  the  difference  in  the 
quantity  of  alcohol  they  contain,  but  also  in  the  circumstance  that,  in  the 
one,  this  ingredient  is  in  the  state  in  which  it  was  produced  by  the  act  of 
fermentation,  in  the  other,  is  partly  superadded,  after  having  undergone 
the  process  of  distillation. 

Another  distinction  is  into  the  white  and  red  wines,  the  former  being 
prepared  from  colourless  grapes,  or  the  juice  of  the  red,  without  the  skins ; 
the  latter,  from  the  red,  with  their  skins  remaining.  The  only  important 
difference  between  them,  medically  considered,  is  that  the  red  contain 
tannic  acid,  which  gives  them  astringent  properties,  and  the  white  little 
or  none.  Of  the  wines  above  mentioned,  sauterne,  champagne,  the  hock 
or  Rhine  wines,  and  the  Moselle  wines,  of  the  lighter  varieties,  and  ma- 
deira, teneriffe,  and  sherry,  of  the  stronger,  generally  rank  among  the 
white ;  and  claret  and  burgundy,  of  the  light,  and  port,  of  the  stronger, 
among  the  red. 

Another  distinction  is  into  the  still  and  sparkling,  the  latter  being 
characterized  by  the  property  of  effervescence,  depending  on  the  presence 
of  carbonic  acid.  This  excess  is  owing  to  the  circumstance  that  they 
have  been  bottled  before  the  entire  completion  of  the  fermentation,  so 
that  the  carbonic  acid  subsequently  generated  is  confined.  Any  wine 
may  be  made  sparkling  in  this  way;  but,  generally  speaking,  it  is  only 
the  champagne  and  sparkling  moselle  that  have  this  quality.  An  ex- 
cellent sparkling  wine  is  made  at  Cincinnati,  Ohio,  from  the  juice  of  the 
Catawba  grape ;  and  I  have  seen  a  fine  variety,  little  inferior  to  French 
champagne,  produced  in  a  vineyard  of  California,  two  hundred  miles 
south  of  St.  Francisco. 

Some  wines  are  acidulous,  others  sweet,  and  others,  again,  have  scarcely 
any  perceptible  sourness  or  sweetness  to  the  taste,  though  almost  all 
contain  acid,  and  most  of  them  more  or  less  grape  sugar.  The  light 
wines  are  generally  the  most  acid. 

Composition.  Besides  alcohol  and  water,  wines  in  general  contain 
small  proportions  of  bitartrate  of  polassa,  malic,  lartaric,  and  carbonic 
acids,  extractive,  mucilaginous  and  colouring  matters,  oenanthic  ether, 
and  a  volatile  odorous  principle;  and  many  of  them,  grape  sugar  and 
tannic  acid.  The  proportion  of  absolute  alcohol  contained  in  them  varies, 
according  to  Christison,  from  6  to  17  per  cent,  by  weight.  The  table  of 
Brande  gives  proportions  varying  from  about  10  to  26  per  cent. ;  but  it 


664  GENERAL    STIMULANTS.  [PART  II. 

is  alcohol  of  the  sp.  gr.  0.825,  containing  a  considerable  proportion  of 
water,  that  is  here  referred  to,  and  the  ratio  is  by  measure  instead  of 
weight ;  so  that  his  numbers  are  necessarily  higher.  It  is  probable  that 
the  former  statement  approaches  the  truth  most  nearly.  It  is  a  point 
worthy  of  special  notice,  that  the  wines  above  mentioned  as  belonging 
to  the  lighter  class  contain,  on  an  average,  about  half  as  much  alcohol 
as  those  belonging  to  the  stronger ;  and  this  remark  holds  true  of  the  sev- 
eral varieties  of  the  two  classes.  This  fact  is  important  in  regulating  the 
dose  of  the  wines. 

Bitarlrale  of  potassa  is  most  abundant  in  new  wines,  and  is  gradually 
deposited  as  they  become  older.  Of  the  free  acids,  the  malic  is  said  to 
be  most  common,  the  tarlario  being  generally  combined.  Carbonic  acid 
is  probably  in  some  degree  present  in  all ;  but  is  most  abundant,  of 
course,  in  the  sparkling.  Acetic  acid  is  sometimes  present,  but  always 
probably  as  a  product  of  the  acetous  fermentation  of  the  alcohol,  and 
therefore  to  be  regarded  as  an  impurity. 

The  odorous  matter  upon  which  each  wine  depends  for  its  character- 
istic aroma  is  probably  a  volatile  oil  peculiar  to  each  ;  but  it  has  not 
been  separated.  There  is  in  most  if  not  all  wines  a  volatile  oily  matter, 
in  extremely  minute  proportion,  which  serves  to  impart  to  wines,  as  a 
class,  their  peculiar  flavour,  and  quite  distinct  from  the  characteristic 
aromatic  principles  of  the  several  wines.  This  is  the  cenanthic  ether, 
discovered  by  Liebig  and  Pelouze,  and  is  said  not  to  exceed  one  in  forty 
thousand  parts.  It  has  been  obtained  separate,  and  has  been  found,  in 
this  state,  to  have  a  disagreeable,  very  strong,  intoxicating  odour,  and 
an  unpleasant  taste.  It  has  been  supposed  that  it  might  contribute  to  the 
intoxicating  effects  of  the  wines  ;  but  the  point  has  not  been  determined. 

Sugar  is  not  a  desirable  ingredient  in  medicinal  wines,  and  the  sweeter 
varieties  are  therefore  little  employed. 

Tannic  acid  is  present  in  the  red  wines,  and  tends  to  render  them 
astringent;  but  its  effect  in  this  way  is,  in  some  of  the  lighter  wines, 
more  than  counteracted  by  the  bitartrate  of  potassa,  and  other  saline 
matter,  and  by  the  free  acids  they  contain.  Both  this  principle  and  the 
colouring  matter  is  gradually  deposited  with  time ;  and  port  wine,  so 
strongly  astringent  when  fresh,  becomes  after  many  years  almost  as 
colourless  and  free  from  astringency  as  madeira. 

By  long  keeping,  wine  becomes  softer  to  the  taste,  in  consequence  of 
the  deposition  of  the  bitartrate  of  potassa,  to  which  they  mainly  owe 
their  tartness,  and  of  the  tannic  acid  and  colouring  matter,  when  contained 
in  them.  When  kept  in  casks,  they  gradually  lose  alcohol ;  but,  accord- 
ing to  a  not  uncommon  opinion,  their  intoxicating  property  is  rather  in- 
creased than  diminished  ;  a  result  which,  if  true,  may  possibly  be  ascribed 
to  the  production  of  O3nanthic  ether. 

Effects  on  the  System.  The  effects  of  wine,  as  a  mere  alcoholic  liquor, 


CHAP.  I.]  CEREBRAL    STIMULANTS.— WINES.  665 

have  been  already  sufficiently  described  ;  but  there  are  certain  peculiari- 
ties in  its  operation  which  demand  notice.  These  result  either  from 
other  ingredients,  or  from  the  peculiar  state  in  which  alcohol  exists  in 
the  fermented  liquors.  Probably  both  these  causes  have  some  influence. 
It  was  at  one  time  supposed  that  alcohol  might  not  pre-exist  in  the  fer- 
mented liquors,  but  result  from  the  distillatory  process.  This,  however, 
has  been  fully  disproved ;  as  Brande  obtained  it  from  wines  without  dis- 
tilling them.  There  can,  however,  be  little  doubt  that  its  influence  on 
the  system  is  modified  by  the  state  of  association  in  which  it  exists  in 
the  fermented  liquors.  Wine  is  much  less  intoxicating,  in  proportion  to 
the  alcohol  it  contains,  than  ardent  spirit ;  and  the  lighter  wines  much 
less,  in  the  same  relation,  than  the  stronger,  to  which  brandy  has  been 
added.  Madeira  has  rather  less  than  half  the  proportion  of  alcohol  con- 
tained in  brandy,  and  claret,  according  to  Christison,  about  half  as  much 
as  madeira ;  yet  every  one  knows  that  two  glasses  of  madeira  are  less 
intoxicating  than  one  of  brandy ;  and  two  of  claret  less  so  than  one  of 
madeira.  It  would  seem,  therefore,  that  distillation  unsettles  some  as- 
sociation of  the  alcohol  which  has  a  strong  influence  in  modifying  its 
intoxicating  power.  Wine,  moreover,  operates  more  slowly  as  a  cerebral 
stimulant  than  ardent  spirit,  and  maintains  its  action  longer;  in  other 
words,  it  is  less  diffusible  and  more  tonic ;  and  the  same  may  be  said  of 
the  lighter  wines  in  relation  to  the  stronger.  The  probability  is,  that  the 
proper  alcohol  of  the  fermented  liquors  is  capable  of  a  more  ready  diges- 
tion and  assimilation  than  that  which  has  been  distilled  ;  and  that,  there- 
fore, while  it  stimulates  the  brain  less,  it  has  greater  efficacy  in  increasing 
and  enriching  the  blood,  and  in  promoting  nutrition.  The  practical  ap- 
plication of  this  fact,  supposing  it  to  be  a  fact,  will  be  seen  directly. 

In  relation  to  the  several  wines,  the  lighter  kinds  are  more  diuretic, 
and  more  disposed  to  be  laxative  than  the  stronger;  and  the  astringent 
wines  are  more  apt  to  produce  costiveness  than  those  not  astringent, 
unless  the  tannic  acid  is  associated  with  enough  saline  matter  to  coun- 
teract its  effects.  Thus,  port  wine,  which  is  highly  astringent,  and  not 
very  acidulous,  not  unfrequently  disposes  to  constipation,  while  claret, 
though  it  also  contains  tannic  acid,  is  yet  rather  laxative  than  otherwise, 
probably  through  its  bitartrate  of  potassa.  Burgundy  has  been  said 
also  to  be  disposed  to  constipate  in  consequence  of  its  astringency;  but 
I  have  not  found  it  so  in  practice.  The  sparkling  wines  are  thought  to 
be  much  more  rapidly  and  powerfully  intoxicating  than  the  still  wines  of 
the  same  strength ;  carbonic  acid  being  supposed  to  favour  their  influence 
upon  the  brain.  But  I  am  inclined  to  think  that  this  difference  has  been 
over  estimated.  Nothing  is  more  true  than  that  persons  drinking  cham- 
pagne are  vastly  more  apt  to  become  excited  than  by  the  still  wines  of 
much  greater  strength  ;  but,  with  careful  observation,  I  think  it  will  be 
found  that  this  results  much  more  from  the  quantity  taken,  and  the  ra- 


666  GENERAL   STIMULANTS.  [PART  II. 

pidity  with  which,  from  its  agreeable  flavour,  it  is  usually  taken,  than 
from  the  mere  difference  in  quality.  Yet  I  do  not  altogether  deny  that 
the  sparkling  wines  are  rendered  more  rapidly  intoxicating  by  their  car- 
bonic acid.  They  are  at  first  also  more  acceptable  to  the  stomach  ;  but, 
in  their  secondary  operation,  are  very  apt  to  discompose  it,  and  to  occa- 
sion headache,  nausea,  and  other  unpleasant  sensations.  This  may  in 
part  be  owing  to  the  saccharine  matter  which  accompanies  them,  and  has 
a  tendency  to  produce  acidity  of  stomach;  an  objection  to  which  sweet 
wines  in  general  are  liable. 

Wines  used  habitually  in  excess  are  much  more  apt  to  produce  gout, 
and  uric  acid  lithiasis,  than  either  delirium  tremens,  or  chronic  disease  of 
the  liver.  The  reason  probably  is,  that,  by  stimulating  less,  and  favour- 
ing the  blood-making  processes,  either  directly  or  indirectly,  more  than 
ardent  spirit,  they  are  more  apt  to  induce  the  plethoric  condition  of  the 
blood  which  favours  these  affections.  Their  injurious  influence  is  very 
much  diminished  by  vigorous  exercise;  and  the  resolute  wine-drinker, 
if  he  have  any  regard  for  his  health,  should  sedulously  avoid  a  sedentary 
life. 

Therapeutic  Application.  Wines  may  be  employed  for  all  the  purposes 
for  which  alcoholic  stimulation  is  demanded,  and,  as  a  general  rule,  are 
greatly  preferable  to  ardent  spirits.  Almost  the  only  exceptions  to  this 
rule  are  in  the  cases  of  the  habitually  intemperate,  and  in  those  instances 
of  great  prostration,  or  extraordinary  insensibility  to  the  effects  of  alco- 
hol, in  which  the  system  refuses  to  respond  to  the  influence  of  wine. 
For  some  local  purposes,  also,  the  distilled  liquors  are  preferable.  Only 
a  few  practical  observations,  therefore,  will  be  required ;  and  these  few 
will  refer  rather  to  the  choice  of  particular  wines  than  to  their  general 
use. 

When  the  habitual  use  of  alcoholic  drinks,  in  moderation,  may  be 
deemed  advisable,  as  in  those  disposed  to  scrofula  and  phthisis,  or  la- 
bouring under  these  diseases  without  the  complication  of  acute  inflam- 
mation, the  lighter  wines  should  always  be  preferred  to  the  stronger. 
Sauterne,  claret,  hock,  or  burgundy  should  be  given  preferably  to  ma- 
deira, sherry,  or  port.  The  object  is  here  not  cerebral  stimulation,  but 
a  sustained  tonic  effect,  the  promotion  of  the  digestive,  assimilative,  and 
nutritive  functions,  and  perhaps  more  than  all,  that  condition  of  the 
blood  which  experience  has  shown  to  be  unfavourable  to  the  tuberculous 
formation.  I  am  not  now  treating  of  the  relative  value  of  wines  and 
malt  liquors,  but  of  the  choice  between  the  different  kinds  of  wine.  In 
relation  to  the  state  of  the  stonuich,  when  that  is  disposed  to  be  disor- 
dered, I  think  burgundy  will  generally  be  found  to  agree  with  it  better 
than,  the  clarets  or  hocks,  though  probably  somewhat  more  stimulant  to 
the  brain. 

When,  on  the  contrary,  wine  is  required  for  a  temporary  purpose,  and 


CHAP.  I.]  CEREBRAL   STIMULANTS. — WINES.  667 

for  its  stimulant  influence  solely,  the  stronger  wines  should  generally  be 
preferred.  They  answer  the  indication  more  effectively,  and  are  less  apt 
to  produce  acescency,  and  otherwise  to  disorder  the  stomach.  They  are 
usually  also  better  adapted  to  cases  attended  with  dyspepsia.  To  fulfil 
the  indications  offered  in  the  low  or  typhoid  states  of  fever,  and  in  gen- 
eral prostration  from  any  cause,  the  stronger  wines  should  be  chosen. 
Madeira  or  sherry  is,  in  general,  preferable  to  the  other  stronger  wines, 
and  especially  the  latter,  as  being  more  free  from  acid.  Whe'n,  how- 
ever, there  is  a  coincident  indication  for  astringency,  as  when  diarrhoea 
exists,  or  hemorrhage,  especially  from  the  bowels,  port  wine  should  be 
preferably  employed.  When  the  stomach,  in  cases  requiring  stimulation, 
is  very  irritable,  and  rejects  the  other  wines,  champagne  or  sparkling 
moselle  will  sometimes  answer  an  admirable  purpose ;  but  those  varieties 
should  be  selected  which  are  most  free  from  saccharine  matter,  and  in 
which  the  fermentation  has  been  most  nearly  completed.  The  factitious 
champagnes  might,  under  these  circumstances,  prove  noxious,  rather 
than  remedial.  "When  wines  are  required  in  cases  presenting  a  joint 
indication  for  a  stimulant  and  diuretic,  as  sometimes  happens  in  dropsy, 
the  lighter  acidulous  wines  should  be  employed  ;  and  the  same  remark 
is  applicable  to  enfeebled  states  of  the  system,  with  copious  phosphatic 
deposition  in  the  urine. 

Wine- whey  is  an  excellent  preparation  for  use  in  all  low  fevers,  in  the 
debility  which  often  attends  the  advanced  stages  of  acute  diseases,  when 
the  violence  of  the  special  disease  is  past,  and  ia  the  same  condition 
occurring  at  the  close  of  incurable  affections.  Whenever  stimulation  is 
required  in  these  cases,  it  is  best,  as  a  general  rule,  to  begin  with  wine- 
whey,  and  advance  to  pure  wine  only  after  that  preparation  may  prove 
inadequate  to  the  demands  of  the  case.  It  should  be  prepared  by  boil- 
ing a  pint  of  milk,  adding  half  a  pint  of  wine  while  it  is  still  boiling  hot, 
and  stirring  until  the  mixture  is  complete.  After  coagulation,  the  whey 
should  be  strained  off,  and  given  generally  without  sweetening.  Madeira 
or  sherry  should  be  employed  in  its  preparation.  The  proportion  of  wine 
mentioned  is  requisite,  in  order  to  ensure  perfect  coagulation.  If  desir- 
able, the  whey  may  afterwards  be  diluted  with  solution  of  gum,  or  one 
of  the  amylaceous  matters,  or  by  rennet-whey.  It  has  the  advantage 
over  diluted  wine  of  being  more  nutritious,  and  often  more  acceptable  to 
the  patient. 

The  dose  of  wine-whey  is,  ordinarily,  in  low  febrile  cases,  a  wine- 
glassful  every  two  hours;  but  it  must  be  diminished  or  increased,  both 
in  frequency  and  amount,  according  to  the  effects  desired,  and  those  pro- 
duced. The  stronger  wines  may  be  given  in  doses  varying  from  a  table- 
spoonful  to  a  wineglassful,  at  the  same  interval.  In  chronic  or  protracted 
cases,  the  dose  should,  in  general,  be  less  frequently  repeated.  When 
the  lighter  wines  are  used,  the  quantity  must  be  regulated  altogether  by 

X 


668  GENERAL    STIMULANTS.  [PART  II. 

their  effects;  but  one  strict  rule  should  be  adhered  to;  namely,  never  to 
allow  their  influence  to  proceed  so  far  as  to  disturb  the  sound  operation 
of  the  brain.  To  become  intoxicated,  or  even  to  approach  intoxication, 
would  be  quite  unjustifiable  in  patients  using  these  wines  habitually  for 
their  health. 

Wine  may  be  given  by  enema,  when,  in  consequence  of  irritation  of 
stomach,  it  cannot  be  retained  if  swallowed.  It  has,  indeed,  been  par- 
ticularly recommended,  in  this  mode  of  administration,  in  old  and  obsti- 
nate cases  of  exhausting  diarrhoea. 


2.  MALT  LIQUOR. — CEREVISIA. 

This  is  prepared,  by  means  of  the  vinous  fermentation,  from  an  infu- 
sion of  malt,  which  is  made  from  barley,  by  exposing  it  to  a  moderately 
elevated  temperature  with  moisture,  so  as  to  promote  germination,  and 
then  drying  the  germinated  grain  by  artificial  heat.  In  the  germination 
of  barley,  there  is  first  generated  a  nitrogenous  principle  called  diastase, 
through  the  agency  of  which  the  starch  of  the  grain  is  converted  into 
grape  sugar  This  is  extracted  by  infusion,  and  along  with  it  a  matter 
which  is  capable  of  acting  as  a  ferment.  Hops  are  added  to  the  infusion, 
and  the  liquid  is  exposed  to  a  temperature  favourable  to  vinous  fermen- 
tation. The  result  is  malt  liquor,  which  differs  according  to  the  quantity 
and  character  of  the  malt  employed.  Three  prominent  varieties  are  re- 
cognized ;  namely,  table  beer,  ale,  and  porter.  In  the  drying  of  the  malt, 
it  is  exposed  to  different  temperatures  from  100°  Fahr.  upward.  When 
dried  at  the  lowest  temperature,  it  undergoes  little  change  of  colour,  and 
is  called  pale  malt;  at  a  greater  heat,  but  insufficient  to  decompose  it, 
the  colour  is  changed  to  amber  brown;  and,  at  a  high  heat,  it  is  roasted 
and  charred,  losing  its  characteristic  properties  to  a  considerable  extent. 
In  the  preparation  of  ale,  the  pale  malt  is  used ;  in  that  of  beer,  the 
brownish ;  and  in  that  of  porter,  the  same  with  the  addition  of  some  of 
the  roasted  malt  to  deepen  its  colour.  Table  beer,  in  which  but  a  small 
proportion  of  malt  is  used,  contains  insufficient  alcohol  to  preserve  it, 
and  is  therefore  apt  to  spoil  in  hot  weather.  It  is  unfit  for  medical  use, 
and  may  be  left  out  of  consideration. 

Composition.  Malt  liquor,  besides  alcohol  and  water,  contains  sugar, 
gummy  and  extractive  matters,  and  gluten,  derived  from  the  malt;  a 
bitter  principle  and  volatile  oil,  from  the  hops*  and  lactic  and  carbonic 
acids,  the  product  of  the  chemical  change  in  fermentation.  There  are 
also  various  salts  of  little  or  no  importance.  The  bitterness  of  the  liquor 
is  owing  to  the  bitter  principle  of  the  hops,  and  its  aroma  in  part  to  their 
volatile  principle. 

ALB  owes  its  light  colour  to  the  paleness  of  the  malt.  According  to 
the  analysis  of  Brande,  it  contains  on  an  average  6.87  per  cent,  by 


CHAP.  I.]  CEREBRAL   STIMULANTS. — MALT   LIQUOR.  669 

measure  of  alcohol  of  the  sp.  gr.  0  825,  and  of  course  has  somewhat 
more  than  one-half  the  average  strength  of  the  light  wines. 

PORTER  is  very  dark-coloured  in  consequence  of  the  burnt  malt  used 
along  with  dried  malt  in  its  preparation.  For  the  same  reason  it  is 
somewhat  weaker  when  prepared  from  an  equal  amount  of  malt ;  for 
the  portion  burnt  has  lost  its  virtues.  The  alcoholic  strength  of  London 
porter,  as  given  in  Brande's  table,  is  4.20  per  cent,  of  brown  stout  6.80 
per  cent. 

The  carbonic  acid  in  malt  liquors  is  owing  to  the  incompleteness  of  the 
fermentation  when  they  are  bottled.  In  consequence  of  having  a  smaller 
proportion  of  alcohol  than  the  wines,  they  more  readily  become  sour  on 
exposure,  and  are  often  unfit  for  use. 

Effects  on  the  System.  So  far  as  their  alcohol  is  concerned,  these 
liquors  do  not  differ  from  the  wines  in  their  effects  ;  and  the  remarks 
made  upon  the  modified  influence  of  the  alcohol  as  existing  in  the  latter, 
are  equally  applicable  to  the  former.  But  the  malt  liquors  are  richer  in 
nutritive  matters,  leaving  the  alcohol  out  of  consideration,  than  the 
wines,  and  have,  in  addition,  the  properties  of  the  hops  employed,  which 
are  actively  tonic,  and  exercise  a  decided  narcotic  influence  on  the  brain, 
producing  a  tendency  to  drowsiness.  Hence  ale  and  porter,  while  they 
are  capable  of  stimulating  to  intoxication,  are  less  enlivening  and  exhil- 
arating than  the  wines,  and  more  tonic  and  soporific.  When  perfectly 
sound, they  usually  agree  well  with  the  stomach;  but  in  the  dyspeptic, 
though  the  hops  they  contain  act  favourably  on  the  digestion,  they  are 
not  unfrequently  injurious  by  their  acescent  tendency. 

Therapeutic  Application.  The  malt  liquors  may  be  used  for  the  same 
general  purposes  as  the  wines ;  but  they  cannot  compete  with  them  in  any 
case  in  which  the  stomach  is  in  a  delicate  state;  and  are  therefore  gen- 
erally unsuited  to  acute  diseases.  In  the  convalescence,  however,  from 
these  affections,  when  the  stomach  is  no  longer  diseased,  they  are  often 
preferable  to  the  wines,  as  less  stimulating  and  more  tonic. 

For  the  same  reason,  they  are  better  suited  to  chronic  cases,  in  which 
the  indication  is  for  the  habitual  employment  of  supporting  measures,  as 
in  scrofulous  or  tuberculous  affections.  Persons  disposed  to  these  com- 
plaints, or  labouring  under  them,  may  often  advantageously  make  use 
of  ale  or  porter,  to  the  amount  of  a  pint  or  more  in  twenty -four  hours. 

They  are  also  an  excellent  substitute  for  the  stronger  alcoholic  drinks, 
when  it  is  desired  gradually  to  correct  habits  of  intoxication ;  the  hops 
they  contain  acting  usefully  towards  obviating  the  wakefulness  and  ner- 
vous disorder,  so  apt  to  ensue  upon  a  material  diminution  of  the  stimu- 
lus. But  it  must  be  understood  that  the  porter  or  ale  also  must  be*  ulti- 
mately withdrawn. 

In  the  treatment  of  delirium  tremens,  it  is  often  sufficient  to  allow  the 
patient  the  free  use  of  malt  liquors  in  connection  with  the  opium  used  ; 


670  GENERAL   STIMULANTS.  [PART  II. 

or,  if  ardent  spirit  is  employed,  it  should  as  soon  as  possible  give  way 
to  these  milder  stimulants. 


b.  Distilled  Liquors. 

Under  this  head  may  be  included  all  that  is  necessary  to  be  said 
both  of  the  ardent  spirits,  and  the  stronger  preparations  called  in  the 
U.  S.  Pharmacopoeia  simply  Alcohol  and  Stronger  Alcohol,  and  in  the 
British,  Rectified  Spirit. 

1.  ARDENT  SPIRITS.—  Proof  Spirit. 

These  are  prepared  by  a  simple  distillation  of  the  fermented  liquors, 
and  receive  names  according  to  the  particular  liquors  from  which  they 
may  be  severally  derived.  Thus,  the  spirit  distilled  from  wine  is  called 
brandy ;  that  from  a  fermented  solution  of  sugar,  rum  ;  and  that  from 
the  fermented  infusion  of  malted  grains,  particularly  rye,  is  called 
whisky,  or,  if  flavoured  with  oil  of  juniper,  gin.  There  is  little  difference 
between  these,  in  relation  to  the  effects  of  the  alcohol ;  but  one  is  some- 
times preferred  for  its  flavour,  or  in  consequence  of  some  peculiarity  of 
effect  from  peculiar  impregnation,  as  in  the  instance  of  gin,  which  is 
more  diuretic  than  the  others  from  its  oil  of  juniper.  Medically,  there- 
fore, it  is  of  little  importance  that  the  different  forms  of  ardent  spirit 
are  now  frequently  prepared  artificially  from  rectified  spirit,  by  freeing  this 
from  fusel  oil  by  passing  it  through  charcoal,  then  reducing  it  with  water 
to  the  requisite  strength,  and  lastly,  giving  the  desired  colour  and  flavour 
by  suitable  additions. 

Li  randy  (Sriiuxus  VINI  GALLICI,  U.  S.)  is  recognized  in  the  U.  S. 
Pharmacopoeia  as  officinal.  It  varies  somewhat  with  the  character  of 
the  wine  from  which  it  is  procured.  French  brandies  have  the  highest 
reputation,  and  of  these  the  cogniac  and  armagnac.  Brandy,  according 
to  Brande,  contains  53.39  per  cent,  by  measure  of  alcohol  of  0.825.  It 
has,  therefore,  somewhat  more  than  twice  the  strength  of  madeira  and 
sherry  wines,  four  times  that  of  the  light  wines,  and  from  eight  to  twelve 
times  that  of  ale  and  porter.  Besides  alcohol  and  water,  it  contains  a 
little  volatile  oil,  colouring  matter,  oeuanthic  and  acetic  ethers,  and  a 
minute  proportion  of  tannic  acid.  Its  colour  is  sometimes  deepened  by 
the  addition  of  burnt  sugar. 

Whisky  (SPIRIT/US  FRUMENTI,  U.  S.)  was  introduced  into  the  U.  S. 
I'iinnacopoeia,  at  the  late  revision,  and  from  its  very  extensive  medici- 
nal use,  very  properly  so.  It  is  the  spirit  obtained  by  the  distillation  of 
the  fermented  infusion  of  rye,  corn,  or  other  grain.  Its  average  strength 
is  about  the  same  as  that  of  brandy,  and  its  medicinal  effects  nearly 
identical,  though  it  differs  considerably  in  flavour.  It  may,  therefore,  if 
of  good  quality,  be  substituted  in  medical  use  for  brandy,  over  which 


CHAP.  I.]         CEREBRAL   STIMULANTS. — ARDENT    SPIRITS.  671 

it  has  the  advantage  of  being1  much  cheaper.  The  Pharmacopoeia  re- 
quires that  it  should  contain  from  48  to  56  per  cent,  of  absolute  alcohol; 
so  that  its  sp.  gr.  should  not  be  greater  than  0.922  at  60°  F.,  nor  less 
than  0.904. 

Effects  on  the  System.  The  effects  of  the  ardent  spirits  have  been 
already  fully  described  in  the  general  observations  on  alcohol.  The  con- 
sequences of  their  abuse  are  so  fearful,  that  they  should  be  banished  alto- 
gether from  customary  use.  Less  apt  than  nines  and  malt  liquors  to 
cause  gout,  they  much  more  frequently  give  rise  to  delirium  tremens 
and  meningeal  inflammation,  and,  in  their  ultimate  operation,  if  the  many 
dangers  by  the  way  be  escaped,  to  diseased  liver,  degeneration  of  various 
organs,  and  finally  death  with  universal  dropsy. 

Therapeutic  Application.  The  distilled  liquors  should  never  be  em- 
ployed, when  the  fermented  will  answer  equally  well,  in  consequence  of 
the  terrific  dangers  of  their  abuse.  But  occasionally  they  are  necessary 
to  the  salvation  of  life.  It  is  sometimes,  in  low  fevers,  advisable  to  in- 
troduce stimulus  into  the  stomach  in  as  concentrated  a  state  as  the  organ 
will  bear,  when  considerable  quantities  both  of  it  and  of  nourishment  are 
required.  Thus,  it  is  better,  in  such  instances,  to  give  a  tablespoonful 
of  brand}'  with  two  of  milk,  than  an  equivalent  quantity  of  wine  and 
other  liquid  aliment.  The  stomach  receives  better,  and  subsequently 
manages  better,  the  material  in  smaller  bulk.  Again,  cases  now  and 
then  occur,  in  which  the  prostration  and  insensibility  are  so  great  that 
wine  is  powerless.  Brandy  or  some  equivalent  liquor  is  then  our  only 
resource.  In  the  low  diseases  of  drunkards,  it  is  necessary  to  stimulate 
with  ardent  spirit ;  as  wine  will  have  little  more  effect  than  water.  In 
delirium  tremens,  it  is  not  unfrequently  necessary  to  use  it  to  prevent 
death  from  sheer  prostration.  There  are  certain  diseases,  too,  in  which 
there  i.s  an  extraordinary  insusceptibility  to  alcoholic  liquids;  and  enor- 
mous quantities  are  requisite  to  act  decidedly  on  the  system.  This  is  often 
the  case  in  tetanus,  and  it  is  said  to  be  so  in  the  state  of  system  resulting 
from  the  bites  of  venomous  snakes.  Sometimes  in  prolonged  syncope, 
and  in  asphyxia,  it  may  be  advisable  to  administer  brandy,  either  by  tin- 
mouth  or  the  rectum. 

In  dyspeptic  affections  a  little  brandy  often  yields  great  relief  to  pa- 
tients unaccustomed  to  its  use.  A  teaspoonful  or  two  will  generally 
relieve  the  peculiar  and  distressing  epigastric  uneasiness  of  that  com- 
plaint, and,  taken  at  meal  times,  will  facilitate  the  solution  and  digestion 
of  the  food.  The  relief,  indeed,  is  so  great,  that  the  patient  often  feels 
an  irresistible  inclination  to  repeat  the  remedy ;  and  as,  from  time  to  time 
by  the  gradual  diminution  of  the  excitability  of  the  organ,  it  becomes 
necessary  to  increase  the  dose  in  order  to  obtain  the  same  relief  as  at 
first,  the  patient  is  led  on,  almost  without  a  suspicion  on  his  own  part, 
into  confirmed  habits  of  intemperance.  Many  a  drunkard  has  probably 


672  GENERAL   STIMULANTS.  [PART  II. 

owed  a  miserable  death  to  the  inconsiderate  recommendation  of  a  little 
brandv  in  dyspepsia.  To  obtain  the  same  advantages  with  less  danger, 
the  bitter  tinctures,  as  those  of  gentian,  quassia,  and  columbo,  may  be 
prescribed,  and  so  associated  with  other  medicines,  that  the  patient  may 
not  be  able  to  trace  his  relief  to  the  spirit.  The  aromatic  spirit  of  am- 
monia, which  is  only  alcohol  holding  a  little  carbonate  of  ammonia  in 
solution,  with  aromatic  oils,  may  also  be  substituted.  In  no  case  should 
the  remedy  be  continued  uninterruptedly  and  indefinitely. 

Brandy  sometimes  affords  quick  relief  in  gaslrodynia,  pure  gastric 
spasm,  and  nervous  colic. 

It  is  also  sometimes  useful  in  correcting  the  effects  of  limestone  water, 
when  no  other  drink  can  be  obtained,  and  when  this  produces  nausea 
and  diarrhoea,  as  it  is  very  apt  to  do  with  persons  unaccustomed  to  it. 
In  travelling  in  limestone  regions,  I  have  often  found  advantage  from 
adding  a  single  teaspoonful  or  two  to  a  tumbler  of  the  water.  It  covers 
the  nauseous  taste,  and  often  corrects  the  purging  tendency. 

Brandy  is  much  and  very  usefully  employed  externally  as  a  stimulant 
and  rubefacient.  In  all  low  states  of  the  system,  with  a  cool  surface,  it 
may  be  employed  in  the  way  of  friction,  and  as  hot  as  the  skin  will  bear 
it.  Under  the  same  circumstances,  it  may  be  rendered  more  efficient  by 
admixture  with  rubefacient  medicines,  as  Cayenne  pepper,  and,  when 
the  case  is  complicated  by  spasmodic  or  other  nervous  disorder,  with 
garlic.  It  may  be  used  also,  in  the  form  of  hot  fomentation,  to  relieve 
internal  abdominal  pains,  when  associated  with  a  depressed  state  of  sys- 
tem. For  the  prevention  of  bed-sores,  and  excoriations  from  other 
causes,  it  is  often  applied  with  benefit  by  lotion  to  the  skin ;  and  Dr. 
Christison  recommends  particularly  a  mixture  of  brandy  and  the  white 
of  egg,  to  be  applied  to  the  part  by  a  brush;  the  application  to  be  re- 
peated as  each  layer  dries,  until  a  coating  of  sufficient  thickness  is  formed. 

Brandy  may  be  given  diluted  with  water,  or  mixed  with  milk,  in  the 
form  of  milk-punch.  The  latter  is  an  excellent  remedy  when  there  is  a 
conjoint  indication,  as  often  happens,  for  stimulation  and  nutrition.  The 
successive  introduction  of  the  milk  in  small  portions,  with  stimulus 
enough  to  promote  its  digestion,  has  a  very  happy  effect.  For  use  in 
low  fevers,  one  part  of  brandy  should  be  added  to  two  or  three  of  milk ; 
and  the  preparation  may  be  given  in  wineglassful  doses. 

Under  the  name  of  MISTURA  SPIRITUS  VINI  GALLICI,  or  Brandy  Mix- 
ture, the  London  College  formerly  directed  a  preparation  consisting  of 
brandy  and  cinnamon-water,  each,  four  fluidounces,  the  yolks  of  two 
eggs,  refined  sugar  half  an  ounce,  and  oil  of  cinnamon  two  minims, 
mixed  together.  If  the  cinnamon-water  of  the  U.  S.  Pharmacopoeia  be 
used,  there  will  be  no  occasion  for  the  addition  of  the  oil  of  cinnamon. 
Two  or  three  tablespoonfuls  may  be  given  for  a  dose  in  low  fevers,  when 
brandy  is  indicated.  The  preparation  has  been  omitted  in  the  British 
Pharmacopoeia. 


CHAP.  I.]  CEREBRAL    STIMULANTS. — ETHER.  673 

2.  ALCOHOL.  U.S.  —  SpmiTUS  RECTIFICATUS.  Land. — Rec- 
tified Spirit. 

By  the  term  alcohol,  as  before  stated,  theTJ.  S.  Pharmacopoeia  recog- 
nizes a  spirit  of  the  sp.  gr  0.835,  prepared  by  distilling  brandy  or  other 
form  of  ardent  spirit.  The  corresponding  British  "rectified  spirit"  has 
the  sp.  gr.  0.838.  Officinal  alcohol  is  never  used  internally;  but  exter- 
nally it  may  be  employed  as  an  evaporating  lotion,  applied  on  a  single 
thickness  of  linen,  so  as  to  admit  of  free  evaporation.  By  its  chemical 
influence  in  the  abstraction  of  water,  it  is  thought  to  produce  the  shrink- 
ing of  blood-vessels;  and,  when  brought  into  contact  with  the  blood, 
causes  its  coagulation.  Hence  it  has  been  recommended  for  the  suppres- 
sion of  hemorrhage  by  direct  application  to  the  bleeding  vessels.  But 
its  chief  value  is  as  a  chemical  and  pharmaceutical  agent.  From  its 
solvent  and  preservative  properties,  it  answers  an  excellent  purpose  for 
preparing  tinctures  of  substances  wholly  insoluble  in  water.  (See  first 
part  of  this  work,  page  61.) 

3.  STRONGER  ALCOHOL.  —  ALCOHOL  FoRTIUS.  U.S. 

This  preparation  is  somewhat  stronger  than  the  preceding,  having  the 
sp.  gr.  0. 81 1.  It  differs  also  in  being  more  completely  destitute  of  fusel  oil ; 
and  on  this  account  was  introduced  into  the  Pharmacopoeia,  as  a  means 
of  preparing  other  officinal  substances,  as  ether,  spirit  of  nitrous  ether, 
etc.  It  is  not  used  of  itself  medicinally,  and  is  therefore  of  more  im- 
portance to  the  pharmaceutist  than  the  medical  practitioner. 

4.  DILUTED  ALCOHOL.  —  ALCOHOL  DlLUTUM.  U.S.  —  SPI- 
RITUS    FORTIOR.  Er. 

This  is  prepared,  according  to  the  U.  S.  Pharmacopoeia,  by  mixing 
equal  measures  of  officinal  alcohol  and  distilled  water.  It  is  not  quite 
so  strong  in  alcohol  as  the  proof  spirit  of  the  British  Pharmacopoeia,  or 
as  ordinary  full  proof  brandy.  It  is  used  chiefly  in  the  preparation  of 
tinctures,  from  substances  containing  active  principles  soluble  both  in 
water  and  alcohol.  (Seepage  61.) 


II.  ETHER. 

AETHER.  U.  S.,  Er. 

Syn.  Sulphuric  Ether.     jElher  Sulphuricus. 

Ether  is  obtained  by  the  distillation  of  a  mixture  of  alcohol  and  sul- 
phuric acid ;  but,  as  thus  procured,  it  is  impure,  containing,  besides  the 
pure  ether,  sulphurous    acid,  ethereal  oil,  alcohol,  and  water.     From 
these  it  is  purified  by  redistillation  from  a  strong  solution  of  potassa. 
VOL.  I. — 43 


674  GENERAL   STIMULANTS.  [PART  II. 

Ether  consists  of  the  same  ingredients  as  alcohol  less  one  equivalent 
of  hydrogen  and  one  of  oxygen,  in  other  words,  less  one  equivalent  of 
water.  This  equivalent  of  water  is  abstracted  by  the  sulphuric  acid. 
Chemists  differ  as  to  the  precise  mode  in  which  the  end  is  attained;  but 
the  result  is  as  stated.  At  the  same  time,  a  reaction  takes  place,  by 
which  a  very  small  portion  of  the  sulphuric  acid  is  converted  into  sul- 
phurous acid,  and  of  the  alcohol  into  heavy  oil  of  wine,  or  ethereal  oil. 
Hence  the  presence  of  these  impurities  in  the  product  of  the  first  distilla- 
tion. In  the  second  distillation,  the  potassa  neutralizes  the  sulphurous 
acid,  and  abstracts  any  water  that  may  be  present ;  the  alcohol  is  retained 
by  the  water,  and  the  ethereal  oil  is  either  decomposed  or  remains  behind. 
The  ether  obtained,  however,  still  contains  a  little  alcohol,  from  which 
it  is  not  necessary  that  it  should  be  entirely  freed  for  certain  medical 
purposes,  especially  as  an  external  application.  But  for  inhalation,  it  is 
important  that  it  should  be  as  pure  as  possible;  and  both  the  U.  S.  and 
British  Pharmacopoeias  give  processes  for  its  purification ;  designating 
the  resulting  preparation  by  names  denoting  either  its  greater  strength  or 
purity. 

STRONGER  ETHER,  —  -ZElHER  FoRTlOR.  U.S. —  Pure Etlter. 
Br.  Appendix. 

The  process  of  the  U.  S.  Pharmacopoeia  consists  in  first  shaking  un- 
purified  ether  and  water  strongly  together,  and,  after  subsidence,  pouring 
off  the  supernatant  ether,  thus  deprived  of  its  alcohol;  then  agitatinir 
this  with  chloride  of  calcium  and  quicklime,  in  fine  powder,  so  as  to  sepa- 
rate the  water ;  and  lastly,  distilling  off  only  a  portion  of  the  liquid.  Even 
thus  strengthened  and  purified,  ether  is  not  absolutely  pure,  as  it  still 
contains  a  little  alcohol ;  but  it  is  sufficiently  pure  for  all  medical  uses. 
The  British  process  is  essentially  the  same. 

Properties.  Ether  is  a  colourless  liquid,  having,  when  quite  pure, 
the  sp.  gr.  of  about  0.712  ;  but,  as  directed  in  our  officinal  code,  it  has  in 
the  crude  state  the  sp.  gr.  0.750,  according  to  the  British  Pharmacopoeia 
0.735;  and  in  the  pure  state  (sether fortior)  0.728,  U.S.,  and  0.720,  Br. 
In^he  latter  condition,  it  should  not  lose  more  than  from  one-tenth  to 
one-eighth  by  agitation  with  water;  should  boil  actively  when  a  test-tube 
half  filled  with  it  is  held  in  the  hand,  and  a  small  piece  of  glass  is  dropped 
into  it;  and,  when  half  a  fluidounce  of  it  is  moved  backward  and  for- 
ward upon  a  porcelain  plate,  should  yield  a  faint  aromatic  odour  as  the 
last  portions  are  volatilized,  and  leave  the  surface  of  the  plate  without 
smell  or  taste,  but  covered  with  moisture.  These  are  the  officinal  tests 
of  its  sufficient  purity. 

The  odour  of  ether  is  strong,  penetrating,  and  rather  grateful;  its 
taste,  hot  and  pungent,  yet  somewhat  cooling  also.  It  is  extremely 
volatile,  rapidly  escaping  when  exposed  to  the  air,  and  producing  cold 
during  its  vaporization.  Its  boiling  point  is.  extremely  low,  scarcely  ex- 


CHAP.  I.]        CEREBRAL  STIMULANTS. — ETHER.  675 

ceeding  the  heat  of  one  of  our  hot  summer  days.  It  is  also  highly  in- 
flammable; and  its  vapour  forms  an  explosive  mixture  with  atmospheric 
air.  Caution  should,  therefore,  be  observed  not  to  allow  the  too  near  ap- 
proach of  flame  when  it  is  used.  The  affinity  between  it  and  water  is 
not  strong.  June  parts  by  measure  of  water  will  dissolve  one  part  of 
ether;  and,  conversely,  ether  will  take  up  about  the  same  proportion  of 
water.  If  mixed  in  other  proportions,  the  two  liquids  will  separate,  the 
ether  floating  on  the  surface.  It  unites  in  all  proportions  with  alcohol. 
On  exposure  to  the  air,  it  undergoes  gradual  decomposition,  producing 
acetic  acid  and  water.  It  should  evaporate  wholly  on  exposure,  and 
should  not  become  milky  on  being  mixed  with  water. 

Composition.  All  agree  that  ether  consists  of  4  eqs.  of  carbon,  5  of 
hydrogen,  and  1  of  oxygen  (C4H5O);  but,  as  to  the  precise  mode  in 
which  its  constituents  are  combined,  different  views  have  been  enter- 
tained. According  to  the  one  most  generally  received,  it  is  simply  the 
oxide  of  ethyl,  consisting  of  1  eq.  of  ethyl  (C4H.)  and  1  of  oxygen. 

1.  Effects  on  the  System. 

Ether  is  a  universal  and  highly  diffusible  stimulant,  closely  resembling 
alcohol  in  its  action,  but  much  more  speedy  and  less  durable.  When  I 
say  that  it  is  universal,  I  do  not  mean  that  it  absolutely  stimulates  every 
function  at  the  same  time ;  but  only  that  there  is  no  function  which  it  is 
not  capable  of  stimulating.  Like  alcohol,  it  more  or  less  excites  the 
secretions,  and,  as  shown  by  Bernard,  stimulates  the  sugar-producing 
function  of  the  liver.  (Arch.  Gen.,  Juin,  1856,  p.  736.)  Its  operation  is 
very  evanescent. 

Applied  externally,  and  confined  so  that  it  cannot  evaporate,  it  speedily 
produces  burning  pain  with  redness,  and,  if  the  application  be  continued, 
sometimes  vesication.  When  taken  internally,  it  occasions  much  irrita- 
tion in  the  mouth  and  fauces,  with  almost  suffocating  sensations,  arising 
in  part  from  its  vaporization ;  so  that  many  persons  find  great  difficulty 
in  swallowing  it.  It  leaves  a  burning  sensation  in  the  oesophagus,  ajd 
produces  the  same  feeling  in  the  stomach.  By  its  rapid  evaporatio^Rt 
fills  the  stomach  with  its  vapour,  which  is  often  thrown  up  by  the  forci- 
ble contractions  excited.  Its  influence  is  very  quickly  diffused  over  the 
body,  causing  an  increased  frequency  of  pulse,  and  excitement  of  the 
nervous  system,  especially  of  the  brain,  attended  with  a  sense  of  fulness 
of  the  head  and  feelings  of  exhilaration.  These  are  followed  by  drowsi- 
ness, and  after  a  short  time  not  unfrequently  with  perspiration,  after 
which  the  effects  pass  off  with  more  or  less  depression.  Its  operation 
in  very  large  doses  upon  man  is  not  well  understood,  because,  in  conse- 
quence of  the  difficulty  of  swallowing  it,  the  instances  are  very  few  in 
which  there  has  been  an  opportunity  of  observing  its  action  when  thus 
ndministered  It  is  said,  however,  when  taken  excessively,  to  produce 


676  GENERAL   STIMULANTS.  [PART  I[. 

intoxication,  nausea,  giddiness,  and  stupefaction.  That,  if  swallowed  in 
very  large  quantities,  it  is  capable  of  producing  fatal  narcotic  effects, 
unless  rejected  from  the  stomach,  is  fairly  inferrible  from  experiments 
which  have  been  made  upon  the  lower  animals,  and  by  its  well-known 
action  when  inhaled.  Orfila  states  that  a  dog,  in  the  stomach  of  which 
half  an  ounce  of  it  was  introduced,  and  the  oesophagus  then  tied,  was 
rendered  comatose,  and  died  in  three  hours,  presenting  marks  of  inflam- 
mation of  the  stomach  after  death ;  and  from  four  to  six  drachms  of  it 
proved  sufficient,  in  the  experiments  of  Brodie,  to  plunge  a  horse  into 
deep  lethargy.  (Herat  et  de  Lens,  iii.  166.) 

Inhalation.  Though  long  known  to  be  capable  of  acting  powerfully 
by  inhalation,  it  is  only  of  late  that  its  effects,  when  given  in  this  way, 
have  been  carefully  studied.  About  fifty  years  ago,  I  remember  well 
that  it  was  a  fashion  among  the  boys  in  Philadelphia  to  inhale  ether  for 
its  intoxicating  effect,  which  resembled  that  produced  by  nitrous  oxide. 
A  teaspoonful  or  more  was  introduced  into  a  large  bladder,  with  a 
mouth-piece  attached,  through  which  the  vapour  was  inhaled.  One  case 
of  death  with  coma  occurred,  and  several  other  cases  of  an  alarming 
character,  and  the  practice  soon  ceased.  The  first  effect  is  ordinarily 
irritation  of  throat  with  coughing,  which  soon  subsides,  and  is  followed 
by  marks  of  general  stimulation;  the  respiration  being  quickened  and 
more  audible,  the  pulse  usually  increased  in  frequency,  and  the  face  more 
or  less  flushed.  An  agreeable  exhilaration,  amounting  to  intoxication,  is 
now  generally  felt,  which  is  sometimes  quiet ;  but  in  other  cases  is  at- 
tended with  various  muscular  movements,  occasionally  amounting  to 
convulsions.  In  a  period  of  from  two  to  five  minutes,  sometimes,  how- 
ever, prolonged  to  ten  or  even  fifteen,  sleepiness  is  produced,  the  eyes 
are  closed,  the  voluntary  muscles  become  relaxed,  and  the  patient  falls 
back  apparently  quite  unconscious.  The  mind,  however,  is  not  wholly 
inactive;  for  the  individual  often  afterwards  speaks  of  curious  dreams  or 
visions,  which  seem  to  him  to  have  been  of  long  duration,  and  which, 
though  occasionally  disagreeable  or  even  fearful,  are  for  the  most  part 
ve£  much  the  reverse ;  and,  altogether,  the  effects  are  so  pleasing  that 
a  repetition  of  the  process  is  frequently  desired.  But,  with  an  increased 
influence  of  the  vapour,  a  deep  comatose  sleep  is  induced,  often  attended 
with  snoring,  in  which  there  is  an  entire  loss  of  consciousness.  When 
the  period  of  stupefaction  commences,  the  pulse  becomes  slower,  the  skin 
relaxed,  and  the  face  palish  or  of  a  venous  hue,  which,  as  the  stupor 
increases,  may  deepen  into  a  dark  suffusion.  If  the  agent  is  omitted  as 
soon  as  the  stupor  appears,  this  state  subsides  as  quickly  as  it  was  pro- 
duced ;  and,  though  there  may  sometimes  remain  a  momentary  confu- 
sion of  mind,  and  slight  languor  of  body  for  a  short  time,  occasionally 
perhaps  a  little  headache  or  nausea,  the  subject  of  the  process  soon  re- 
turns to  his  previous  condition,  as  if  nothing  had  happened.  In  the 


CHAP.  I.]        CEREBRAL  STIMULANTS. — ETHER.  677 

period  of  excitement,  it  occasionally  happens  that  the  sexual  function 
becomes  the  special  seat  of  stimulation  ;  and  the  delusions  of  the  patient, 
or  his  dreams,  may  take  a  corresponding  direction,  and,  even  after  the 
perfect  return  of  consciousness,  may  remain  impressed  on  the  mind  with 
the  vividness  of  reality.  This  is  a  very  important  medico-legal  fact. 
Should  the  inhalation  be  persevered  in,  there  is  risk  of  a  suspension  of 
the  function  of  the  respiratory  centre  in  the  medulla  oblongata,  and  of 
death  from  asphyxia.  Some  instances  of  this  kind  are  on  record;  but 
they  are  extremely  rare.  With  ordinary  care,  and  in  an  ordinary  state  of 
system,  death  can  scarcely  result  from  this  cause  under  the  influence  of 
ether.*  Indeed,  I  believe  that  the  ethereal  intoxication  is  much  less 
dangerous  even  than  the  alcoholic.  But  an  undue  perseverance  in  its 
ii>e,  in  cases  which  resist  the  stupefying  influence  of  the  ether,  is  some- 
times followed  by  serious  nervous  disorders,  and  injurious  if  not  dan- 
gerous sanguineous  determinations,  which  may  last  for  a  considerable 
time,  and  should  serve  as  a  warning  to  the  practitioner  not  to  urge  the 
measure,  in  all  instances,  and  at  all  hazards,  to  entire  stupefaction. 

For  many  hours  after  the  immediate  effects  of  the  inhalation  of  ether 
are  over,  there  is  an  escape  of  its  vapour  from  the  lungs,  and  possibly 
from  other  emunctories,  which  is  obvious  to  the  senses  of  an  observer, 
and  which  sometimes  continues,  according  to  my  own  observation,  for 
one  or  two  days  or  more.  So  striking  is  this  effect,  that  a  patient  who 
has  inhaled  ether  at  bedtime,  will  often  scent  a  large  apartment  next 
day  with  its  odour.  There  is  also  sometimes  a  sensation  of  heat  in  .the 

*  But  very  few  cases  of  death,  under  the  influence  of  ether  used  as  an  anaesthetic 
agent,  are  on  record.  I  have  seen  a  detailed  notice  of  but  one  case.  It  was  that  of 
a  woman  in  New  York,  for  whom  the  inhalation  of  ether  was  used  to  relieve  violent 
pain  in  the  head.  A  large  tumour  was  found  in  the  cerebellum,  which  was  prob- 
ably the  real  cause  of  death,  perhaps  aided  by  the  additional  stimulus  of  the  ether, 
which  had  been  given  three  times  previously  without  unpleasant  effects.  (See  Boat. 
Med.  and  Surg.  Journ.,  Ixi.  p.  245.)  In  the  same  journal  (liii.  231),  a  case  of  hemi- 
plegia  is  recorded  following  the  use  of  ether,  given  in  anticipation  of  a  surgical 
operation.  When  it  is  considered  how  extensively  ethereal  inhalation  is  used  ii^this 
country,  both  by  surgeons  and  dentists,  it  is  remarkable  that  accidents  have  not 
been  more  frequent.  At  a  meeting  of  the  Imperial  Society  of  Medicine,  of  Lyons, 
Dr.  Barrier  stated  that,  to  his  knowledge,  there  were  only  three  well  authenticated 
cases  in  which  ether  had  caused  death,  and  that  in  these 'there  were  extenuating 
circumstances.  (Pharm.  Journ.  and  Tram.,  July,  1859,  p.  41.) — Note  to  the  second 
edition. 

Since  the  publication  of  the  last  edition  of  this  Treatise,  though  a  very  few  cases 
of  death  following  the  use  of  ether  have  been  recorded,  I  have  seen  none,  in  which 
the  details  were  given,  which  could  be  ascribed  to  the  direct  and  unmixed  influence 
of  the  ether,  or  which  ought  to  deter  from  the  use  of  this  anaesthetic  in  cases  not 
obviously  unsuited  to  it,  as  in  those  with  existing  disease  of  the  brain,  or  with  a 
strong  predisposition  to  it.  See  on  this  subject  a  paper  by  Dr.  F.  D.  Lente,  in  the 
Am.  Journ.  of  Med.  Sci.  (April,  1861,  p.  360).— Note  to  the  third  edition. 


678  GENERAL    STIMULANTS.  [PART  II. 

chest,  attendant  on  the  exhalation  of  the  vapour,  indicating  that  it  is 
escaping  by  the  lungs. 

There  are  two  points,  in  connection  with  the  influence  of  ethereal  in- 
halation, which,  though  strictly  pathological,  and,  therefore,  not  belonging 
exactly  to  the  physiological  effects  of  ether,  may  be  most  conveniently 
considered  in  this  place,  in  order  that  the  whole  series  of  facts  in  relation 
to  the  influence  of  the  process  may  be  presented  in  one  view.  I  allude 
to  the  anaesthetic  influence  of  etherization  by  the  lungs,  and  that  which 
it  exercises  in  relaxing  spasm. 

That  ether  is  capable,  when  inhaled,  of  abolishing  sensibility,  is  an 
obvious  corollary  to  its  stupefying  power.  The  sense  of  touch,  as  well 
as  every  other  special  sense,  is,  in  the  very  nature  of  the  case,  suspended 
in  coma.  This,  then,  is  no  new  discovery.  But  it  was  not  so  obvious 
that  the  general  sensibility  might  be  diminished^  and  even  quite  sus- 
pended, while  consciousness,  and,  to  a  considerable  degree,  the  special 
senses,  remain  unaffected.  This,  however,  is  a  most  important  fact  in 
relation  to  etherization.  Under  the  influence  of  this  agent,  pain  is  often 
abolished  if  existing,  and  averted  when  it  would  otherwise  have  been 
produced,  before  the  occurrence  of  any  degree  of  stupor,  or  of  any  con- 
siderable anaesthesia  of  hearing,  sight,  etc.  The  woman  in  childbed 
ceases  to  suffer  from  her  labour-pains,  though  still  conscious ;  the  patient 
under  the  knife  of  the  surgeon  sometimes  scarcely  suffers,  though  he  may 
follow  every  step  of  the  operation ;  and  the  pain  of  violent  spasm  is  sub- 
dued as  by  a  charm,  without  the  least  degree  of  apparent  stupefaction. 
An  eminent  medical  gentleman  once  assured  me  that,  while  labouring 
under  the  most  exquisite  pain  from  spasm  of  the  bladder,  he  had  inhaled 
ether,  with  the  effect  of  completely  relieving  the  pain,  though  he  retained 
his  consciousness  unimpaired,  and  even  took  pleasure  in  noting  the  re- 
turn of  each  contraction  of  the  bladder,  of  which  he  was  distinctly  sen- 
sible, though  it  was  quite  painless. 

The  other  point  referred  to  was  the  efficacy  of  ether  when  inhaled  in 
relaxing  spasm.  That  it  should  have  this  power,  in  reference  to  the 
vol^ptary  muscles,  so  far  as  the  cerebral  centres  are  concerned,  was  al- 
most inferrible  from  the  property  it  evinces  in  health  of  relaxing  these 
muscles,  when  the  system  is  brought  completely  under  its  influence. 
But  the  muscles  of  organic  life  usually  remain  unaffected,  at  least  not 
materially  affected,  in  the  stupefaction,  unless  carried  to  the  last  degree 
short  of  absolute  death.  Respiration  goes  on ;  the  peristaltic  movements, 
so  far  as  is  known,  are  not  impaired ;  the  sphincters  generally  act  as  in 
health ;  and  the  uterine  contractions  during  labour  are  undiminished  in 
force,  though  no  longer  painful.  But  over  the  morbid  contractions  of 
these  muscles,  over  their  spasmodic  conditions,  for  example,  etherization 
has  great  control.  It  is  capable  not  only  of  relieving  the  pain  of  these 
spasms,  but,  in  a  somewhat  higher  degree  of  its  action,  of  relaxing  the 


CHAP.  I.]  CEREBRAL    STIMULANTS. — ETHER.  679 

spasms  themselves.  Though,  as  before  stated,  the  spasm  will  sometimes 
continue  after  the  pain  has  ceased,  yet  the  two  often  cease  together,  and, 
when  this  is  not  the  case,  the  muscular  relaxation  generally  soon  follows 
the  anaesthetic  eifect.  This  only  proves  that  the  nervous  centres  of  pain, 
and  those  of  the  involuntary  movements,  are  not  the  same,  and  that  the 
former  usually  come  under  the  influence  of  the  anodyne  before  the  latter. 
The  pains  of  tetanus,  for  instance,  cease  before  the  muscular  spasms,  but 
these  also  will  often  yield,  temporarily  at  least,  to  ether.  In  their  tetanic 
movements,  the  muscles  cease  to  be  voluntary  muscles ;  and  are  under 
the  control  of  the  spinal  centres.  From  all  this,  it  may  be  physiologi- 
cally deduced  that,  in  etherization,  the  nervous  centres  of  organic  life, 
those,  namely,  of  the  spinal  marrow,  and  the  sympathetic  ganglia,  either 
come  last  under  the  power  of  the  stupefying  agent,  or,  to  speak  more 
precisely,  are  the  least  susceptible  to  its  action. 

Another  valuable  therapeutic  agency  of  ether  by  inhalation  is  the 
relaxation  it  often  produces  in  the  mucous  tissues,  with  an  increase  of 
the  mucous  discharge.  This  has  been  noticed  in  the  mucous  membrane 
of  the  generative  organs  of  women  in  childbed,  and  in  the  bronchial 
tubes,  and  may  possibly  extend  to  the  others;  as  it  is  probably  rather 
through  the  organic  nervous  centres  that  it  acts,  than  directly  on  the 
tissue  affected. 

Judging  from  the  effects  above  detailed,  we  may  pretty  certainly  con- 
clude that  the  cerebral  centres  of  general  sensation,  and  those  of  thought 
and  emotion,  are  most  susceptible  to  the  influence  of  ethereal  inhala- 
tion, that  next  in  order  are  those  of  special  sensation  and  the  will,  and 
that  lower  still  in  the  scale  of  susceptibility  are  the  centres  of  organic 
force,  of  which  the  respiratory  centre  in  the  medulla  oblongata  is  the 
lowest. 

Perhaps  there  is  no  powerful  remedy  to  which  the  system  becomes 
more  speedily  accustomed  than  this ;  so  that,  to  sustain  a  given  effect 
for  a  long  time,  it  must  be  administered  on  successive  occasions,  in  rap- 
idly increasing  quantities ;  and  the  amounts  which  have  been  given,  in 
some  cases,  without  material  injury,  are  almost  astounding,  considering 
the  powerful  effect  produced  at  first  by  a  small  quantity,  and  the  rapidity 
with  which  the  larger  amount  has  been  reached.  Even  while  the  ether, 
which  may  have  caused  all  the  characteristic  phenomena,  still  remains  in 
great  measure  in  the  system,  it  has  quite  lost  its  effects  on  the  cerebral 
centres ;  for  the  breath  continues  to  smell  of  it  long  after  all  the  phenom- 
ena of  its  action  have  disappeared.  The  previous  habit  of  using  alcohol 
or  opium  also  greatly  lessens  the  susceptibility  to  the  impression  of  ether, 
showing  a  close  resemblance  between  these  three  cerebral  stimulants  in 
their  mode  of  action. 

The  only  morbid  appearances  noticed  after  death  from  ether  are  those 
incident  to  asphyxia ;  namely,  darkness  of  the  blood,  fulness  of  the  right 
cavities  of  the  heart,  and  congestion  of  the  brain,  lungs,  etc. 


680  GENERAL   STIMULANTS.  [PART  II. 

In  poisoning  from  ethereal  inhalation,  the  shock  of  cold  water  upon 
the  face,  head,  or  shoulders,  and  the  introduction  of  pure  air  into  the 
lungs  bv  artificial  respiration,  are  probably  the  most  efficient  meas- 
ures. When  the  prostration  is  great,  the  ammoniacal  stimulants  may  be 
resorted  to  by  the  mouth  or  rectum,  and  external  stimulation  by  rubefa- 
cients  should  not  be  neglected. 

2.  Mode  of  Operating. 

Ether  probably  operates  as  a  stimulant  by  a  direct  influence  on  the 
vital  susceptibilities  of  the  tissues,  without  any  chemical  reaction.  One 
proof  of  this  is  the  vast  amount  which  may  be  taken  with  impunity,  after 
the  system  has  become  accustomed  to  it,  by  a  gradual  increase  of  the 
dose.  The  case  of  a  chemist  is  recorded,  who  took  a  pint  of  ether  daily. 
(Herat  and  De  Lens,  iii.  166.)  When  large  quantities  have  been  intro- 
duced by  inhalation,  the  observable  effects  often  cease  long  before  the 
evidence  afforded  by  the  breath  that  a  portion  still  remains  in  the  sys- 
tem. This  could  scarcely  be,  if  the  effect  were  chemical,  whether  on  the 
solid  tissues,  or  the  blood.  The  higher  carbonization  of  the  blood  has 
been  supposed  to  have  something  to  do  with  the  effects  of  ether.  This, 
however,  is  probably  a  mere  respiratory  result.  That  the  first  stimulant 
impression  on  the  circulation,  respiration,  and  cerebral  functions,  may 
depend  on  the  propagation  of  the  local  influence,  through  the  nerves,  to 
the  nervous  centres  of  those  functions,  is  not  impossible;  and  the  rapid- 
ity with  which  the  effect  is  produced  might  be  advanced  as  an  argument 
in  favour  of  this  view ;  but  experiments  have  satisfactorily  shown,  that 
the  round  of  the  circulation  is  accomplished  in  time  to  permit  the  opera- 
tion by  this  route  within  the  actual  period;  so  that  the  view  referred  to 
cannot  by  any  means  be  considered  as  demonstrated.  The  probability 
is  that  most  of  the  effects  of  ether  are  due  to  its  absorption  into  the  cir- 
culation, and  direct  action  upon  the  nervous  centres,  the  functions  of 
which  are  first  increased  by  the  stimulation,  then  deranged,  and  after- 
wards diminished  or  temporarily  suppressed,  under  the  general  law  of 
irritation.  I  have  already  referred  to  the  relative  degree  in  which  the 
centres  are  susceptible,  deduced  from  the  period  at  which  they  respect- 
ively come  under  its  influence.  That  ether  is  absorbed,  is  almost  too 
obvious  to  require  proof.  The  odour  of  the  breath,  which  always  smells 
strongly  of  ether,  in  whatever  way  administered,  is  a  sufficient  evidence ; 
not  to  allude  to  the  fact,  that  its  odour  has  been  noticed  in  the  ventricles 
of  the  brain,  when  death  has  from  any  cause  followed  soon  after  its  ex- 
hibition. The  great  difference  in  the  effects  of  the  medicine,  as  adminis- 
tered by  the  stomach  and  the  lungs,  is  probably  owing  to  its  much  slower 
absorption  from  the  former  organ.  Its  powerful  direct  stimulant  action, 
in  the  liquid  state,  upon  the  stomach,  producing  an  active  congestion  of 
the  blood-vessels,  may  be  one  reason  of  its  relatively  slower  absorption 


CHAP.  I.]        CEREBRAL  STIMULANTS. ETHER.  681 

through  this  organ  than  the  lungs,  when  compared  with  some  other  vol- 
atile medicines,  such  as  hydrocyanic  acid. 

3.  Therapeutic  Application. 

The  use  of  ether  as  a  medicine  dates  from  an  early  period  in  modern 
history.  I  shall  treat  of  its  employment  first  as  administered  by  the 
stomach,  secondly  by  inhalation,  and  lastly  as  an  external  application. 

1.  Use  by  the  Stomach.  In  the  course  of  low  fevers,  especially  of  ma- 
lignant typhus,  in  cases  of  delirium  tremens,  and  in  other  diseases  of 
debility,  sudden  sinking  spells  occasionally  take  place,  approaching  as- 
phyxia in  character,  which  require  prompt  and  energetic  stimulation  of 
the  nervous  centres.  In  such  cases  ether  is  strongly  indicated,  and  may 
be  given  in  connection  with  carbonate  of  ammonia,  or  the  aromatic  spirit 
of  ammonia,  in  order  as  speedily  as  possible  to  restore  action,  which  may 
then  be  sustained,  if  necessary,  by  the  more  permanent  stimulants  and 
tonics.  In  the  poisoning  by  mushrooms  it  has  been  recommended, 
probably  upon  similar  grounds. 

A  similar  condition  sometimes  occurs  in  angina  pectoris,  and  demands 
instant  interference  to  prevent  death.  Here  also  ether  is  highly  valuable 
in  .connection  with  other  medicines.  In  the  seemingly  spasmodic  pains 
of  that  affection,  in  which  it  would  appear  that  sudden  cramp  had  seized 
on  some  portion  of  the  cardiac  muscles,  and  during  which  the  whole 
system  is  extremely  prostrate,  ether  and  laudanum  are  the  internal  rem- 
edies mainly  to  be  relied  on.  Such  a  condition  occasionally  takes  place 
in  nervous  gout,  constituting  probably  the  most  dangerous  example  of 
that  disease. 

The  prompt  and  powerful  stimulation  with  which  ether  operates  upon 
the  nerves  adapts  it  admirably  to  those  spasmodic  affections,  unattended 
with  acute  inflammation,  which  are  characterized  by  great  depression  of 
the  circulation,  coolness  and  dampness  of  the  surface,  and  apparent  gen- 
eral prostration.  Hence  its  usefulness  in  violent  spasms  of  the  stomach, 
and  of  the  bowels,  attended  with  feeble  pulse,  cold  skin,  etc.,  in  which 
it  may  often  be  advantageously  combined  with  laudanum  or  other  liquid 
preparation  of  opium,  and  given  in  teaspoonful  doses.  The  same  remark 
is  applicable  to  spasms  of  the  urelers  and  of  the  gall-ducts,  occasioned 
by  the  passage  respectively  of  urinary  or  biliary  calculi.  In  the  latter 
affection,  it  has  been  supposed  to  be  peculiarly  useful  when  combined 
with  oil  of  turpentine.  Upon  the  same  grounds,  too,  it  is  indicated  in 
the  approaching  collapse  of  cholera,  attended  with  internal  and  external 
cramps.  Its  powerful  stimulation  of  the  nervous  centres,  in  these  cases, 
may  be  supposed  to  rouse  them  from  the  torpor  into  which  they  appear 
to  be  thrown  by  the  concentration  of  the  nervous  energy  in  the  suffering 
organ,  and  thus  to  act  revulsively  in  the  relief  of  the  spasm. 

In  the  paroxysm  of  spasmodic  asthma  it  has  sometimes  been  used 


682  GENERAL    STIMULANTS.  [PART  II. 

beneficially,  though  less  efficient  in  this  disease  than  some  other  rem- 
edies. 

In  small  doses,  ether  acts  purely  as  a  nervous  stimulant,  and  is  much 
employed  for  the  relief  of  various  mild  nervous  affections.  For  this 
purpose  it  is  usually  prescribed  in  the  form  of  compound  spirit  of  ether, 
or  Hoffmann's  anodyne,  under  which  this  highly  useful  application  of 
the  remedy  will  be  more  particularly  noticed. 

Ether  has  also  been  recommended  in  sea-sickness,  in  which  a  tea- 
spoonful  of  it  may  be  given  in  a  glass  of  sherry  or  madeira  wine. 

M.  Bourdier  has  employed  it  with  success  for  the  expulsion  of  the 
tapeworm,  giving  it  both  by  the  stomach  and  rectum  with  an  infusion  of 
male  fern,  and  following  it  in  an  hour  by  a  dose  of  castor  oil.  M.  Lor- 
tet  also  has  had  favourable  results.  In  five  cases,  all  in  which  he  had 
tried  the  remedy,  he  gave  60  grammes  (nearly  two  troy  ounces)  of  ether 
at  once,  followed  in  two  hours  by  half  the  quantity  of  castor  oil.  In 
every  case,  the  worm  was  discharged  without  suffering,  and  always 
either  entire  or  nearly  so,  including  the  head.  (Ann.  de  Therap.,  1860, 
p.  281.) 

Ether  is  contraindicated  in  all  cases  of  sthenic  febrile  action  and  acute 
inflammation,  especially  of  the  stomach  and  brain. 

Administration.  The  dose  of  ether  is  from  half  a  fluidrachm  to  two 
fluidrachms,  which,  if  a  given  effect  is  to  be  sustained,  should  be  repeated 
at  intervals  of  half  an  hour,  or  at  most  one  hour,  as  the  effect  rapidly 
passes  off.  It  may  be  given  in  one  or  two  wineglassfuls  of  sweetened 
water,  well  mixed  at  the  moment  of  administration,  and  taken  cold.  A 
useful  method  of  dissolving  it  in  water  for  exhibition,  suggested  origin- 
ally, I  believe,  by  the  late  Dr.  Joseph  Hartshorne,  of  Philadelphia,  is  to 
rub  it  up  with  spermaceti,  two  grains  being  used  to  each  fluidrachm,  then 
to  rub  this  mixture  well  with  water,  and  to  strain.  As  water  will  take 
up  about  one-ninth  of  its  bulk  of  ether,  the  dose  ought  to  be  readily  dis- 
solved in  a  wineglassful  of  that  fluid.  In  France,  a  syrup  of  ether  is 
prepared  by  putting  one  part  of  the  ether  and  sixteen  of  syrup  in  a 
flask,  with  a  tubulure  at  the  lower  part  on  the  side,  fitted  with  a  cork, 
through  which  passes  a  short  tube,  the  outer  extremity  of  which  is  closed 
with  a  small  cork.  The  mixture  is  shaken  occasionally  for  four  or  five 
days,  and  then  allowed  to  stand.  The  syrup,  at  first  turbid,  afterwards 
becomes  clear,  with  a  portion  of  the  ether  floating  on  the  top  undissolvi-d. 
It  is  drawn  off  through  the  tubulure  when  wauled  for  use,  and  a  fluid- 
ounce  may  be  given  at  a  dose.  (Trousseau  and  Pidoux,  4e  ed.,  ii.  260.) 

2.  Use  by  Inhalation.  Ether  has  long  been  used  in  this  method.  The 
late  Dr.  P.  S.  Physick  was  much  in  the  habit  of  employing  it  in  pul- 
monary affections,  and  invented  a  small  extemporaneous  inhaler  for  the 
purpose.  It  is  only  as  an  anaesthetic  agent,  that  any  claim  to  discovery 
has  recently  been  advanced  in  reference  to  its  exhibition  by  the  lungs. 


CHAP.  I.]         CEREBRAL  STIMULANTS. ETHER.  683 

The  way  to  this  discovery  had  been  gradually  opened  by  attempts  to 
effect  the  same  object  by  other  agents,  and  especially  by  the  favourable 
result  of  some  trials  with  nitrous  oxide  by  Dr.  Horace  Wells,  of  Con- 
necticut; but  tlje  credit  of  the  first  application  of  ether  to  this  purpose 
must  be  ascribed  to  Dr.  W.  T.  G.  Morton,  of  Boston.  It  was  in  Octo- 
ber, 1846,  that  the  attention  of  the  profession  was  called  to  this  highly 
important  discovery.  The  process  was  originally  applied  by  Dr.  Morton 
to  the  relief  of  pain  in  dentistry.  He  made  known  his  success  to  the 
late  Dr.  John  C.  Warren,  who  was  the  first  to  test  its  efficacy  in  an  im- 
portant surgical  operation. 

Though  first  used  to  prevent  pain  in  surgical  operations,  this  mode  of 
administering  ether  may  be  resorted  to  in  a  wide  circle  of  spasmodic, 
convulsive,  and  neuralgic  affections.  Of  the  painful  spasmodic  diseases, 
it  may  be  used  advantageously  in  spasm  of  the  stomach,  bowels,  bladder, 
ureters,  gall-ducts,  and  diaphragm,  in  violent  external  cramps  as  those 
of  cholera,  and  in  tetanus.  In  the  atrocious  affection  last  named,  it  will 
generally  afford  more  or  less  relief,  and  sometimes  contributes  to  the  cure. 
In  the  poisoning  from  strychnia  it  is  also  indicated.  In  infantile  con- 
vulsions from  spasm  of  the  bowels,  it  should  be  resorted  to  if  other 
means  fail. 

The  measure  has  been  recommended  in  chorea,  pertussis,  and  the 
convulsive  affections  of  hysteria;  but,  as  it  will  seldom  cure  these  com- 
plaints, but  only  afford  temporary  relief,  there  may  be  danger  of  inducing 
a  bad  habit  of  indulgence,  without  corresponding  benefit.  I  have  used 
it  with  apparent  advantage  in  peculiarly  violent  or  obstinate  hysterical 
convulsions,  but,  as  a  general  rule,  it  would  be  more  prudent  to  dispense 
with  it.  For  the  relaxation  of  spasm,  it  may  also  be  employed  in  dys- 
phagia  from  spasm  of  the  oesophagus,  and  in  strangulated  hernia. 

In  the  paroxysm  of  spasmodic  asthma,  when  not  complicated  with 
acute  bronchitis,  it  may  be  tried  with  good  hope  of  benefit;  and  in  the 
dyspnoea  dependent  on  chronic  bronchitis  it  is  doubly  useful,  if  carefully 
managed,  both  by  relieving  the  distressing  sensation,  and  favouring 
mucous  secretion.  In  these  cases  the  remedy  should  not  be  pushed  to 
positive  insensibility. 

Neuralgia,  dysmenorrhcea,  angina  pectoris,  and  severe  or  obstinate 
nervous  headaches,  are  complaints  in  which  the  remedy  is  indicated  for 
its  anaesthetic  virtues. 

In  delirium  tremens  it  sometimes  powerfully  co-operates  with  opium 
in  producing  sleep,  and  may  be  tried  in  obstinate  cases. 

It  has  born  used  also  as  an  antiperiodic  in  intermittent*,  and  there  can 
scarcely  be  a  doubt,  that  it  would  frequently  interrupt  the  paroxysms  if 
applied  about  the  expected  period  of  their  approach.  It  is,  however, 
only  in  exceptional  cases  that  there  can  be  any  occasion  for  its  use.  I 
would  recommend  that  it  should  be  tried  in  otherwise  desperate  cases  of 


684  GENERAL    STIMULANTS.  [PART  II. 

the  pernicious  paroxysm  of  miasmatic  fever,  when  not  attended  with 
comatose  symptoms. 

A  case  has  been  reported  by  Dr.  J.  H.  Hutehinson,  of  Philadelphia,  one 
of  the  physicians  to  the  Episcopal  Hospital  of  that  city,  in  which  a  young 
woman  of  twenty  years  was  completely  cured,  by  repeated  inhalations 
of  ether,  of  deafness  and  dumbness,  probably  hysterical,  after  a  duration 
of  several  months.  (Am.  Journ.  of  Med.  Sci.,  April,  1864,  p.  412.) 

As  an  Anaesthetic  Agent  in  Surgery.  There  has  been  no  little  contro- 
versy about  the  propriety  of  using  measures  to  prevent  pain  in  surgery; 
but  the  mass  of  the  profession,  influenced  in  some  degree,  no  doubt,  by 
the  powerful  instincts  of  our  nature,  have  come  to  the  conclusion  that 
such  measures  are  not  only  admissible,  but  very  often  advisable.  The 
advocates  for  their  use  maintain,  and,  as  appears  to  me,  very  reasonably, 
that  not  only  is  the  suffering  of  the  patient  mi  titrated  if  not  entirely  pre- 
vented, but  that,  in  severe  operations,  the  measure  proves  positively  sa- 
lutary, and  conduces  to  a  favourable  result  by  obviating  the  shock  on  the 
nervous  system,  which  is  sometimes  fatal  even  during  the  operation. 
The  objection  on  the  score  that  nature  intended  that  there  should  be  pain 
in  surgical  operations,  if  it  need  an  answer,  is  fully  met  by  the  simple 
counter  statement,  that  nature  has  also  presented  us  with  a  remedy  for 
the  pain.  The  notion  that  ether  might  act  injuriously  by  depraving  the 
blood,  and  retarding  the  healing  process,  has  proved  as  groundless  on 
trial,  as  it  really  was  in  theory.  The  opium  which  almost  every  surgeon 
formerly  gave,  left  a  much  more  powerful  impression  on  the  system  than 
the  brief  action  of  ether  could  do;  and  yet  no  one  supposed  that  it  pre- 
vented the  healing  of  wounds.  Another  objection  to  the  use  of  ether  has 
been  the  doubt,  whether  it  really  exercised  the  anaesthetic  influence  as- 
cribed to  it,  as  patients,  by  their  agitation  during  the  operation,  seem  to 
evince  some  degree  of  suffering.  But  when,  as  has  often  happened,  they 
have  retained  sufficient  consciousness  of  what  was  going  on  to  give  an 
authoritative  statement  in  the  case,  they  have  almost  uniformly  declared 
that  they  felt  no  pain  or  very  little ;  and  the  agitation  was  really  ascrib- 
able  to  some  dreamy  delusion  at  the  time,  or  merely  to  reflex  action. 
The  only  real  question,  as  it  seems  to  me,  is  whether  ether  can  be  given 
safely ;  for  I  doubt  whether  we  have  the  moral  right  to  relieve  pain,  at 
any  appreciable  risk  of  life.  Reasoning  from  our  knowledge  of  the 
effects  of  ether,  I  should  say  that  a  full  dose  of  it,  sufficient  to  bring  on 
the  state  of  anaesthesia,  is  less  dangerous  than  a  full  soporific  dose  of 
opium,  supposing  in  both  cases  the  system  to  be  in  health.  Etherization 
is  certainly  less  dangerous  than  intoxication  from  alcoholic  liquor,  as  the 
circulation  is  disturbed  less,  and  the  influence  is  much  shorter  in  dura- 
tion. Nor  has  experience  contradicted  the  suggestions  of  reason.  The 
instances  are  extremely  rare,  if  in  fact  there  are  any  on  record,  in  which 
etherization,  employed  to  prevent  pain  in  operations,  has  proved  fatal 


CHAP.  I.]        CEREBRAL  STIMULANTS. — ETHER.  685 

when  the  measure  was  judiciously  applied,  and  the  case  properly  selected. 
*The  measure  itself  is  certainly  not  accountable  for  the  ignorance  or  care- 
lessness of  the  person  who  employs  it,  and  should  not  be  rejected  on  this 
score,  any  more  than  opium  or  mercury,  or  even  quinia,  should  be  re- 
jected for  the  mischief  they  have  often  done  in  reckless  and  unskilful 
hands.  Indeed,  considering  the  number  of  instances  in  which  ether  has 
been  used,  even  by  the  most  notoriously  ignorant  persons,  it  is  some- 
what surprising  that  we  have  heard  so  little  of  its  mischievous  effects. 
This  assuredly  cannot  be  said  of  chloroform,  which  our  professional 
brethren  in  Europe  cling  to  with  so  much  pertinacity,  notwithstanding 
that  almost  every  journal  comes  to  us  burdened  with  some  fatal  case, 
and  it  is  presumable  that  many  happen  which  never  find  their  way  into 
the  public  records. 

Ether  has  also  been  much  employed  to  mitigate  or  annul  the  pains  of 
childbirth.  Upon  the  propriety  of  this  application  of  it,  there  has  been 
even  greater  difference  of  opinion,  or  rather  there  has  been  greater  oppo- 
sition to  the  measure,  than  in  reference  to  its  use  in  surgery.  Having 
no  practical  experience  of  my  own  in  this  branch  of  our  profession,  I 
feel  altogether  incompetent  to  give  an  opinion  upon  the  subject,  and 
allude  to  it  here  as  a  point  in  the  history  of  etherization  which  cannot  be 
wholly  overlooked. 

Cautions.  Ether  should  not  be  recklessly  used.  In  cases  of  seriously 
diseased  heart,  active  congestion  or  acute  inflammation  of  the  lungs, 
brain,  or  stomach,  organic  cerebral  disease,  apoplectic  or  active  hemor- 
rhagic  tendencies,  or  a  generally  plethoric  condition,  it  should  either  be 
avoided  altogether,  or  used  only  after  a  careful  preparation  of  the  sys- 
tem. It  should  be  carried  no  further  than  is  sufficient  for  bringing  about 
the  state  of  anesthesia,  and  should  be  at  once  withdrawn,  if  a  failing 
pulse  indicate  any  danger  of  asphyxia.  The  utmost  care  should  be  taken 
that  sufficient  atmospheric  air  is  inhaled.  The  want  of  this  is  probably 
the  greatest  danger  of  the  process  under  unskilful  management.  The  pa- 
tient, by  the  very  state  of  insensibility  into  which  he  is  thrown,  becomes 
incapable  of  giving  warning  through  his  feelings  of  suffocation ;  and  hence 
the  greater  necessity  for  care  on  the  part  of  the  operator.  The  rule 
simply  is  that,  while  the  vapour  of  ether  is  admitted  into  the  lungs,  it 
should  be  accompanied  with  free  access  of  the  atmospheric  air. 

Various  instruments  have  been  invented  to  meet  the  requisitions  of 
convenience  and  safety  in  inhalation;  but  probably  nothing  is  better,  on 
the  whole,  than  a  large  piece  of  sponge,  hollowed  out  on  one  side  so  as 
to  admit  the  nose.  This  should  be  applied  saturated  with  the  ether,  so 
that  the  vapour  may  enter  with  the  air  drawn  by  inspiration  into  the 
lungs.  In  this  way  a  due  supply  of  atmospheric  air  is  ensured ;  and  the 
only  disadvantage  is,  that  more  of  the  ether  is  lost  by  evaporation  than 
when  it  is  confined  within  an  instrument.  The  patient  should  breathe 


l!86  GENERAL    STIMULANTS.  [PART  II. 

preferably  through  the  nostrils.  Bags  containing  ether  should  never  be 
used.*  < 

When  an  instrument  is  used  confining  the  ether,  from  one  to  two 
fluidounces  maybe  employed;  when  a  sponge,  the  quantity  should  be 
doubled.  The  operator  should  keep  his  fingers  on  the  pulse,  and,  if  he 
find  it  failing,  should  withdraw  the  ether.  Should  convulsions  super- 
vene, he  must  also  suspend  the  process. 

3.  External  Use.  Ether  is  used  externally  for  two  purposes,  for  stim- 
ulation, and  refrigeration.  For  the  first,  it  is  confined  to  the  part  to 
which  it  is  applied;  for  the  second,  it  is  allowed  freely  to  evaporate  so 
as  to  lower  the  temperature. 

In  neuralgic  pains,  nervous  headache,  and  nervous  earache,  it  may 
be  applied  near  the  part  affected,  by  means  of  a  compress  saturated  with 
it,  and  then  covered  by  a  piece  of  oiled  silk,  to  prevent  evaporation. 
Sometimes  a  little  of  it,  applied  to  the  forehead,  and  held  there  in  the 
hollow  of  the  hand,  will  prove  rapidly  serviceable  in  nervous  headache. 
It  very  quickly  produces  burning  sensation  and  redness.  In  earache  it 
is  said  sometimes  to  afford  instantaneous  relief,  when  dropped  into  the 
external  meatus.  Among  the  external  uses  of  ether  may  be  mentioned 
its  application  to  the  nostrils  in  cases  of  faintness,'  or  even  positive  syn- 
cope, in  which  it  will  often  do  good  by  its  pungency. 

Ether  dropped  into  the  external  meatus  is  asserted  to  have  repeatedly 
cured  deafness;  and,  when  this  is  purely  functional,  we  may  readily  ad- 
mit that  it  might  yield  to  the  remedy.  The  practice  originated  with  a 
French  lady,  Mademoiselle  Cleret,  who,  having  used  the  ether  advan- 
tageously in  her  own  case,  afterwards  tried  it  with  marked  effect  in  a 
number  of  deaf  and  dumb  children.  Her  statements  were  submitted  to 
a  commission,  composed  partly  of  medical  men,  who  after  a  sufficient 
examination,  and  some  trials,  reported  favourably  of  the  remedy.  (Gaz. 
des  Hopitaux,  Mai  8,  1860.) 

Dr.  John  J.  Black,  of  Philadelphia,  having  been  induced,  by  the  suc- 
cessful use  of  ether  locally  in  aphthous  affections  of  the  mouth  by  Dr. 
Jules  Worms,  to  give  the  remedy  a  trial  in  other  local  diseases,  report  >• 
very  favourably  of  its  efficiency  in  aphthous  ulcerations,  in  thrush,  in  ul- 
cerous stomatitis,  acute  pharyngitis  or  ordinary  sore-throat,  diphtheria. 
and  various  chronic  ulcers.  The  ether  was  applied  by  means  of  a  camel's- 

*  For  the  description  of  an  apparatus,  very  advantageously  applied  by  Dr.  F.  D. 
Lente,  of  Cold  Spring,  N.  Y.,  to  the  production  of  anaesthesia  for  surgical  purposes, 
nee  the  N.  York  Mtd.  Journ.  (Jan.  1866,  p.  262).  Its  advantages  are  that  it  saves- 
the  ether,  and  by  ensuring  a  more  steady  and  thorough  application  of  the  vapour, 
shortens  the  time  preliminary  to  the  anaesthetic  effect.  In  a  case  in  which  it  was 
used  at  the  N.  Y.  Hospital,  the  patient  was  completely  insensible  in  a  minute  and 
three-quartern,  and  the  quantity  of  ether  used  was  only  an  ounce  and  a  half.  (Nott 
to  the  third  edition.) 


CHAP.  I.]        CEREBRAL  STIMULANTS. — ETHER.  687 

hair  pencil;  and,  though  it  sometimes  occasioned  a  stinging  pain  at  first, 
this  was  soon  followed  by  an  agreeable  coolness  and  marked  relief.  In 
ordinary  angina,  one  of  its  most  striking  effects  was  the  rapid  subsidence 
of  the  swelling,  with  decided  relief  to  the  patient.  (Am.  Journ.  of  Med. 
Sci.,  April,  1866,  p.  350.) 

With  a  view  to  local  refrigeration,  ether  may  be  used  in  any  case 
where  this  effect  is  required  upon  the  surface  of  the  body ;  the  cuticle 
being  sound.  It  is  employed,  however,  chiefly  in  headaches  with  external 
heat,  and  in  superficial  burns  or  scald*.  It  may  be  dropped  on  the  part, 
or  applied  on  a  single  layer  of  thin  muslin  or  linen.  In  strangulated 
hernia,  it  has  been  much  commended  ;  the  object  being,  in  this  case,  to 
produce  contraction  of  the  strangulated  part,  and  thus  enable  it  to  pass 
back  through  the  opening.  It  is  applied  most  effectually  by  letting  it 
fall  upon  the  seat  of  the  hernia  in  a  slender  stream.  A  considerable 
reduction  of  the  temperature  can  be  obtained  in  this  way. 

Since  the  publication  of  the  preceding  edition  of  this  work,  a  new 
method  of  obtaining  the  refrigerating  effect  of  ether,  locally  applied,  has 
been  introduced  into  use  by  Dr.  Richardson,  of  London.  It  consists  in 
causing  the  liquid  to  fall  upon  the  part  to  be  refrigerated,  in  the  form  of 
spray,  by  means  of  the  atomizer.  The  cold  produced  is  so  great  that 
the  tissue  may  be  frozen  to  a  considerable  depth ;  and  advantage  has 
been  taken  of  the  local  anesthesia  which  attends  the  congelation,  to  per- 
form surgical  operations  without  pain.  More  will  be  said  on  this  subject 
when  the  anaesthetic  effects  of  cold  are  treated  of. 


There  are  two  officinal  preparations  of  ether  which  require  notice,  viz. 
the  Spirit  of  Ether,  and  the  Compound  Spirit  of  E  (her. 

1.  SPIRIT  OF  ETHER — SPIRITUS  ^TIIERIS.  Br.  —  Spirit  of  Sul- 
phuric Elher. 

This  is  simply  a  mixture  of  one  part  by  measure  of  ether  and  two  of 
rectified  spirit,  or  officinal  alcohol.  The  only  advantage  of  the  prepara- 
tion is  that  it  is  readily  miscible  with  water,  and  may,  therefore,  be 
taken  more  conveniently  than  pure  ether.  The  dose  of  it  is  two  or  three 
fluidrachms. 

2.  COMPOUND  SPIRIT  OP  ETHER SPIRITUS^ETHERIS  COM- 

POSITUS.  U.S. —  Compound  Spirit  of  Sulphuric  Ether.  —  Hoffmann's 
Anodyne  Liquor.  — Hoffmann's  Anodyne. 

As  directed  in  the  Pharmacopoeia,  this  is  made  by  mixing  together 
half  a  pint  of  ether,  a  pint  of  alcohol,  and  six  fluidounces  of  ethereal 
oil  or  heavy  oil  of  wine. 

The  Ethereal  Oil  (OLEUM  JETHEREUM,  U.  S.),  on  heavy  oil  of  wine,  is 
\\  yellowish  liquid,  heavier  than  water,  of  a  penetrating  peculiar  odour, 


P  GENERAL   STIMULANTS.  [PART  II. 

and  a  sharp  bitterish  taste,  and  boiling  at  536°  Fahr.  It  contains  sul- 
phuric acid,  combined  with  certain  products  of  the  decomposition  of 
alcohol  acting  as  a  base  or  bases,  and  is  considered  by  Liebig  as  a  double 
sulphate  of  ether  and  etherole;  the  latter  being  another  name  for  light 
oil  of  wine,  which  is  a  4-4  carbo-hydrogen  (C4H4).  It  is  obtained 
by  distilling  a  mixture  of  alcohol  and  sulphuric  acid,  the  latter  being  in 
much  larger  proportion  than  is  used  in  the  preparation  of  ether.  A  por- 
tion of  it  is  usually  produced  in  the  ptocess  for  procuring  ether,  especially 
towards  the  close,  and  hence  contaminates  that  product  as  obtained  by 
the  first  distillation. 

But,  though  precise  rules  are  given  for  the  preparation  and  use  of  the 
ethereal  oil  in  the  Pharmacopoeias,  it  is  in  fact  seldom  properly  prepared 
in  this  country ;  aud  the  product  sold  as  Hoffmann's  anodyne,  in  our 
shops,  is  asserted  to  be  sometimes  prepared  by  continuing  the  distilla- 
tion in  the  process  for  procuring  ether,  after  it  has  been  stopped  in  refer- 
ence to  the  latter  product.  A  mixture  is  thus  obtained  of  ether,  alcohol, 
and  oil  of  wine,  which  is  somewhat  modified  to  make  it  suit  the  views  of 
the  manufacturers,  and  sold  as  Hoffmann's  anodyne.  It  contains  the 
ingredients  of  the  officinal  preparation,  but  much  less  of  the  ethereal 
oil. 

Compound  spirit  of  ether  has  a  peculiar  odour,  which  it  owes  to  the 
ethereal  oil.  In  taste  it  is  very  hot,  pungent,  and  somewhat  sweetish. 
It  should  be  completely  volatilizable  by  heat  and  destitute  of  acid  reac- 
tion ;  and,  when  mixed  with  water,  should  have  a  somewhat  milky  ap- 
pearance, owing  to  the  separation  of  the  oil. 

Medical  Uses.  The  effects  of  Hoffmann's  anodyne  on  the  system  are 
essentially  the  same  as  those  of  ether,  but  somewhat  modified  by  the  oil 
of  wine,  so  as  perhaps  to  bring  it  more  nearly  into  accordance  with  the 
class  of  nervous  stimulants.  Ether  itself,  in  small  doses,  insufficient  to 
disturb  specially  the  cerebral  centres,  is  really  a  nervous  stimulant ;  and, 
were  it  used  only  by  the  stomach,  might  perhaps  be  ranked  appropri- 
ately with  this  class  of  medicines;  as  it  is  never  given  in  this  way  for 
its  narcotic  effects.  But  used,  as  it  is  at  present  by  inhalation,  promi- 
nently as  a  cerebral  stimulant,  and  conforming  so  closely  in  its  effects, 
as  thus  administered,  with  alcohol  and  opium,  it  could  not  with  propriety 
be  removed  from  this  connection. 

Hoffmann's  anodyne  is  much  used  to  quiet  nervous  irritation  in  its 
various  forms.  Among  other  effects  is  that  of  producing  sleep;  but  this 
it  does  only  when  sleep  is  prevented  by  nervous  discomposure ;  so  that 
it  acts,  not  directly  on  the  brain  as  a  narcotic,  but  simply  as  a  general 
stimulant  to  the  nervous  system,  equalizing  its  actions,  and  thus  re- 
moving the  cause  of  wakefulness.  From  its  common  name  it  might  be 
supposed  to  have  extraordinary  powers  of  relieving  pain.  If  given  in 
large  quantities,  it  might  possibly  produce  this  effect  directly,  as  the  va- 


CHAP.  I.]          CEREBRAL   STIMULANTS. — NITROUS    OXIDE.  689 

pour  of  ether  does  when  inhaled,  by  rendering  the  cerebral  centres  in- 
sensible to  the  irritations  which  occasion  pain.  As  ordinarily  given, 
however,  it  does  not  act  in  this  way,  but  only  by  quieting  the  irritation 
upon  which  the  pain  may  depend  ;  and,  when  this  is  beyond  its  powers, 
it  is  itself  inoperative  as  an  anodyne.  In  painful  affections,  therefore, 
purely  dependent  on  functional  disorder,  it  will  occasionally  afford  relief; 
in  the  pains  of  a  surgical  operation,  and  those  dependent  on  inflamma- 
tion, or  even  active  congestion,  seldom  or  never  in  any  ordinary  dose. 
Mild  spasmodic  affections  will  not  unfrequently  yield  to  it. 

It  is  much  used  in  febrile  diseases  to  calm  restlessness,  and  general 
malaise,  to  obviate  the  nervous  twitchings  and  startings  so  common  in 
children,  and  to  produce  sleep,  when  the  patient  is  wakeful.  In  the  low 
or  typhoid  fevers,  it  is  particularly  indicated  for  the  subsultus  tendinum, 
and  mild  delirium  so  common  in  those  affections.  In  all  the  slighter 
troubles  of  hysteria,  in  faintness,  languor,  lowness  of  spirits,  palpita- 
tions, etc.,  and  in  analogous  affections  in  the  male  sex,  Hoffmann's  ano- 
dyne is  often  an  admirable  aid  to  the  physician,  when  more  powerful 
remedies  are  not  indicated. 

Flatulent  colic,  singultus,  and  gastric  uneasiness,  will  frequently  be 
relieved  by  it. 

It  is  often  an  efficient  remedy  in  nervous  headache. 

It  might  be  employed,  in  very  large  doses,  for  obtaining  those  more 
powerful  effects  in  spasmodic  diseases  for  which  ether  itself  is  given; 
but  the  proportion  of  alcohol  it  contains  must  always  be  taken  into 
account  in  such  cases. 

When  laudanum  sickens  the  stomach  or  occasions  headache,  the 
effect  may  sometimes  be  obviated  by  giving  Hoffmann's  anodyne  along 
with  it. 

The  dose  is  from  half  a  fluidrachm  to  two  fluidrachms.  Sometimes  it 
produces  very  pleasant  effects  in  restlessness,  in  the  dose  of  from  thirty 
to  sixty  drops.  It  should  be  given  in  a  wineglassful  of  water,  sweet- 
ened or  not  as  the  patient  may  prefer.  The  dose  may  be  repeated 
every  hour  or  two  if  required.  It  is  often  usefully  combined  with  solu- 
tion of  sulplufte  of  morphia,  or  other  preparation  of  opium,  in  affections 
in  which  both  medicines  are  indicated. 


III.  NITROUS  OXIDE 

Syn.  Protoxide  of  Nitrogen.     Laughing  Gas. 

Though  not  yet  recognized  by  the  Pharmacopoeias,  nitrous  oxide  pos- 
sesses such  valuable  properties,  and  is  at  present  so  largely  employed, 
VOL.  i. — 44 


690  GENERAL   STIMULANTS.  [PART  II. 

that  it  cannot  be  passed  over  in  silence  in  a  work,  purporting  to  repre- 
sent the  Materia  Medica  in  its  existing  state.  It  was  discovered  by 
Dr.  Priestly  in  1776,  but  attracted  little  attention  until,  in  1800,  Sir 
Humphrey  Paw  made  known  the  remarkable  exhilarating  property 
which  gave  it  the  name  of  laughing  gas.  Even  after  this  time,  notwith- 
standing the  excitant  powers  exhibited  by  it.  and  some  futile  attempts 
to  take  advantage  of  these  powers  therapeutic-ally,  it  was  scarcely  looked 
on  in  the  light  of  a  remedy  until  its  application,  in  1844,  by  Dr.  Horace 
Wells,  of  Connecticut,  to  the  purposes  of  an  anaesthetic  in  dentistry. 
Since  that  period,  though  for  a  time  neglected,  it  has  risen  into  groat  im- 
portance, partly  as  a  therapeutic  agent  through  the  investigations  of  Pr. 
Geo.  J.  Ziegler,  of  Philadelphia,  but  chiefly  as  an  anaesthetic,  in  which 
capacity,  it  is  due  to  the  dentists  to  say  they  have  taken  the  lead  in  its 
practical  use. 

Preparation.  The  most  convenient  method  of  preparing  nitrous  oxide 
is  by  the  decomposition,  by  means  of  heat,  of  nitrate  of  ammonia,  which 
for  this  purpose  should  be  very  pure.  The  salt  is  exposed  in  a  glass  re- 
tort, by  means  of  a  lamp  or  sand-bath,  to  a  heat  not  exceeding  400°  F.: 
and  the  gaseous  product  collected  in  a  glass  reservoir,  over  a  saturated 
solution  of  common  salt,  as  pure  water  absorbs  a  considerable  propor- 
tion of  the  gas,  and  much  loss  might  be  incurred  in  using  it.  Warm 
water,  however,  absorbs  much  less  than  cold,  and  is  often  employed  for 
the  purpose.  When  nitrate  of  ammonia  is  heated,  it  is  entirely  decom- 
posed ;  the  hydrogen  of  the  ammonia  forming  water  with  three  equiva- 
lents of  the  oxygen  of  the  acid,  and  the  nitric  oxide  thus  liberated,  com- 
bining with  the  liberated  nitrogen  of  the  ammonia  to  generate  nitrous 
oxide;  so  that  this  gas  and  water  are  the  sole  results  of  the  decomposi- 
tion, if  the  process  is  properly  conducted.  But  there  are  two  sources  of 
impurity  which  must  1><-  guarded  against.  In  the  first  place,  if  too 
much  heat  be  employed,  which  will  be  known  by  the  rising  of  white 
fumes  in  the  retort,  other  products  will  be  evolved,  especially  nitric 
oxide,  uncombined  ammonia,  and  possibly  a  little  nitric  acid;  all  highly 
injurious  in  their  effects  when  inhaled.  Secondly,  nitrate  of  ammo- 
nia is  apt  to  contain  a  portion  of  muriate  of  ammonia,  or  other  impurity. 
in  consequence  of  which  chlorine  may  be  among  the  products.  To 
separate  these  impurities,  which  would  unfit  the  gas  for  use,  it  should 
be  passed,  on  leaving  the  retort,  successively  through  a  saturated 
solution  of  protosulphate  of  iron,  and  a  solution  of  caustic  potassa  or 
soda,  the  former  of  which  will  remove  the  nitric  oxide,  and  the  latter. 
chlorine  and  whatever  acid  may  be  present.  The  gas  thus  purified  may 
be  kept  in  gasometers  for  use;  or,  as  suggested  by  Dr.  Ziegler,  it  may 
be  forced  into  water,  which  can  be  made  to  take  up  five  times  its  bulk, 
and, kept  indefinitely  in  this  state.  When  wanted  for  use,  nothing  in«iv 
will  be  necessary  than  to  heat  the  water  thus  impn-irnatrd.  which  will 
yield  the  gas  with  great  rapidity. 


CHAP.  I.]          CEKEBRAL    STIMULANTS. — NITROUS    OXIDE.  691 

Properties.  Nitrous  oxide  is  a  colourless  gas,  inodorous,  slightly 
sweetish,  and  of  the  sp.  gr.  1.527.  Water  at  ordinary  temperatures 
will  absorb  about  three-fourths  of  its  volume,  and  under  pressure  will 
take  up  much  more ;  and,  thus  impregnated,  has  a  slightly  sweetish 
taste,  and  a  feeble  not  unpleasant  odour.  The  gas  supports  combustion 
vigorously,  and  for  a  time  will  support  respiration,  having  thus  a  great 
advantage  over  other  anaesthetics,  which  have  no  power  of  sustaining 
life.  By  the  combined  influence  of  cold  and  pressure,  it  may  be  con- 
densed into  a  liquid,  which  is  colourless,  very  mobile,  and  capable  of 
retaining  its  form,  without  pressure,  at  about  negative  9°  of  Fahr. 
Nitrous  oxide  consists  of  one  eq.  of  nitrogen  and  one  of  oxygen,  and 
its  formula  is  NO. 

Medical  Properties  and  Uses.  Nitrous  oxide  has  all  the  physiological 
properties  which  entitle  a  medicine  to  rank  among  the  cerebral  stimulants. 
In  whatever  mode  introduced  into  the  system,  it  especially  stimulates 
the  cerebral  functions.  But  it  has  another  important  property,  wholly 
independent  of  its  powers  over  the  nervous  centres;  that,  namely,  of 
directly  oxygenizing  the  blood,  which  renders  it  highly  useful  in  several 
morbid  affections.  Its  exhilarating  effect  on  the  spirits,  and  the  species 
of  intoxication  or  delirium  induced  by  it  when  inhaled,  have  been  ren- 
dered familiar  to  every  one  through  the  public  exhibition  of  its  extraor- 
dinary powers  in  this  respect.  The  most  remarkable  circumstance  con- 
nected with  its  influence  on  the  brain,  is  the  exemption  of  those  who 
have  experienced  its  excitant  effects  from  the  subsequent  depression, 
which,  as  an  almost  universal  rule,  follows  stimulation.  I  know  no 
other  explanation  which  can  be  offered  of  this  peculiarity,  than  that,  in 
consequence  of  its  chemical  nature,  the  exhaustion  of  the  cerebral  cell? 
through  the  over-excitement  it  produces,  is  immediately  repaired  by  the 
nutritive  material,  oxygen  and  nitrogen,  which  it  offers  to  them;  the 
carbonaceous  and  hydrogenous  matter  being  always  ready  in  the  blood. 
Besides  its  general  stimulating  effects,  nitrous  oxide  is  said  to  have 
decided  aphrodisiac  properties,  similar  to  those  sometimes  exhibited 
under  the  influence  of  other. 

Besides  the  exhilarating  powers  of  nitrous  oxide,  Davy  also  discov- 
ered its  anesthetic  property,  and  even  advanced  so  far  as  to  suggest  that 
advantage  might  be  &ken  of  this  property  in  obviating  the  pain  of  sur- 
gical operations.  But  no  practical  advantage  was  taken  of  this  sug<:> •-- 
tion  until  the  year  1844,  when  Dr.  Horace  Wells,  of  Connecticut,  who 
had  been  thinking  of  the  means  of  rendering  surgical  operations  pain- 
less, and  especially  the  extraction  of  the  teeth,  having  become  acquainted 
with  the  anaesthetic  property  of  nitrous  oxide,  immediately  turned  his 
knowledge  to  account  by  trying  an  experiment  on  himself.  Having 
occasion  for  the  extraction  of  a  tooth  in  his  own  person,  he  put  himself 
under  the  influence  of  nitrous  oxide,  while  the  operation  for  extraction 


692  GENERAL    STIMULANTS.  [PART  II. 

was  performed,  and  was  happy  to  find  that  the  operation  was  entirely 
painless.  Soon  afterward,  as  the  result  of  his  experiment,  t\vo  import- 
ant surgical  operations  were  performed,  one  by  Dr.  Marcy,  and  the 
other  by  Dr.  Ellsworth,  of  Waterford,  Connecticut,  both  of  which  con- 
firmed the  expectations  of  Dr.  Wells.  (Med.  and  Surg.  Reporter,  Feb. 
10, 1866,  p.  117  )  For  sixteen  or  eighteen  years  after  this,  the  subject 
of  nitrous  oxide  inhalation  seems  to  have  been  forgotten  by  the  profes- 
sion, probably  under  the  excitement  of  the  ether  and  chloroform  discov- 
eries, until  revived  by  Mr.  G.  L.  Colton,  of  New  York,  in  its  application 
to  dentistry,  and  by  Dr.  J:  M.  Carnochan,  of  the  same  place,  in  its  appli- 
cation to  higher  surgery.  In  the  former  respect,  it  has  now  come  into 
extensive  use;  and  thousands,  if  not  tens  of  thousands,  every  year  expe- 
rience its  benefits.  In  surgery,  too,  it  is  slowly  making  its  way,  but  is 
as  yet  far  from  having  superseded  ether  and  chloroform.  There  are 
some  objections  to  it  as  an  anaesthetic  in  the  more  serious  surgical  oper- 
ations which  are  not  applicable  to  dentistry.  Though  very  speedily  in- 
duced, its  anaesthetic  effect  is  as  quickly  over;  so  that,  to  maintain  the 
insensibility  long  enough  for  most  of  the  serious  operations,  it  is  neces- 
sary frequently  to  renew  the  inhalation;  and  as,  in  the  case  of  nitrous 
oxide,  this  requires  the  co-operation  of  the  patient,  it  can  readily  be  per- 
ceived that  there  must  generally  be  considerable  difficulty,  and  sometimes 
an  impossibility  of  sustaining  the  anaesthetic  action  of  the  medicine  a 
sufficient  length  of  time.  One  great  advantage,  however,  which  the 
nitrous  oxide  has  over  all  the  other  known  anaesthetics  is,  that  it  is  itself 
a  supporter  of  respiration,  so  that  a  temporary  exclusion  of  the  atmos- 
pheric air  from  the  lungs  would  not  endanger  asphyxia,  while  its  place 
was  supplied  by  the  nitrous  oxide.  The  period  at  which  the  anaesthetic 
effect  takes  place  after  the  administration  of  nitrous  oxide,  varies  exceed- 
ingly. It  may  take  place  in  a  minute  or  two,  or  not  till  a  great  deal 
longer ;  much  depending  upon  the  depth  of  the  inhalation.  One  writer 
states  that  he  has  known  anaesthesia  to  come  on  after  only  three  deep 
and  slow  inhalations;  while  the  process  is  often  prolonged  i<>  twenty 
inhalations,  in  cases  of  superficial  breathing  from  compressed  or  diseased 
lungs.  (Boxt.  Med.  and  Surg.  Journ  ,  Sept.  7,  1865,  p.  118.)  The  dura- 
tion of  the  insensibility  is  short,  generally,  perhaps,  not  much  exceeding 
the  time  required  for  inducing  it. 

The  use  of  nitrous  oxide  as  an  anaesthetic  in  surgery  is  gradually 
spreading.  It  has  been  employed  in  Philadelphia  in  several  of  the 
higher  surgical  operations;  but  the  general  conclusion  thus  far  obtained 
is,  I  believe,  that  it  is  more  especially  adapted  to  dentistry,  and  to  sur- 
gical operations  which  require  little  time ;  but  that  for  the  more  pro- 
tracted cases  ether  is  preferable.  The  insensibility  to  pain  is  quite  as 
complete,  while  it  lasts,  as  that  caused  by  the  other  anaesthetics;  and 
the  only  objection,  therefore,  is  its  brevity.  When  some  method  shall 


CHAP.  I.]          CEREBRAL   STIMULANTS. — NITROUS    OXIDE.  693 

be  contrived  for  continuing  the  effect,  without  the  instrumentality  of 
the  patient,  there  is  no  reason,  so  far  as  is  now  known,  why  the  nitrous 
oxide  should  not  supersede  all  others ;  being  in  its  administration  much 
less  unpleasant  than  ether,  in  its  effects  vastly  less  dangerous  than  chlo- 
roform, and  in  its  after-effects  less  disagreeable  than  either  of  the  others, 
both  of  which  are  not  unfrequently  followed  by  nausea  and  depression. 

The  danger  from  inhalation  of  nitrous  oxide,  when  managed  with  due 
caution,  may  be  considered  as  absolutely  nothing.  Of  course  if  used 
in  cases  not  adapted  to  it.  harm  may  result  as  from  any  other  remedy. 
If,  for  example,  it  were  to  be  applied  in  cases  of  active  congestion  of  the 
brain,  acute  inflammation,  and  general  plethora,  it  would  be  likely  to 
prove  injurious,  like  alcoholic  remedies  under  the  same  circumstances. 
But  with  ordinary  caution  in  this  respect,  and  care  to  use  only  a  perfectly 
pure  article,  there  is  really  no  danger,  unless  from  the  existence  of  some 
latent  predisposition,  which  might  be  called  into  action  by  this  as  by  any 
other  medicine.  In  a  single  dental  establishment,  out  of  4,000  cases  in 
which  it  was  used,  not  the  least  injury  resulted  in  a  single  case.  (Boston 
Med.  and  Surg.  Journ.,  Sept.  29,  1864.) 

Xor  is  it  simply  a~  an  aiuvsthetic  that  nitrous  oxide  is  likely  to  be 
employed.  Its  conjoined  powers  of  general  stimulation  especially  di- 
rected to  the  cerebral  centres,  and  of  directly  oxidizing  the  blood,  render 
it  applicable  to  a  great  number  of  diseases,  in  which  life  is  endangered 
by  general  prostration,  loss  of  brain  power,  and  insufficiently  oxidized 
blood.  The  collapsed  condition  of  cholera ;  the  vast  prostration  of  the 
pernicious  chill ;  the  cold  stage  of  all  other  fevers  in  which  reaction  is 
feeble  or  insufficient,  as  in  malignant  cases  of  typhus,  yellow  fever,  diph- 
theria, scarlet  fever,  erysipelas,  etc. ;  the  debilitated  states  of  these  same 
fevers,  and  of  others,  as  enteric  for  example,  in  their  course,  or  towards 
their  close ;  cases  of  positive  or  threatened  asphyxia,  from  strangula- 
tion, drowning,  cold,  and  narcotic  poisons;  all  these  afford  decided  indi- 
cations for  this  remedy,  to  which  the  only  objection,  in  such  cases,  is  the 
inconvenience  of  its  administration.  Hitherto  the  remedy  has  made 
little  headway  in  this  direction  ;  but  in  an  interesting  report  of  Dr.  Geo. 
(T.  Shmuard,  Medical  Director  in  the  U.  S.  Army,  an  account  is  given  of 
eight  cases  of  disease,  of  the  character  above  mentioned,  which  were  con- 
sidered hopeless  under  any  ordinary  treatment,  in  which  the  inhalation 
of  this  gas,  even  under  circumstances  not  the  most  favourable  for  its 
effective  exhibition,  was  followed  in  all  by  decided  signs  of  improvement, 
and  in  three  was  believed  to  have  saved  life.  (Boston  Med.  and  Surg. 
Journ.,  Jan.  18, 1863,  p.  446  ) 

Mode  of  Exhibition.  The  ordinary  method  of  administration  is  by 
means  of  an  air-tight  bladder,  with  a  tube  and  mouth-piece  attached, 
through  which  the  patient  breathes,  inhaling  the  contents  of  the  bag,  and 
returning  into  it  the  air  from  the  lungs ;  the  nostrils  being  closed  during  the 


(394  GENERAL    STIMULANTS.  [PART  II. 

process.  Though  the  effects  of  the  gas  may  be  obtained  in  this  way,  yet 
it  is  liable  to  the  objection,  that  the  same  air  is  constantly  breathed  over 
again ;  and,  as  the  carbonic  acid  from  the  lungs  is  steadily  increasing, 
and  the  nitrous  oxide  as  steadily  diminishing,  it  must  happen  at  length,  if 
the  process  be  long  continued,  that  the  air  breathed  will  bo  chiefly  the 
former  gas,  and  asphyxia  may  be  endang-ered  from  this  cause.  To  ob- 
viate the  chance  of  this  evil,  the  bag  should  be  large  enough  to  hold  all 
the  gas  required  to  produce  the  anesthetic  effect;  and,  instead  of  one 
or  two  gallons,  which  is  often  its  capacity,  should  contain  several  gallons, 
not  less,  according  to  Dr.  Spears,  than  six  or  eight,  though  this  would 
probably,  in  general,  be  considered  unnecessarily  large.  (Med.  and  Surg. 
Reporter,  Feb.  10,  1866,  p.  118.)  But  a  still  better  plan  is  to  use  a  bag 
with  a  valve  in  the  tube  opening  outward,  so  as  to  permit  the  entrance 
of  the  air  of  the  bag  into  the  lungs,  but  to  prevent  the  return  of  the  ex- 
pired air  into  it.  When  the  operation  is  carried  on  very  largely,  as  in 
the  office  of  a  dentist,  it  will  be  convenient,  in  order  to  ensure  at  once  a 
sufficient  supply  of  the  pure  gas  always  on  hand,  and  the  greatest  con- 
venience of  administration,  to  be  provided  with  an  apparatus  both  for 
the  preparation  and  preservation  of  the  gas ;  including  the  retort  with 
the  means  of  heating  it,  several  bottles  containing  the  purifying  liquids 
through  which  the  gas  is  to  pass  successively,  and  a  larsre  reservoir  or 
gasometer  of  zinc,  which  may  receive  the  gas  as  generated,  and  retain 
it  for  use.  With  this  gasometer  a  tube  may  be  connected,  furnished 
with  a  valve  opening  outward,  through  which  the  patient  may  inhale 
the  gas  without  returning  a  particle  to  the  reservoir.* 

Nitrous  Oxide  Water.  The  aqueous  solution  of  the  gas  without  press- 
ure, containing  from  three-quarters  to  an  equal  bulk  of  the  gas,  was 
tried  internally  by  Sir.  H.  Davy.,  who  believed  it  to  promote  digestion, 
and  to  act  as  a  diuretic.  An  oversaturated  solution  made  under  pi 
ure,  and  containing  five  volumes  of  the  gas  for  one  of  water,  was 
patented  in  England,  where  it  was  known  as  Searle's  oxygenous  aerated 
water,  and  has  been  used  to  some  extent  as  an  internal  remedy.  By 
Serullas  it  was  thought  to  be  useful  in  Asiatic  cholera.  In  this  country, 
the  internal  use  of  nitrous  oxide  water  has  been  especially  investigated 
by  Dr.  Geo.  J.  Ziegler,  of  Philadelphia,  who  made  various  experiments 
both  on  the  human  subject  and  the  lower  animals,  and  published  the 
results  of  his  researches.  The  solution  taken  into  the  stomach,  or  in- 
jected into  the  bowels,  appears  to  exercise  in  some  degree  the  stimulant 
and  exhilarating  effects  of  the  gas  inhaled,  at  the  same  time  that  it  pro- 
duces a  gently  excitant  effect  on  the  mucous  membrane,  and  by  absorp- 

*  For  an  account,  with  a  figure,  of  an  apparatus,  contrived  by  Prof.  V.tmler 
Weyde,  and  described  by  Dr.  Sam.  W.  Francis,  of  New  York,  see  the  Medical  and 
Surgical  Reporter  (May  19,  1866,  p.  382). 


CHAP.  I.]          CEREBRAL   STIMULANTS. — NITROUS    OXIDE.  695 

tion  to  improve  the  blood,  when  deficiently  oxygenated.  Among  other 
effects  which  it  has  in  common  with  the  inhaled  gas,  is  that  of  obviating 
asphyxia  from  various  causes,  by  at  the  same  time  oxidizing  the  blood 
and  stimulating  the  nervous  centres  and  the  heart.  The  diseases  in 
which  the  nitrous  oxide  water  has  been  employed,  with  supposed  advant- 
age, or  may  be  used  with  hope  of  benefit,  are  dyspepsia ;  depression  of 
spirits;  general  torpor  and  debility ;  neuralgia  connected  with  debility; 
gastralgia;  asthma;  syncope ;  threatened  or  existing  asphyxia;  the  debility 
following  the  excitement  of  the  stimulating  narcotics,  as  opium,  alcohol, 
ether,  etc.,  and  that  attending  the  immediate  action  of  the  cerebral  or 
nervous  sedatives,  as  chloroform,  hydrocyanic  acid,  digitalis,  tobacco, 
aconite,  etc.;  and,  finally,  the  low  condition  of  all  fevers  requiring  stimu- 
lation, in  which  this  remedy  is  particularly  indicated,  as  not  being  fol- 
lowed by  depression.  Dr.  Chapelle,  of  Angouleme,  in  France,  has  found 
the  remedy  especially  beneficial  in  lypemania,  or  that  form  of  monomania 
in  which  the  delusion  is  attended  with  depression  of  spirits  or  melancholy. 
(Arch.  Gen.,  Juin,  1865,  p.  739.)  According  to  the  observations  of  Dr. 
Ziegler,  its  long-continued  use  occasions  emaciation,  resulting  from  the 
too  rapid  oxidation  and  consequent  excess  of  the  vital  changes  of  the 
tissues;  but  this  condition  is  much  less  serious  than  that  proceeding 
from  an  opposite  cause,  as  it  indicates  no  depreciation  of  the  vital 
powers.  Indeed,  the  remedy  may  be  used,  in  case  of  morbid  obesity, 
with  a  view  to  this  very  effect. 

Where  it  cannot  be  taken  by  the  mouth,  it  may  be  administered  with 
similar  results  by  the  rectum.  From  half  a  pint  to  a  pint  and  a  half  of 
the  nitrous  oxide  water  may  be  taken,  in  wineglassful  doses,  less  or  more, 
through  the  day.  Three  times  the  quantity  may  be  given  by  enema. 


Peroxide  of  Hydrogen.  Some  attention  has  recently  been  attracted 
to  peroxide  of  hydrogen  as  an  oxidizing  agent  in  the  system,  and  as  a 
remedy  of  diversified  powers,  by  the  experiments  and  researches  of  Dr. 
Richardson,  of  London ;  but  it  has  not  yet  practically  obtained  such  a 
position  in  therapeutics,  as  to  authorize  its  adoption  into  the  catalogue 
of  remedies.  Further  trials  may  justify,  or  perhaps  even  exceed  the 
hopes  entertained  in  relation  to  it.  At  present  I  must  content  myself 
with  referring  to  the  U.  S.  Dispensatory  (12th  ed.,  p.  1579),  where  an 
abstract  will  be  found  of  all  that  is  at  present  known  concerning  it  in  a 
remediate  capacity. 


696  GENERAL    STIMULANTS.  [PART  II. 

IV.  CAMPHOR. 

CAMPHOR  A.   U.  S.,  Br. 

Origin.  Camphor  is  a  concrete  substance  obtained  from  Camphora 
officinarum,  an  evergreen  tree,  of  considerable  size,  growing  in  China 
and  Japan,  and  other  neighbouring  countries,  and  occasionally  kept  in 
conservatories  in  temperate  latitudes.  The  whole  plant  is  impregnated 
with  the  camphor,  which  is  separated  either  by  sublimation,  or  by  boil- 
ing, and,  in  the  latter  case,  is  sublimed  before  being  sent  into  market. 
It  comes  to  us  either  from  the  ports  of  China,  or  indirectly  from  Japan 
through  Dutch  commerce.  As  imported,  it  is  not  sufficiently  pure  for 
use,  and  is,  therefore,  submitted  to  another  sublimation,  along  with  a 
small  proportion  of  quicklime.  Thus  prepared,  it  is  in  large  circular 
cakes,  an  inch  or  two  in  thickness,  slightly  convex  on  one  side  and  con- 
cave on  the  other,  and  perforated  in  the  centre. 

Properties.  As  kept  in  the  shops,  camphor  is  usually  in  fragments  of 
the  cakes  above  mentioned,  usually  somewhat  whitish  on  the  surface,  but 
beautifully  clear  and  translucent  within.  It  has  a  strong,  fragrant,  char- 
acteristic odour,  and  a  warm,  pungent,  somewhat  bitter  taste,  which 
leaves  a  sense  of  coolness  ir  he  mouth,  especially  perceptible  when  the 
air  passes  over  the  tongue  during  inhalation.  It  is  somewhat  unctuous 
to  the  touch,  and  very  brittle,  yet  of  difficult  pulverization,  in  conse- 
quence of  a  certain  tenacity  in  its  constituent  granules,  which  causes 
them  to  flatten  under  the  pestle,  without  breaking  into  powder.  It  may, 
however,  be  readily  reduced  to  powder,  by  first  adding  a  little  alcohol, 
by  grating  and  sifting,  or  by  precipitation  by  water  from  its  alcoholic 
solution.  Camphor  is  lighter  than  water,  and,  when  thrown  upon  it  in 
small  fragments,  floats  on  the  surface,  and  performs  various  gyratory 
movements,  probably  in  consequence  of  the  repulsion  of  its  vapour.  It 
is  highly  volatile,  and  if  exposed  to  the  air  will  in  time  wholly  disappear. 
At  a  temperature  somewhat  above  that  of  boiling  water,  it  melts,  at  a 
higher  temperature  boils,  and  at  a  still  higher  takes  fire,  burning  with  a 
brilliant  flame,  but  much  smoke,  and  leaving  no  residue.  In  close  ves- 
sels it  may  be  sublimed  unchanged.  It  is  very  slightly  soluble  in  water, 
which,  by  simple  agitation  with  it,  takes  up  one-thousandth  of  its  weight, 
and  acquires  the  smell  and  taste  of  the  camphor.  By  the  intervention  of 
an  agent  which  enables  it  to  be  very  minutely  divided,  as  magnesia  or 
its  carbonate,  it  may  be  dissolved  in  water  in  much  larger  proportion. 
It  is  very  soluble  in  alcohol,  extremely  so  in  chloroform,  and  to  a  con- 
siderable extent  also  in  ether,  the  volatile  and  fixed  oils,  strong  acetic 
acid,  and  the  diluted  mineral  acids;  even  carbonic  acid  water  dissolving 


CHAP.  I.]  CEREBRAL    STIMULANTS. — CAMPHOR.  697 

it  more  largely  than  water  itself.  When  rubbed  with  resinous  substances, 
it  often  loses  a  part  of  its  odour,  becomes  softened,  and  is  thus  rendered 
more  readily  suspensible  in  water. 

Composition.  Camphor  consists  of  carbon,  hydrogen,  and  oxygen, 
which  are  thought  to  be  combined  in  the  form  of  oxide  of  camphene, 
a  compound  radical  consisting  of  10  equivalents  of  oxygen  and  8  of 
hydrogen,  and  supposed  to  be  identical  with  pure  oil  of  turpentine. 

Another  variety  of  camphor,  denominated  Borneo,  or  Sumatra,  or 
Dryobalanops  camphor,  is  obtained  from  the  interstices  of  the  wood  of 
Dryobalanops  C  amphora,  a  large  forest  tree  of  Sumatra  and  Borneo. 
It  is  never,  however,  imported  for  use  into  America  or  Europe. 

1.  EFFECTS  ON  THE  SYSTEM. — Opinions  the  most  opposite,  and  facts 
apparently  the  most  contradictory,  have  been  published  in  relation  to 
the  mode  of  operation  and  effects  of  camphor.  Some  consider  it  essen- 
tially sedative  in  its  action,  whether  on  the  circulatory  or  nervous  sys- 
tem; while  others  with  equal  positiveness  determine  that  it  is  stimulant; 
and  others  again  think  that  it  may  be  the  one  .or  the  other;  and  facts 
not  to  be  denied  are  adduced  in  support  of  each  opinion.  In  the  present 
state  of  our  experimental  knowledge  on  the  subject,  it  is  impossible  to 
decide  with  certainty  between  these  conflicting  views  and  statements. 
More  numerous  observations,  made  under  every  variety  of  circumstances, 
and  without  influence  from  preconceived  opinions,  are  necessary  before 
any  view  of  its  mode  of  operation  can  be  received  as  demonstrated. 
Nevertheless,  it  may  be  possible  to  find  some  clue  through  the  labyrinth 
of  seeming  contradictions;  and,  after  giving  a  succinct  account  of  the 
effects  produced  by  camphor,  as  deduced  from  the  great  multitude  of 
published  facts,  and  from  my  own  personal  observation,  I  shall  endeav- 
our to  explain  them,  as  far  as  practicable,  in  accordance  with  the  general 
principles  maintained  in  this  work. 

Local  Effects.  In  the  first  place,  when  applied  locally,  and  confined 
so  as  to  prevent  evaporation,  camphor  produces  heat,  more  or  less  red- 
ness, and  not  unfrequently  pain.  These  effects  are  not  very  obvious 
upon  the  skin  protected  by  the  cuticle ;  but,  when  the  medicine  is 
applied  in  concentrated  solution,  they  will,  I  think,  be  found  to  take 
place  in  some  degree.  In  blistered  and  ulcerated  surfaces,  and  in  the 
mouth,  they  are  incontestable.  MM.  Trousseau  and  Pidoux  state,  as 
the  result  of  personal  experiment,  that  pieces  of  camphor,  held  in  the 
mouth  for  half  an  hour,  had,  at  the  end  of  that  time,  produced  redness, 
heat,  and  painful  swelling  in  the  part  with  which  they  were  in  contact. 
(Mat.  Mcd.,  4e  ed.,  ii.  235.)  The  experiments  of  Orfila  on  animals 
prove  that  the  same  effect  is  produced  in  the  gastric  mucous  membrane. 
When  camphor  was  given  in  small  fragments,  it  was  found,  after  the 
death  of  the  animal,  to  have  caused  inflammation,  and  numerous  small 
points  of  ulceration.  It  is  well  known  that,  in  man,  when  swallowed 


698  GENERAL    STIMULANTS.  [PART  II. 

in  the  form  of  pill,  it  is  apt  to  occasion  uneasiness  or  pain  in  the  stom- 
ach, and,  if  in  considerable  quantities,  even  nausea  and  vomiting.  It 
would  seem,  therefore,  that  camphor  is  a  local  stimulant.  But  how  are 
we  to  account  for  the  coldness  felt  in  the  mouth  when  it  is  swallowed,  and, 
as  some  assert,  even  in  the  stomach?  Simply  by  its  volatility.  In  its 
conversion  from  the  solid  state  to  that  of  vapour,  it  necessarily  absorbs 
heat,  and  produces  the  sensation  of  cold ;  and  this  is  especially  observed 
when  the  air  is  drawn  through  the  mouth,  thus  favouring  the  evapora- 
tion. There  can  be  no  doubt  that  the  same  change  goes  on  to  some 
extent  in  the  stomach,  under  the  higher  temperature  to  which  the  cam- 
phor is  there  exposed,  and  a  necessary  result  there  also  is  the  production 
of  more  or  less  coolness.  But  excitement  of  the  part  is  probably  not 
the  only  effect  of  camphor.  It  is  scarcely  possible  that  the  medicine 
should  have  been  adhered  to,  as  a  local  anodyne  in  rheumatism  and 
other  painful  diseases,  so  universally,  so  pertinaciously,  and  through  so 
long  a  series  of  years,  if  it  really  possessed  no  power  of  this  kind.  But 
nothing  is  more  common,  in  our  experience  of  the  operation  of  medi- 
cines, than  the  succession  of  a  stimulant  and  sedative  effect.  Chloro- 
form powerfully  irritates  a  surface  for  a  time,  and  afterwards  as  power- 
fully reduces  its  sensibility  to  painful  impressions.  Camphor  operates 
in  the  same  way ;  but,  whether  its  sedative  effect  on  the  nervous  extrem- 
ities is  direct,  or  consequent  upon  a  previous  stimulant  effect  upon  them, 
there  are  no  facts  which  enable  us  to  determine.  The  question  may 
perhaps  be,  in  some  degree,  analogically  settled,  if  we  can  determine 
how  the  medicine  acts  upon  the  nervous  centres;  for  it  is  probable, 
though  by  no  means  certain,  that  it  acts  upon  the  same  principle  in  both 
positions. 

General  Effects.  Our  attention  is  next  to  be  directed  to  the  effects  of 
camphor  on  the  system  at  large.  Omitting  the  impression  it  may  pro- 
duce on  the  stomach,  which  will  vary  with  the  predominance  of  the  refrig- 
erant influence  of  the  evaporation,  or  the  direct  excitant  influence  of  the 
camphor,  and  with  the  mode  of  its  exhibition,  whether  in  solution,  finely 
divided,  or  in  mass,  I  shall  notice  only  the  constitutional  effects.  From 
a  very  small  dose,  sufficient,  however,  to  make  a  decided  impression  in 
certain  morbid  states  of  the  system,  no  sensible  effect  whatever  is  expe- 
rienced in  health.  A  somewhat  larger  dose  will  usually  be  followed  by  a 
slight  increase  in  the  frequency  and  perhaps  fulness  of  the  pulse,  and  in 
the  warmth  of  the  surface,  and  occasionally  by  some  diaphoresis.  In 
the  course  of  about  twenty  minutes,  there  may  be  a  slight  exhilaration 
of  spirits,  or  feeling  of  comfort  induced,  which,  however,  is  much  more 
observable  in  depression  or  uneasiness  from  nervous  disorder  than  in 
health.  This  passes  over  in  a  short  time,  and  no  other  discoverable 
effect  may  be  produced.  Thus  far  the  medicine  operates  in  exact 
accordance  with  the  class  of  nervous  stimulants.  A  larger  dose  will 


CHAP.  I.]  CEREBRAL   STIMULANTS. — CAMPHOR.  699 

occasion  obvious  narcotic  symptoms.  With  or  without  preliminary 
excitement  of  the  circulation,  there  will  now  be  a  feeling  of  giddiness, 
perhaps  also  of  languor  or  lassitude,  with  more  or  less  mental  confusion 
or  unsteadiness ;  and,  if  the  impression  be  very  decided,  there  may  also 
be  some  disorder  in  vision  and  hearing.  These  symptoms  are  soon 
followed  by  heaviness,  mental  hebetude,  and  a  disposition  to  sleep; 
during  which  the  general  sensibility  is  impaired,  the  pulse,  whether  at 
first  excited  or  not,  usually  becomes  slower,  though  perhaps  still  full, 
and  the  temperature  of  the  surface  is  somewhat  lowered. 

Very  opposite  statements  have  been  made,  in  reference  to  the  effects 
of  the  medicine  upon  the  urinary  and  genital  organs,  by  persons  who 
equally  speak  from  their  own  experience,  and,  so  far  as  can  be  determ- 
ined, are  equally  deserving  of  confidence.  While,  according  to  one 
statement,  camphor  is  apt  to  irritate  the  urinary  passages  and  the  organs 
of  generation,  producing  even  strangury  in  the  one,  and  sensations  of 
voluptuous  excitement  in  reference  to  the  other,  the  opposite  statement 
affirms  that  the  medicine,  instead  of  causing,  is  admirably  adapted  to  re- 
lieve strangury,  and  is  a  powerful  antaphrodisiac,  producing  excellent 
effects  in  priapism,  nymphomania,  a  disposition  to  onanism,  etc.  Now 
these  assertions  are  not  so  contradictory  as  they  seem.  Allowing  the 
camphor  to  act  upon  the  nervous  centres  as  a  stimulant,  the  first  stage  of 
its  action  may  be  an  excitation  of  the  function  over  which  the  centres 
respectively  preside,  while,  in  the  second  stage,  the  congestion  of  the 
centre  shall  be  such  as  to  impair  its  power,  and  consequently  depress  the 
dependent  function.  Thus,  camphor  may  excite,  and  may  depress  the 
generative  organs,  and  whether  it  will  do  the  one  or  the  other,  may 
depend  upon  the  stage  of  its  action,  as  well  as  on  the  quantity  given, 
and  on  various  circumstances  which  may  hasten  or  retard,  increase  or 
diminish  its  influence.  If  it  act  promptly  and  powerfully  on  the  centre, 
the  first  stage  of  excitation  may  pass  over  so  rapidly  that  only  the  suc- 
ceeding sedative  effect  may  be  felt ;  if,  on  the  contrary,  less  rapidly  and 
less  powerfully,  its  congestive  effect  in  the  centre  may  not  pass  the 
boundary  of  pure  excitation,  and  the  function  be  stimulated  accord- 
ingly. The  different  effects  on  the  urinary  passages  may  be  explained 
on  the  same  principles ;  or  we  may  suppose  that,  in  producing  one  effect, 
the  camphor  may  act  through  the  system,  and,  in  producing  the  other, 
locally. 

Poisonous  Effects.  In  great  excess,  camphor  sometimes  occasions 
nausea  and  vomiting,  by  which  it  is  discharged,  and  ill  effects  averted. 
If  not  speedily  thrown  off  from  the  stomach,  it  gives  rise  to  anxiety, 
vertigo,  disordered  or  obtunded  hearing  and  vision,  delirium,  insensi- 
bility, muscular  twitchings,  convulsions,  and  deep  stupor.  Along  with 
these  symptoms  there  are  usually  diminution  in  the  frequency  and  force 
of  the  pulse,  paleness  of  the  face,  and  coolness  of  the  skin,  which  is 


700  GENERAL   STIMULANTS.  [PART  II. 

sometimes  bathed  in  cold  sweat.  The  symptoms  come  on  usually  in  less 
than  half  an  hour,  increase  gradually  in  intensity,  and  in  the  course  of 
an  hour  or  two  end  in  unconsciousness.  If  the  poison  is  evacuated,  they 
will  go  off  quickly ;  otherwise,  they  may  continue  several  hours,  and 
gradually  decline,  the  patient  returning  to  consciousness,  but  with  some 
confusion  of  mind  and  feebleness  of  memory  remaining  for  a  longer  or 
shorter  time  Except  in  the  case  of  an  infant,  of  about  eighteen  months, 
who  died  from  the  effects  of  the  poison,  after  taking  about  ten  grains,  no 
instance  of  fatal  result  is  on  record;  but  in  many  instances  the  symptoms 
have  been  very  alarming,  and  quite  sufficient  to  suggest  caution  in  the 
use  of  large  doses.  It  is  a  singular  fact  that,  in  some  of  these  cases  of 
poisoning,  there  have  been  at  first  evidences  of  high  circulatory  excite- 
ment, with  flushed  face,  and  other  symptoms  of  determination  of  blood 
to  the  head,  followed  by  a  state  of  depression ;  while  in  other  cases  the 
depressed  condition  has  first  occurred,  and  the  symptoms  of  excitement, 
amounting  even  to  fever,  have  followed.  It  has  been  attempted  to  ex- 
plain the  latter  by  the  reaction  following  depression ;  but  we  do  not  see 
the  same  phenomena  succeeding  the  prostrating  influence  of  real  direct 
sedatives,  such  as  conium,  chloroform,  digitalis,  hydrocyanic  acid,  etc. 
It  is  more  probable  that  they  were  the  result  of  the  direct  action  of  the 
poison  on  the  brain ;  and  the  different  states  of  excitement  and  prostra- 
tion were  probably  merely  the  results  of  different  degrees  of  excitant  or 
irritant  influence  on  the  cerebral  centres,  in  one  instance  being  only  suffi- 
cient to  stimulate  them  to  excessive  action,  in  the  other  overwhelming 
them  with  an  active  congestion,  and  thus  preventing  their  due  influence 
on  the  functions  over  which  they  preside,  whether  of  the  heart,  lungs, 
or  special  senses.  The  occurrence  of  febrile  symptoms,  and  obvious 
cerebral  excitement,  after  the  depressing  effects  have  been  for  some  time 
experienced,  may  be  owing  to  a  subsidence  of  the  active  congestion  of 
the  cerebral  centres  to  a  point,  at  which  their  operations  are  unembar- 
rassed, and  at  which,  consequently,  they  are  enabled  to  extend  the  direct 
effects  of  their  irritation  throughout  the  system.  If  any  physician  will 
ask  himself  the  question,  whether  he  would  venture  to  give  camphor,  in 
large  doses,  in  acute  inflammation  or  active  congestion  of  the  brain,  he 
will  at  least  determine  what  is  his  own  real  belief  of  its  action.  If  he 
agree  with  the  author  in  thinking  that  it  could  do  only  injury  under  such 
circumstances,  he  will  be  disposed  to  rank  camphor,  as  is  here  done, 
among  the  cerebral  stimulants.  Until  he  is  prepared  to  administer  it  as 
an  effectual  remedy  in  such  cases,  he  cannot  be  thoroughly  convinced  of 
its  direct  sedative  properties. 

The  quantity  in  which  camphor  is  capable  of  producing  poisonous 
effects  varies  exceedingly,  according  to  individual  peculiarity,  or  to  cir- 
cumstances not  well  understood.  Thus,  while  Mr.  Alexander,  of  Edin- 
burgh, suffered  the  most  threatening  symptoms,  including  convulsions  and 


CHAP.  I.]  CEREBRAL    STIMULANTS. — CAMPHOR.  701 

stupor,  from  forty  grains,  and  even  twenty  grains  have  produced  alarm- 
ing effects,  more  than  two  drachms  have  been  taken  without  serious 
consequences.  The  ten  grains  which  proved  fatal  in  the  child  of  eighteen 
months,  are  probably  equivalent  to  eight  or  ten  times  as  much  given  to 
an  adult. 

The  main  remedy  in  poisoning  from  camphor  is  to  evacuate  the  stom- 
ach. The  after  treatment  depends  altogether  on  the  symptoms  pre- 
sented; but,  in  general,  little  else  is  required. 

2.  MODE  OF  OPERATION. — Camphor  probably  acts  on  the  system  at 
large  exclusively  through  the  blood.     That  it  is  absorbed  is  proved  by 
its  odour  in  the  breath  and  perspiration,  and,  as  some  have  asserted,  in 
the  urine,  and  by  the  result  of  an  experiment  of  Tiedemann  and  Gmelin, 
who  distinctly  perceived  the  smell  of  camphor  in  the  portal  blood  of  a 
horse,  to  which  the  drug  had  been  given. 

From  what  has  been  stated  above,  it  has  been  already  inferred  that  1 
consider  camphor  as  directly  stimulant,  both  locally  and  generally,  with 
very  little  comparative  influence  on  the  circulation,  but  a  powerful  ac- 
tion in  large  doses  on  the  brain,  and  as  indirectly  sedative  to  all  the 
functions,  including  of  course  that  of  the  heart,  through  the  over-stimu- 
lation or  congestion  of  the  nervous  centres. 

3.  THERAPEUTIC  APPLICATION. — Camphor  was  probably  unknown  to 
the  ancient  Greek  and  Roman  physicians,  and  was  introduced  into  Eu- 
rope by  the  Arabians.     In  small  doses  of  from  one  to  three  grains,  re- 
peated at  short  intervals  if  required,  it  often  answers  an  admirable  pur- 
pose as  a  nervous  stimulant,  relieving  slight  pains,  vague  uneasiness, 
nervous  headaches,  muscular  twitchings,   restlessness,  jactitation,  etc., 
and  often  enabling  the  patient  to  sleep  by  removing  the  causes  which 
keep  him  awake.     It  is  much  used  for  this  purpose  in  various  diseases, 
generally  in  the  state  of  camphor  water,  or  combined  with  opium  in  the 
officinal  camphorated  tincture  of  opium,  or  paregoric. 

In  a  full  dose,  calculated  to  act  as  a  cerebral  stimulant,  it  may  be  em- 
ployed to  stimulate  the  brain  in  a  depressed  state  of  its  functions,  to 
relieve  pain,  and  to  allay  spasm  and  other  nervous  disorder.  It  probably 
produces  the  two  latter  effects  by  rendering  the  cerebral  centres,  through 
its  congestive  influence  upon  them,  insensible  to  the  impressions  sent 
from  the  affected  part,  and  incapable  of  transmitting  influence  to  the 
muscular  or  other  dependent  function. 

The  following  are  the  special  diseases  in  which  'it  has  been  most  em- 
ployed ;  but,  whatever  may  be  the  name  of  the  affection  in  which  the 
indications  above  mentioned  may  be  presented,  it  may  be  used  to  meet 
them,  provided  no  contraindication  exist. 

Idiopathic  Fevers.  Whenever,  in  any  one  of  these  complaints,  what- 
ever may  be  the  particular  character  of  the  fever,  there  may  be  general 
uneasiness,  restlessness,  jactitation,  tremors,  twitchings  or  starlings  of 


702  GENERAL   STIMULANTS.  [PART  II. 

the  muscles,  slight  delirium,  wakefulncss,  etc.,  and  these  symptoms  may 
be  in  no  degree  dependent  on,  or  connected  with  active  congestion  or 
inflammation  of  the  brain,  camphor  may  be  employed  as  a  nervous  stim- 
ulant, and  will  often  be  found  to  act  most  happily  in  relieving  them. 
The  most  convenient  form  for  using  it,  under  these  circumstances,  is  that 
of  the  camphor  water  of  the  U.  S.  Pharmacopoeia,  of  which  one  or  two 
tablespoonfuls  may  be  given  every  hour  or  two,  until  the  desired  effect 
is  produced.  The  symptoms  referred  to  are  peculiarly  apt  to  occur  in 
children,  for  whom,  according  to  the  age,  the  dose  may  vary  from  thirty 
minims  to  one  or  two  fluidrachms,  at  the  same  intervals.  Advantage 
will  often  accrue  from  combining  or  alternating  it  with  compound  spirit 
of  ether  (Hoffmann's  anodyne),  or  with  spirit  of  nitric  ether  (sweet  spirit 
of  nitre),  under  the  same  circumstances,  and  sometimes  with  one  of  the 
liquid  preparations  of  opium,  when  that  medicine  may  be  simultaneously 
indicated. 

In  enteric  and  typhus  fevers,  and  in  the  low  typhoid  state  of  febrile 
diseases  generally,  camphor  is  particularly  indicated ;  and  may  some- 
times be  employed  with  benefit,  not  only  for  the  purposes  above  men- 
tioned, but  also  as  a  cerebral  stimulant,  in  aid  of  wine-whey,  carbonate 
of  ammonia,  etc.,  \viien  the  pulse  is  frequent  and  feeble,  the  tongue  and 
skin  dry,  and  the  patient  affected  with  low  muttering  delirium.  The 
supposed  diaphoretic  property  of  the  medicine  comes  here  in  aid  of  its 
stimulant  action  on  the  brain,  which  is  in  a  depressed  condition  under 
the  sedative  influence  of  the  depraved  blood,  or  directly  of  some  absorbed 
poison. 

Inflammation.  Under  the  impression  of  its  sedative  powers,  camphor 
has  been  recommended  strongly  in  inflammatory  diseases  generally,  and 
especially  in  acute  rheumatism,  in  which  it  has  been  supposed  to  exer- 
cise peculiarly  beneficial  powers.  Of  course  it  may  be  used  in  these 
complaints  when  the  nervous  symptoms  above  referred  to  call  for  it ;  but 
it  is  not  in  this  capacity  that  its  employment  is  now  alluded  to.  It  is 
supposed,  in  these  complaints,  to  exercise  a  directly  sedative  influence 
over  the  inflammatory  excitement,  at  the  same  time  favouring  perspira- 
tion. I  have  no  doubt  that  it  may  act  beneficially,  but  not  precisely  in 
the  manner  supposed.  Whatever  sedative  influence  it  may  exert  is,  I 
believe,  secondary,  and  dependent  on  a  direct  stimulation  and  consequent 
congestion  of  the  cerebral  centres;  and  the  inference  from  this  view  is, 
that  it  should  not  be  employed  in  acute  cerebral  inflammation,  or  active 
cerebral  congestion;  nor,  indeed,  in  any  other  inflammation  with  a  full 
strong  pulse  and  sthenic  state  ef  system,  until  the  vascular  fulness  and 
excitement  have  been  subdued  by  depletory  measures.  In  other  words. 
I  think  that  it  acts  upon  the  same  principles  precisely  as  opium  in  these 
cases,  and,  like  it,  should  be  associated  with  medicines  calculated  to  give 
it  a  direction  to  the  skin,  and  obviate  any  stimulation  it  may  produce, 


CHAP.  I.]  CEREBRAL    STIMULANTS. — CAMPHOR.  703 

such  as  tartar  emetic,  the  neutral  mixture,  nitre,  etc.  It  is  probably  the 
similarity  and,  at  the  same  time,  inferiority  of  its  action  to  that  of  opium, 
that  has  led  to  its  disuse  in  inflammations  ;  and  advantage  might  some- 
time^ accrue,  particularly  in  inflammatory  rheumatism,  from  having  re- 
course to  it  as  a  substitute  for  opium,  when  that  medicine,  from  its  pecu- 
liar properties,  may  act  in  some  way  disadvantageously.  When  on  the 
subject  of  opium,  I  shall  more  fully  discuss  its  mode  of  operation  in  in- 
flammations;  and  what  maybe  said  there  will  apply  in  considerable 
degree  to  camphor.  With  a  view  to  its  antiphlogistic  effects,  it  must  be 
used  in  full  doses. 

Painful  Affections.  Camphor  has  been  occasionally  used  as  an  ano- 
dyne in  neuralgia,  but  is  much  less  efficient  than  several  other  medicines 
belonging  to  the  class.  In  nervous  headaches  it  may  be  useful,  when 
they  depend  on  cerebral  depression  ;  and,  in  slight  cases,  when  the  head- 
ache is  merely  an  expression  of  some  trivial  nervous  disorder,  a  small 
dose  of  camphor,  with  a  little  opium,  as  in  the  common  paregoric  elixir, 
will  often  operate  happily.  It  is,  however,  in  dysmenorrhcea  that  cam- 
phor has  been  most  used  merely  as  an  anodyne.  To  fulfil  this  indica- 
tion it  must  be  given  in  the  largest  doses. 

Spasmodic  and  other  Nervous  Disorders.  In  the  more  violent  of  the 
painful  spasms,  the  anodyne  and  relaxing  powers  of  camphor,  in  any 
ordinary  dose,  are  quite  inadequate  to  the  results  desired.  It  is  of  little 
use.  therefore,  in  spasm  of  the  stomach,  ureters,  or  bile-ducts,  in  the  se- 
vere forms  of  colic,  in  tetanus,  etc.;  yet  it  has  been  employed,  with  sup- 
posed advantage,  in  the  violent  cramps  attendant  upon  poisoning  by 
strychnia;  and,  in  conjunction  with  opium,  is  occasionally  used  in  epi- 
demic cholera,  and,  in  small  doses,  in  the  diarrhoea  or  cholerine  prelimi- 
nary to  that  disease.  In  the  convulsive  affections  produced  through  the 
cerebral  centres,  it  has  sometimes  been  employed  with  great  asserted 
benefit,  particularly  in  puerperal  convulsions ;  but,  having  no  personal 
experience  of  it  in  this  affection,  I  do  not  feel  at  liberty  to  recommend 
it.  It  has  been  used  also  in  epilepsy,  chorea,  and  hysterical  convulsions 
with  occasional  advantage ;  but  cannot  be  depended  on  for  more  than 
temporary  relief,  and  often  fails  to  produce  that.  In  pertussis,  and  other 
instances  of  spasmodic  cough,  it  may  be  given  as  an  adjuvant  to  more 
efficient  medicines  ;  but  is  little  used.  In  the  cough  attendant  upon  in- 
flammatory affections  of  the  chest,  in  their  advanced  stages  and  chronic 
forms,  it  may  sometimes  be  usefully  associated  with  expectorants,  when 
opium  may  be  contraindicated,  or  in  connection  with  that  narcotic.  In 
the  form  of  camphorated  tincture  of  opium,  it  very  often  enters  into  cough 
mixtures  under  the  circumstances  mentioned;  but,  in  this  form,  should 
not  be  employed  in  the  earlier  stages.  In  the  various  slighter  nervous 
disorders  of  hysteria,  of  the  puerperal  slate,  of  hypochondriasis,  of 
feeble  paralytic  c.:se?.  and  of  chronic  debility  in  general,  it  may  be  used 


70 1  GENERAL    STIMULANTS.  [PART  II. 

with  occasional  benefit,  in  small  doses,  as  a  nervous  stimulant,  either 
alone,  or  associated  with  other  medicines. 

It  has  been  much  used  by  some  practitioners  in  insanity  to  produce 
sleep  and  quiet  irritation ;  and  may  be  considered  as  indicated  in  that  com- 
plaint under  similar  circumstances  with  opium,  to  which,  however,  it  is 
greatly  inferior.  It  has  been  particularly  recommended  in  melancholy. 
In  occasional  attacks  of  apparently  causeless  mental  depression,  it  some- 
times acts  very  happily. 

From  its  stimulant  influence  on  the  nervous  centres,  it  has  been  used 
in  cases  of  amaurosis,  of  a  purely  functional  character,  with  asserted 
success ;  but  it  has,  under  these  circumstances,  generally  been  prescribed 
with  other  medicines,  such  as  valerian,  arnica,  etc. 

It  has  been  used  in  delirium  tremens  to  aid  in  procuring  sleep,  as  well 
as  in  quieting  the  varied  nervous  disorders  of  that  affection ;  but,  if  used 
at  all,  it  should  be  merely  as  an  adjuvant  of  opium,  or  in  conjunction 
with  other  narcotics  when  opium  cannpt  be  used. 

One  of  the  applications  of  camphor  about  which  there  has  been  the 
greatest  difference  of  opinion,  is  to  the  alleviation  of  irritations  of  the 
urino-genital  apparatus.  The  testimony,  however,  in  favour  of  its  occa- 
sional efficiency  in  morbid  sexual  excitement  is  too  strong  to  be  rejected. 
Sometimes  in  small,  and  sometimes  in  large  doses,  it  has  been  given, 
with  at  least  temporary  advantage,  in  cases  of  nymphomania,  priapism, 
and  uncontrollable  venereal  propensities  exhibited  in  other  forms.  Alone, 
or  associated  with  lactucariurn  or  lupulin,  it  may  always  be  given  in 
such  affections  with  hope  of  benefit. 

Many  employ  it  habitually  to  prevent  or  relieve  strangury  from  Span- 
ish flies  used  for  blistering.  For  this  purpose  it  is  sprinkled  on  the  sur- 
face of  the  plaster  before  application,  and  is  given  internally  to  relieve 
the  affection  when  produced.  I  have  never,  however,  found  any  very 
satisfactory  influence  from  it,  in  the  doses  in  which  I  have  been  willing 
to  employ  it;  but  have  no  doubt  that,  in  large  doses,  whether  by  the 
mouth  or  rectum,  it  would  sometimes  have  the  desired  effect;  but  the 
relief  obtained,  under  such  circumstances,  by  an  anodyne  enema  of  lauda- 
num is  so  prompt  and  certain,  that  I  have  seldom  thought  it  worth 
while  to  resort  to  less  efficient  means. 

Camphor  has  also  been  employed  in  the  retrocession  of  cutaneous 
eruptions,  in  order  to  relieve  internal  irritation  by  its  calming  influence, 
and  to  favour  the  return  of  the  eruption  by  its  diaphoretic  action. 

Contraindications.  It  is  scarcely  necessary  to  repeat  that  camphor 
should  not  be  given  during  the  existence  of  active  vascular  irritation, 
congestion,  or  inflammation  of  the  brain,  nor  in  high  febrile  excitement 
with  a  strong  pulse  and  sthenic  state  of  system ;  and  that,  in  any  case 
presenting  these  conditions,  whatever  otherwise  may  be  the  indication 
for  its  use,  they  should  be  subdued  before  it  can  with  propriety  be  pre- 
scribed. Nor  should  it  be  administered  when  the  stomach  is  inflamed. 


CHAP.  I.]       CEREBRAL  STIMULANTS. — CAMPHOR.  705 

Local  Use  of  Camphor.  Few  medicines  are  more  frequently  employed 
topically  than  camphor.  In  the  form  of  vapour,  it  is  sometimes  inhaled 
in  aslhma,  spasmodic  coughs,  and  chronic  catarrh al  affections;  and 
there  is  no  doubt  that  its  constitutional  impression  may  be  obtained  in 
the  same  way.  It  may  be  applied  by  means  of  an  ordinary  inhaler, 
placed  in  water  more  or  less  heated  to  favour  the  volatilization  of  the 
camphor.  M.  Raspail  recommends  that  a  small  tube,  a  quill  for  example, 
should  be  filled  with  the  coarsely  powdered  medicine,  and  loosely  closed 
at  each  end  so  as  to  admit  the  passage  of  air,  and  that  this  should  be 
used  in  the  same  manner  as  a  cigar,  but  without  burning.  In  the  inha- 
lation of  camphor,  care  must  be  taken  to  arrest  the  process,  when  signs 
are  exhibited  of  its  acting  on  the  brain. 

Another  mode  of  using  the  vapours  of  camphor  is  in  the  form  of  a 
vapour  bath.  For  this  purpose  the  patient  may  be  seated  naked  on  a 
stool,  and  covered  with  a  blanket  closely  applied  about  his  neck,  and 
hanging  down  around  him  upon  the  floor.  A  plate  of  heated  metal, 
holding  half  an  ounce  of  camphor,  should  then  be  placed  underneath  the 
blanket,  so  that  the  vapours  may  completely  surround  the  body.  A 
similar  arrangement  may  be  made,  by  means  of  crossed  hoops  and  the 
bedclothes,  about  the  patient  in  bed,  if  unable  to  rise.  The  vapour 
thus  applied  is  highly  recommended  by  M.  Dupasquier,  in  'chronic 
rheumatism. 

A  piece  of  camphor  held  before  the  nostrils,  so  that  its  vapour  may 
be  snuffed  up  into  the  nasal  passages,  is  sometimes  beneficial  in  coryza. 
Powdered  camphor  has  been  recommended  to  be  used  in  the  same  way, 
and  for  the  same  purpose,  as  well  as  for  the  relief  of  various  spasmodic 
and  catarrhal  affections  of  the  air-passages. 

Dissolved  in  different  liquids,  camphor  is  injected  into  the  urethra, 
vagina,  and  rectum,  for  the  purpose  of  relieving  irritations  of  those  pas- 
sages, and  is  very  much  used  as  an  application  to  the  surface,  chiefly 
with  a  view  to  its  anodyne  effect,  in  various  painful  affections,  as  gout, 
rheumatism,  neuralgic  pains,  sprains,  bruises,  chilblains,  etc.  It  is 
also  used  as  a  stimulant  to  gangrenous,  flabby,  and  indolent  ulcers. 

In  the  solid  state,  also,  camphor  is  sometimes  employed  externally. 
Allusion  has  already  been  made  to  the  use  of  the  powder  in  the  form  of 
snuff,  for  which  purpose  it  should  be  made  very  fine.  In  a  similar  state, 
it  may  be  applied  in  cataplasms  to  painful  parts;  and  half  a  drachm  of 
it,  thus  applied  to  the  perineum,  will  sometimes  relieve  the  chordee  at- 
tendant on  gonorrhoea. 

ADMINISTRATION. — Camphor  may  be  used  in  pill  or  emulsion,  but  the 
latter  form  is  greatly  to  be  preferred ;  as,  in  the  former,  it  is  more  apt  to 
irritate  the  stomach,  probably  by  floating  upon  the  gastric  liquids,  and 
thus  coming  in  a  concentrated  state  into  contact  with  the  mucous  coat. ' 
The  emulsion  may  be  made  by  first  pulverizing  the  camphor  with  a  few 
VOL.  i. — 45 


706  GENERAL   STIMULANTS.  [PART  II. 

drops  of  alcohol,  and  then  rubbing  it  up  with  powdered  gum  arable,  loaf- 
sugar,  and  water,  to  which  a  little  myrrh  may  be  added,  in  order  to 
favour  the  suspension  of  the  camphor.  Another  mode  of  preparing  the 
emulsion  is  first  to  dissolve  the  camphor  in  a  little  chloroform  (see  Chlo- 
roform), and  then  to  incorporate  the  solution,  by  means  of  the  yolk  of 
an  egg,  with  water.  The  medicine  may  also  be  given  suspended  in 
milk  ;  but  an  objection  to  this  is  its  liability  to  undergo  change  in  a  short 
time.  The  officinal  aqueous  solution,  and  the  tincture,  are  convenient 
forms  for  administration. 

The  dose  of  camphor  varies  from  one  to  twenty  grains.  As  a  simple 
nervous  stimulant,  it  may  be  given  in  the  dose  of  from  one  to  three 
grains,  repeated  every  hour  or  two,  if  required.  For  its  full  effect  as  a 
cerebral  stimulant,  or  indirect  sedative,  the  medium  dose  is  from  five  to 
fifteen  grains.  When  a  powerful  effect  is  required,  as  in  certain  painful 
neuralgic  or  spasmodic  affections,  the  dose  may  be  increased  to  a  scruple. 
By  enema,  it  may  be  given  in  twice  or  three  times  these  quantities. 

The  following  preparations  of  camphor  are  officinal. 

1.  CAMPHOR  WATER — AQUA  CAMPHORS.  U.  S.,  Br. 

This  is  made,  according  to  the  U.  S.  Pharmacopeia,  by  rubbing  two 
drachmp  of  camphor,  first  with  forty  minims  of  alcohol,  afterwards  with 
four  drachms  of  carbonate  of  magnesia,  and  lastly  with  two  pints  of  dis- 
tilled water,  and  then  filtering.  The  camphor  is  thus  dissolved  in  water 
much  more  largely  than  by  simple  agitation.  The  carbonate  of  mag- 
nesia merely  serves  the  purpose  of  dividing  its  particles  minutely.  Each 
fluidounce  of  the  preparation,  when  well  made,  contains  about  three 
grains  of  camphor.  The  British  preparation,  which  is  made  by  exposing 
camphor,  enclosed  in  a  muslin  bag,  to  the  solvent  power  of  water  in  a 
jar,  is  much  feebler,  and  probably  never  used  with  us.  Camphor  water 
is  an  elegant  preparation  for  obtaining  the  slighter  effects  of  camphor 
as  a  nervous  stimulant,  in  the  nervous  disorders  of  febrile  diseases,  slight 
hysterical  affections,  uterine  after-pains,  etc.  It  also  frequently  serves 
as  a  good  vehicle  of  other  medicines  in  bowel  complaints,  especially  of 
nitric  and  nitromuriatic  acids.  It  is  not  adapted  for  obtaining  the  more 
powerful  effects  of  camphor.  The  dose  of  it  is  one  or  two  tablespoon- 
fuls  every  hour  or  two.  It  was  a  favourite  application  of  Scudamoiv  in 
acute  gout,  mixed  with  alcohol,  in  the  proportion  of  three  parts  of  the 
former  to  one  of  the  latter.  The  mixture  was  applied  to  the  inflamed 
joint  on  linen  compresses  of  six  or  eight  folds,  or  by  means  of  bread  poul- 
tices saturated  with  it, 

2.  SPIRIT  OF  CAMPHOR.  _  SPIRITUS  CAMI-HOINE.  U.  S.,  Br.— 
TINCTURA  CAMPHOH.K   U.  S.  1850.  —  Tincture  of  Camphor. 

This  is  simply  a  solution  of  camphor  in  officinal  alcohol.  A  fluid rachm 
of  it  contains  seven  and  a  half  grains.  It  is  diidly  used  externally,  a- 


CHAP.  I.]  CEREBRAL    STIMULANTS. — CAMPHOR.  707 

an  anodyne  embrocation  in  rheumatic  and  gouty  pains,  chilblains,  sprains, 
bruises,  etc.  I  have  sometimes  used  it  mixed  with  five  or  six  parts  of 
milk,  and  applied  on  linen  compresses,  as  an  anodyne  and  emollient  in 
acute  gout.  It  is  also  frequently  employed  in  nervous  disorders,  as 
lassitude,  faintness,  and  slight  hysterical  affections,  applied  to  the  forehead, 
cheeks,  etc.,  and  held  to  the  nostrils,  so  that  its  vapour  may  be  inhaled. 
The  tincture  may  also  be  used  internally,  whenever  the  alcoholic  vehicle 
may  not  be  contraindicated.  The  camphor  is  precipitated  by  water,  but 
may  be  held  in  suspension  by  sugar  or  gum.  The  dose  is  from  ten  drops 
to  a  fluidrachm.  first  dropped  upon  loaf-sugar,  and  then  mixed  with  water. 

3.  CAMPHOR  LINIMENT.  — LIXIMENTUM  CAMPHOR*.  U.  S.,  Br. 
This  is  a  solution  of  camphor  in  olive  oil,  half  an  ounce  of  the  former 

being  employed  to  two  fluidounces  of  the  latter.  It  is  used  locally  for 
the  same  purposes  as  the  spirit,  and  as  a  discutient  application  to  gland- 
ular swellings.  It  may  also  be  used  as  an  injection  into  the  rectum  in 
the  tenesmus  of  ascarides  and  dysentery,  and  into  the  urethra  for  the  re- 
lief of  the  ardor  urinje  of  gonorrhoea.  As  an  enema,  not  more  than  one 
or  two  fluidrachms  of  it  should  be  thrown  into  the  rectum  at  once,  diluted 
with  from  two  to  four  fluidounces  of  olive  oil ;  and  a  preparation  of  the 
same  strength  may  be  used  for  the  urethra. 

The  British  Pharmacopoeia  directs  a  Compound  Camphor  Liniment 
(LiMMENTUM  CAMPHORS:  COMPOSITUM,)  consisting  of  camphor,  solution 
of  ammonia,  and  spirit  of  lavender  ;  but  such  mixtures  might  well  be  left 
to  extemporaneous  prescription.  It  is  in  fact  a  spirit  of  camphor,  ren- 
dered more  stimulating  by  the  ammonia,  and  intended,  therefore,  to  act 
both  as  a  rubefacient  and  anodyne.  It  is  employed  externally  for  the 
same  purposes  as  the  tincture. 

4.  CAMPHORATED  TINCTURE  OP  OPIUM TINCTURA  OPII 

CAMPIIOUATA.  U.  S. — Paregoric. 

This  tincture  will  be  treated  of  among  the  preparations  of  opium,  to 
which  the  reader  is  referred. 

5.  SOAP  LINIMENT.  _LINIME\TUM  SAPONIS.  U.  S.,Rr.—  TINC- 
TURA SAPONIS  CAMPHORATA.  U.  S.  1850.  —  Camphorated   Tincture  of 
Soap. 

This  consists  of  Castile  soap,  camphor,  and  oil  of  rosemary,  dissolved 
in  alcohol  diluted  with  one-eighth  of  its  measure  of  water.  It  is  a  clear 
liquid,  and  is  very  much  used  as  an  anodyne  and  gently  rubefacient  lini- 
ment, in  all  the  outward  pains  for  which  camphor  is  locally  employed. 
(See  pages  704-5.)  To  render  it  more  anodyne,  it  may  be  mixed  with 
an  equal  measure  of  laudanum,  constituting  the  Anodyne  Liniment  or 
LINIMEXTUM  OPII  of  the  British  Pharmacopoeia;  and,  if  stronger  rubefa- 
cient properties  are  required,  stronger  solution  of  ammonia  may  be  in- 
corporated with  it  in  the  proportion  of  one-fourth  by  measure.  The  latter 


708  GENERAL    STIMULANTS.  [PART  II. 

preparation  may  be  used  as  an  effective  rubefacient  in  pectoral  inflam- 
mation, angina,  laryngitis,  and  tonsillitis. 

6.  CAMPHORATED  SOAP  LINIMENT.  — LINTMEXTUM  SAPO- 
NIS  CAMPIIORATUM.  U.  S.  1850.  — Opodeldoc. 

The  camphorated  soap  liniment  is  essentially  the  same  as  the  soap 
liniment  just  described,  differing  in  the  kind  of  soap  employed,  which  in 
this  preparation  is  the  common  white  soap,  made  with  animal  fat,  in- 
stead of  the  Castile  soap,  made  with  olive  oil.  The  effect  of  the  substitu- 
tion is  that  the  liniment  is  obtained  of  the  consistence  of  a  jelly,  in  con- 
sequence of  the  hot  alcoholic  solution  of  common  soap  gelatinizing  when 
it  cools.  It  is  usually  sold  in  broad-mouthed  bottles,  containing  about 
four  fluidounces.  Though  of  the  consistence  of  a  soft  solid  at  ordinary 
temperatures.  it  assumes  the  liquid  state  when  applied  to  the  surface  of 
the  body.  It  is  much  used  popularly,  under  the  name  of  opodeldoc,  in 
rheumatic  pains,  bruises,  sprains,  etc.  It  was,  however,  discarded  from 
the  U.  S.  Pharmacopoeia  at  the  late  revision. 


V.  OPIUM.  U.S.,Br. 

This  is  a  concrete  juice  obtained  by  incisions  in  the  unripe  capsules 
of  Papaver  somniferum,  or  the  poppy,  an  annual  plant,  inhabiting  Asia, 
in  different  parts  of  which,  as  well  as  in  Egypt,  it  is  abundantly  culti- 
vated for  the  sake  of  the  opium  which  it  yields.  There  are  two  varie- 
ties of  the  plant,  the  white  and  black,  both  of  which  afford  opium ;  but 
it  is  said  Jo  be  chiefly  procured  from  the  former.  (See  Poppy  Cap- 
sules.) The  juice,  when  collected,  is  put  into  convenient  receptacles, 
and,  after  concreting  into  a  proper  consistence,  is  made  up,  either  with 
or  without  addition,  into  masses  of  different  shape,  usually  surrounded 
with  leaves  to  prevent  their  adhering  together,  and  then  sent  into  market. 

Commerce  is  supplied  with  opium  chiefly  from  Hindostan,  Anatolia  or 
Asia  Minor,  and  Egypt.  It  is  produced  also  in  Persia;  but  little  or  none 
is  exported.  The  opium  of  Hindostan  is  either  consumed  in  India,  or 
sent  to  China,  and  reaches  Europe  and  this  country  only  as  an  object  of 
curiosity.  It  is  the  product  of  the  Asiatic  dominions  of  Turkey,  and 
that  of  Egypt,  with  which  the  western  world  is  supplied.  The  opium 
consumed  in  the  United  States  is  chiefly  the  variety  produced  in  Anato- 
lia, and  introduced  into  commerce  through  the  ports  of  Smyrna  and 
Constantinople.  It  is  called  Turkey  opium,  and  is  usually  distinguished 
into  two  varieties,  the  Smyrna  and  Constantinople  opium,  so  named 
from  the  ports  from  which  they  are  respectively  distributed.  Of  these, 
the  Smyrna  opium  is  the  one  most  largely  consumed  in  this  country. 
Some  Egyptian  opium  is  occasionally  imported  ;  but  is  seldom  kept  in 
the  shops. 


CHAP.  I.]  CEREBRAL   STIMULANTS. — OPIUM.  709 


1.  Varieties  of  Opium. 

The  only  varieties  which  it  is  necessary  to  notice  are,  first,  the  Tur- 
key opium,  including  the  Smyrna  and  Constantinople,  and,  secondly,  the 
Egyptian. 

1.  TURKEY  OPIUM.  — This  comes  in  masses  of  irregular  size  and  shape, 
from  half  a  pound  to  two  and  a  half  pounds  in  weight,  originally  prob- 
ably spherical,  but  usually  flattened,  or  irregularly  angular,  in  conse- 
quence of  the  pressure  to  which  they  are  subjected,  while  yet  soft,  in 
the  cases  containing  them.  On  their  outer  surface  are  the  remains  of 
the  leaves  in  which  they  were  originally  enveloped  ;  and  adhering  to  it, 
in  greater  or  less  number,  the  light  reddish-brown  capsules  of  a  species 
of  Rumex,  added,  no  doubt,  with  the  object  of  absorbing  moisture,  and 
preventing  the  adhesion  of  the  lumps.  These  are  usually,  as  first  im- 
ported, soft  and  tenacious  in  the  interior,  but  hard  upon  the  surface. 
When  completely  dried  by  time  and  exposure,  they  are  brittle,  and  have 
a  somewhat  shining  though  uneven  fracture. 

a.  Smyrna  Opium.   Of  the  two  varieties  of  Turkey  opium,  the  Smyrna 
is  most  largely  imported.     It  is,  indeed,  almost  the  only  variety  kept  in 
our  retail  shops.     Besides  the  characters  above  mentioned,  it  has  the 
peculiarity,    when    cut    into,    and   then   torn,    of   exhibiting  numerous 
minute  shining  tears,  very  obvious  under  the  microscope,  which  some- 
what resemble  small  seeds,  and  are  no  doubt  the  concrete  drops  of  juice 
formed  on  the  capsules,  upon  exudation,  after  these  have  been  incised. 
Along  with  the  tears  are  numerous  minute  pieces  of  the  outer  covering 
of  the  capsule  itself,  scraped  off  with  the  juice.  The  best  Smyrna  opium 
consists  of  these  ingredients  exclusively ;    but   inferior  specimens   are 
often  sent  into  market,  variously  and  in  different  degrees  adulterated, 
and  frequently  so  much  so  as  to  unfit  them  for  use  in  the  shops.     The 
adulterating  matt-rials  are  an  extract  made  from  the  leaves,  grapes  freed 
from  their  seeds  and  crushed,  different  gummy  matters,  liquorice,  minute 
stones  or  pieces  of  metal,  etc.    Different  samples  of  Smyrna  opium  vary 
in  the  quantity  of  morphia  they  contain  from  3  to   13  per  cent.     The 
better  kinds  ought  t»  yield  at  least  8  per  cent,  to  a  careful  analysis. 
Good  Smyrna  opium  is  of  a  light  reddish-brown  colour  in  the  interior. 
"When  blackish,  of  a  weak  empyreumatic  odour,  a  sweetish  taste,  a  viscid 
or  greasy  consistence,  an  entirely  dull  fracture  when  dry,  or  containing 
obvious  impurities,  it  should  be  regarded  as  inferior.    If  wholly  without 
the  Rumex  capsules,  or  very  scantily  supplied  with  them,  it  may  be 
looked  on  suspiciously,  as  probably  of  the  kind  which  is  said  to  be  "made 
over  again  "  in  some  of  the  Mediterranean  ports. 

b.  Constantinople  Opium.   This,  so  far  as  it  is  a  distinct  variety,  is 
characterized  by  the  entire  want  of  the  tears  which  distinguish  the  gen- 


710  GENERAL    STIMULANTS.  [PART  II. 

nine  Smyrna  opium.  But  the  drug  brought  from  Constantinople  has 
probably  been  taken  thither  from  all  the  different  parts  of  the  Turkish 
dominions  where  it  is  produced :  and  it  is  not,  therefore,  a  matter  of 
surprise  that,  under  this  name,  Smyrna  and  Egyptian  opium  should 
have  found  their  way  into  commerce. 

•2.  EGYPTIAN  OPIUM. — This  is  in  flat,  roundish  cakes,  of  different 
sizes,  from  half  an  ounce  to  a  pound  in  weight,  and  often  either  wrapped 
in  a  poppy  leaf,  or  presenting  vestiges  of  the  leaf,  so  applied  that  the 
midrib  divides  the  cake  into  two  equal  parts.  It  has  none  of  the  Kumex 
capsules,  and  is  always  hard  and  brittle,  breaking  with  a  smooth  frac- 
ture of  a  waxy  lustre.  It  has  usually  much  less  morphia  than  good 
Smyrna  opium,  and  should  not  be  kept  for  use  in  the  shops. 

It  is  important  that  only  good  opium,  of  a  strength  at  least  approach- 
ing to  uniformity,  should  be  kept  for  internal  use,  or  for  making  those 
preparations,  the  strength  of  which  depends  on  that  of  the  opium  u.-e<l; 
otherwise  it  wrould  be  impossible  to  have  any  fixed  dose  of  this  most  im- 
portant medicine,  or  to  prescribe  it  with  any  certainty  of  obtaining  its 
peculiar  effects  in  the  degree  desired.  The  inferior  kinds,  should  they 
be  admitted  into  the  country,  ought  to  be  employed  exclusively  by  the 
manufacturers  in  the  preparation  of  morphia  or  the  other  alkaloids. 


2.  Properties  of  Opium  in  General. 

Good  opium  is  of  a  reddish-brown  or  deep-fawn  colour  in  mass,  and 
when  dry  yields  a  yellowish-brown  powder,  which  becomes  adhesive  at 
a  slight  elevation  of  temperature.  When  drawn  over  paper,  it  leave:-  an 
interrupted  trace  of  a  light-brown  colour.  Its  odour  is  strong,  narcotic, 
and  peculiar;  its  taste  bitter,  somewhat  acrid,  and  nauseous.  When  long 
chewed  it  irritates  the  mouth,  and  may  even  vesicate.  It  is  inflamma- 
ble. Water,  alcohol,  and  the  diluted  acids  extract  its  virtues,  which, 
however,  it  will  not  yield  to  ether.  The  liquids  impregnated  with  it 
have  a  deep-brown  colour. 

Composition.  Besides  several  principles  found  in  other  vegetable  pro- 
ducts, as  gummy  and  extractive  matter,  resin,  a  ^ubstance  resembling 
caoutchouc,  fixed  oil,  albumen,  and  various  mineral  substances  in  very 
small  proportion,  opium  contains  morphia,  narcotina,  codeia,  narcein 
or  narceia,  thebaina  or  paramorphia,  papaverina,  and  opiania,  hav- 
ing alkaline  properties,  meconin,  and  porphyroarin,  which  are  neuter,  an 
acid  denominated  meconic  acid,  and  a  characteristic  odorous  principle. 
all  of  which  are  peculiar  to  opium.  Morphia  exists  in  it  combined  with 
meconic  acid,  and  probably  in  small  proportions  with  sulphuric  acid. 
Of  these  principles  the  only  one  hitherto  much  employed  in  medicine  is 
morphia.  Narcotina,  codeia,  and  narceia  have  been  recommended 


CHAP.  I.]  CEREBRAL    STIMULANTS. — OPIUM.  711 

for  special  purposes.  Of  the  remainder,  though  some  of  them  may  be 
and  probably  are  efficient  in  their  action  on  the  system,  so  little  is  posi- 
tively known,  that  it  will  not  be  worth  while  to  burden  the  memory  of 
the  reader  with  an  account  of  their  properties.  The  four  particularly 
mentioned  will  be  sufficiently  described  among  the  preparations  of 
opium. 

Incompatibles.  Many  substances  produce  precipitates  with  opium, 
which,  as  they  do  not  affect  its  active  principles,  are  not  medically  in- 
compatible, so  far  as  the  opium  itself  is  concerned.  With  the  infusion, 
the  alkalies  throw  down  its  alkaloids,  and  the  astringents  containing 
gallo-tannic  acid,  as  well  as  kino,  catechu,  and  rhatany,  precipitate  insol- 
uble tannates  of  the  same  alkaloids;  but  alcohol,  inconsiderable  propor- 
tion, or  an  excess  of  acid,  will  redissolve  the  precipitate  in  both  in- 
stances. Tincture  of  galls,  notwithstanding  the  alcohol  it  contains, 
throws  down  a  copious  precipitate. 

Tests  of  Opium.  An  infusion  of  opium  reddens  litmus  paper,  becomes 
turbid  with  solution  of  ammonia,  assumes  a  deep-red  colour  on  the 
addition  of  sesquichloride  of  iron  in  consequence  of  the  formation  of 
meconate  of  iron,  is  reddened  by  nitric  acid,  and  is  copiously  precipi- 
tated by  infusion  of  galls.  But  the  only  satisfactory  test  of  its  value  is 
the  proportion  of  morphia  contained  in  it.  Good  opium,  treated  as 
directed  in  the  U.  S.  Pharmacopoeia  for  the  preparation  of  morphia, 
should  afford  from  10  to  12  per  cent,  of  the  impure  morphia  precipi- 
tated from  its  infusion  by  a  mixture  of  alcohol  and  solution  of  ammo- 
nia; and  ether  should  not  dissolve  more  than  from  2  to  4  parts  of  this 
impure  product. 

3.  Effects  upon  the  System. 

It  may  be  said  of  opium,  in  general  terras,  that,  being  at  first  moder- 
ately stimulant  to  the  parts  to  which  it  may  be  applied,  and  to  the  cir- 
culation, and  energetically  so  to  the  nervous  system  generally,  and 
especially  to  the  brain,  it  subsequently  operates  with  even  greater  en- 
ergy and  universality  as  an  apparent  sedative.  But  little  idea  of  the 
real  powers  of  the  medicine  would  be  obtained  from  such  a  definition  of 
its  effects.  In  order  to  form  an  exact  and  profitable  conception  of  its 
influence,  so  far  as  known,  it  is  necessary  to  follow  it  through  the  differ- 
ent functions,  and  trace  its  operation  carefully  in  each,  step  by  step.  Its 
vast  importance,  and  diversified  applicability,  call  for  more  minute  details 
than  are  necessary  or  advisable  in  relation  to  most  other  medicines.  I 
shall  consider  it  in  relation  first  to  the  nervous  system,  secondly  to  the 
circulatory  and  respiratory  systems,  thirdly  to  other  functions  or  organs, 
and  fourthly  to  the  part  with  which  it  may  be  directly  brought  into 
contact. 


712  GENERAL   STIMULANTS.  [PART  II. 

1.  Action  -upon  the.  Nervous  System.  From  a  full  dose  of  opium,  taken 
internally,  no  other  immediate  effect  is  experienced  than  a  slight  feeling 
of  warmth,  or  perhaps  of  weight  in  the  stomach.  But  in  a  short  time, 
varying  somewhat  according  to  the  form  in  which  the  medicine  is  used, 
and  the  state  of  the  stomach,  but  seldom  exceeding  ten  or  fifteen  min- 
utes, and  often  much  less,  a  sensation  of  fulness  is  felt  in  the  head,  soon 
followed  by  a  universal  feeling  of  delicious  ease  and  comfort,  with  an 
elevation  and  expansion  of  the  whole  moral  and  intellectual  nature, 
which  is,  I  think,  among  the  most  characteristic  of  its  effects.  There  is 
not  the  same  uncontrollable  excitement  as  from  alcohol,  but  an  exalta- 
tion of  our  better  mental  qualities,  a  warmer  glow  of  benevolence,  a  dis- 
position to  do  great  things,  but  nobly  and  beneficently,  a  higher  devo- 
tional spirit,  and  withal  a  stronger  self-reliance,  and  consciousness  of 
power.  Nor  is  this  consciousness  altogether  mistaken.  For  the  intel- 
lectual and  imaginative  faculties  are  raised  to  the  highest  point  compati- 
ble with  the  individual  capacit}r.  The  poet  never  has  brighter  fancies, 
or  deeper  feelings,  or  greater  felicity  of  expression,  nor  the  philosopher 
a  more  penetrating  or  profounder  insight,  than  when  under  the  influence 
of  opium  in  this  stage  of  its  action.  It  seems  to  make  of  the  individual. 
for  the  time,  a  better  and  a  greater  man.  Sometimes  there  may  be  de- 
lusion; but  it  is  not  so  much  in  relation  to  the  due  succession  or  depend- 
ence of  thought,  as  in  the  elevation  of  the  imagination  and  the.  soul 
above  the  level  of  reality.  The  hallucinations,  the  wildness,  the  deli- 
rious imaginations  of  alcoholic  intoxication,  are,  in  general,  quite  wanting. 
Along  with  this  emotional  and  intellectual  elevation,  there  is  also  in- 
creased muscular  energy;  and  the  capacity  to  act,  and  to  bear  fatigue,  is 
gn-atly  augmented. 

If  the  quantity  of  opium  taken  has  been  just  insufficient  to  induce  sleep, 
this  delightful  exaltation  may  continue  for  hours,  supporting  the  mind 
and  body  under  an  amount  of  exertion,  to  which  they  would  be  wholly 
inadequate  in  their  ordinary  condition. 

In  two  remarkable  points,  besides  thflse  mentioned,  the  operation  of 
opium  differs  from  that  of  alcohol;  in  the  absence,  namely,  of  that  erotic 
excitement,  and  that  incapacity  of  combined  muscular  movement  for 
a  given  purpose,  which  are  so  strongly  characteristic  of  alcoholic 
stimulation. 

With  the  psychological  phenomena  above  mentioned,  there  is  very 
frequently  a  roaring,  singing,  or  buzzing  in  the  head,  of  which  there  is 
scarcely  a  consciousness,  unless  the  attention  is  specially  directed  towards 
it.  Sometimes  these  noises,  combined  with  throbhings  or  tlminpinirs  in 
the  brain,  are  somewhat  disagreeable;  but  they  are  seldom  sufficiently  so 
to  call  back  the  mind  from  its  higher  flights,  or  the  spirit  from  it>  keen 
enjoyments. 

After  a  length  of  time  varying,  according  to  the  dose  of  the  drug  and 


CHAP.  I.]  CEKEB11AL    STIMULANTS.^ — OPIUM.  713 

the  susceptibility  of  the  individual,  from  half  an  hour,  to  two,  three,  or  four 
hours,  or  even  longer,  this  exaltation  sinks  into  a  corporeal  and  mental 
calmness,  which  is  scarcely  less  delicious  than  the  previous  excitement, 
and  in  a  short  time  ends  in  sleep.  Perhaps,  in  most  instances,  where  a 
full  dose  has  been  taken,  this  result  occurs  within  an  hour.  But,  when 
the  quantity  of  opium  is  insufficient  for  this  effect,  the  individual  will 
remain  awake  for  hours,  sometimes  for  many  hours,  even  for  the  whole 
flight,  supposing  the  drug  to  have  been  given  at  bedtime,  lying  calmly 
and  placidly,  without  mental  effort  or  uneasiness,  and  submitting  himself 
to  a  current  of  vague,  but  generally  pleasing  fancies. 

Should  the  dose  be  sufficient  only  to  induce  a  light  sleep,  there  will  be 
a  constant  succession  of  dreams,  having  the  vividness  almost  of  reality, 
usually  pleasant  in  their  character,  but  sometimes  very  much  the  reverse. 
I  have  repeatedly  known  patients  to  complain  of  excessively  disagree- 
able effects  from  opium,  and  chiefly  of  horrible  dreams  with  which  they 
have  been  tormented  during  the  night,  and  to  declare  that  nothing  would 
ever  induce  them  to  take  the  medicine  again ;  but  I  have  almost  inva- 
riably found,  under  such  circumstances,  that  by  increasing  the  dose  on  a 
subsequent  occasion,  or  by  giving  an  additional  quantity  when  such 
symptoms  may  have  presented  themselves,  that  sound  sleep  is  induced, 
and  all  discomfort  vanishes.  So  real  do  these  dreams  appear,  and  so 
much  like  waking  thoughts,  that  patients  will  often  assert  that  they  have 
not  closed  their  e}7es  all  night,  when  the  fact  is  that  they  have  scarcely 
been  awake  during  that  time. 

The  illusions  of  opium  are  so  strong  that  one  who  uses  the  drug  ha- 
bitually can  sometimes  scarcely  distinguish  them  from  realities;  arid  I 
have  known  intelligent,  well  educated  men,  having  the  ordinary  regard 
for  opinion,  and  perfectly  free  from  any  suspicion  of  insanity,  to  make 
statements,  in  the  presence  of  numbers,  as  to  occurrences  which  were 
known  to  every  one  present  to  be  impossible,  but  were  as  fully  believed 
by  themselves  as  any  other  event  of  ordinary  life  ;  and  I  have  been  able 
to  explain  such  aberrations,  only  upon  the  supposition  that  the  dreams 
produced  by  opium  had  been  mistaken  for  realities.  I  have  no  doubt 
that  perfectly  truthful  persons  have  thus  got  the  credit  of  habitual  men- 
dacity, when  in  fact  their  only  immorality  was  the  habitual  use  of  opium, 
perhaps  to  relieve  sufferings  otherwise  intolerable. 

When  opium  exercises  its  full  soporific  influence,  the  sleep  is  usually 
profound  and  dreamless,  and  continues  for  about  eight  or  ten  hours. 
Should  the  patient  be  awakened  before  the  direct  effect  of  the  medicine 
has  been  exhausted,  the  feelings  of  comfort  or  bienaise  before  expe- 
rienced will  often  continue  for  hours  in  the  following  day  ;  and  I  have 
known  the  same  thing  to  happen  repeatedly  even  after  a  good  night's 
rest.  But  generally,  upon  awaking  from  the  full  uninterrupted  effects  of 
opium,  the  patient  experiences  a  state  of  greater  or  less  depression,  indi- 


714  GENERAL    STIMULANTS.  [PART  II. 

cated  by  languor  and  listlessness,  a  relaxed  .surface,  a  rather  feeble  pulse, 
and  not  unfrequently  loss  of  appetite,  nausea,  and  even  vomiting.  This, 
however,  gradually  passes  away,  and  the  system  returns  to  its  ordinary 
condition,  without  having  experienced  any  appreciable  disadvantage. 

A  remarkable  diminution  of  sensibility  attends  the  narcotic  operation 
of  opium,  beginning  even  before  the  soporific  effect,  and  continuing  in  a 
greater  or  less  degree  throughout  the  direct  action  of  the  medicine,  and 
even  into  the  secondary  stage  of  depression.  It  is  the  general  sensibility, 
or  that  to  painful  impressions,  which  is  first  and  most  prominently  af- 
fected ;  but  the  special  senses  are  in  some  degree  involved,  especially 
under  the  influence  of  very  large  doses ;  though  I  have  met  with  no 
instance,  even  of  opium  poisoning,  in  which,  until  the  advanced  stage 
when  profound  coma  had  set  in,  the  patient  cquld  not  hear  and  see  when 
roused.  In  this  respect  opium  differs  strikingly  from  some  other  narcotic 
medicines,  and  especially  belladonna. 

2.  Action  upon  the  Circulation.  It  was  long  an  undecided  point, 
whether  opium  was  to  be  regarded  as  stimulant  or  sedative.  The  ex- 
periments of  Dr.  Crumpe,  published  in  1793,  decided,  what  any  one 
might  have  determined  for  himself  by  counting  his  own  pulse  under  a 
dose  of  opium,  that,  in  its  first  operation,  it  is  stimulant  at  least  to  the 
circulation.  Within  ten  or  fifteen  minutes  after  its  administration,  the 
pulse  is,  in  general,  moderately  increased  in  frequency,  fulness,  and  force, 
and  at  the  same  time  the  surface  of  the  body  becomes  warmer,  and  the 
face  somewhat  flushed.  When  the  period  of  general  excitement  is  past, 
and  that  of  calmness  or  drowsiness  supervenes,  the  pulse  either  resumes 
its  original  condition  as  to  frequency,  or,  under  a  large  dose  of  the  opium, 
becomes  somewhat  slower,  retaining,  however,  its  fulness  and  for  a  time 
its  force.  In  this  condition  it  continues  for  some  time  during  the  period 
of  sleep ;  but  then  gradually  relaxes,  and  becomes  soft  with  the  relaxing 
surface,  and  in  the  end,  participates  in  the  general  depression  which 
attends  the  cessation  of  the  direct  influence  of  the  medicine. 

With  the  increased  frequency  of  the  pulse,  the  respiration  is  also  some- 
what quickened ;  and,  as  the  former  becomes  slower,  the  latter  undergoes 
a  similar  change,  and  generally  even  in  a  greater  degree.  Under  the  full 
influence  of  opium,  one  of  the  most  striking  phenomena  is  the  relative 
slowness  of  the  breathing,  which,  is  sometimes  even  stertorous,  when  the 
sleep  is  profound. 

Corresponding  with  the  condition  of  the  circulatory  and  respiratory 
movements  is  that  of  the  blood  itself.  Retaining  its  florid  colour  for  a 
time,  it  may  give  a  bright  tint  to  the  complexion  during  the  stage  of  ex- 
citement;  but,  with  the  diminished  influence  from  the  respiratory  cen- 
tres, the  change  from  venous  to  arterial  is  less  thoroughly  effected,  and 
the  blood  becomes  darker-lined.  This  is  not  vn-y  obvious  from  ordinary 
<loses  of  opium  ;  but,  when  it  has  been  very  largely  taken,  the  venous 
hue  upon  the  surface,  and  particularly  in  the  face,  is  often  conspicuous. 


CHAP.  I.]  CEREBRAL   STIMULANTS. — OPIUM.  715 

3.  Action  upon  other  Functions  or  Organs.  Some  other  effects  of 
opium,  which  may  be  considered  as  more  local  than  the  preceding,  are 
yet  very  important  in  a  therapeutical  point  of  view. 

On  the  secretions  its  influence  is  especially  worthy  of  notice.  Most 
of  them  are  diminished  by  it,  perhaps  all  occasionally;  but  some  are  at 
times  promoted,  and  one,  that,  namely,  of  the  surface,  generally  so. 
The  mucous  secretion  is  almost  invariably  diminished.  Hence,  in  part, 
the  remarkable  dryness  of  the  mouth,  nostrils,  and  fauces,  which  char- 
acterizes the  action  of  opium.  The  same  deficiency  probably  exists 
throughout  the  alimentary  canal,  contributing  to  the  thirst  which  is 
among  its  prominent  symptoms.  There  is  often  also  a  feeling  of  dryness 
in  the  conjunctiva  from  the  same  cause.  The  secretion  of  the  salivary 
glands  is  certainly  diminished,  and  probably  that  also  of  the  pancreas. 
The  secretory  function  of  the  liver  is  much  impaired  by  a  continued  use 
of  the  medicine,  as  may  be  known  by  the  light-coloured  passages  from  the 
bowels.  This  I  have  very  often  noticed ;  and  it  is  ooe  of  the  effects 
which  the  physician  will  have  most  frequently  to  counteract.  There  can 
be  little  doubt  that  a  single  dose  produces  a  proportionate  effect.  The 
kidneys  are  variously  affected.  In  the  greater  number  of  instances  their 
secretion  is  diminished,  especially  when  the  patient  is  warm  in  bed ;  but 
I  have  sometimes  known  it  to  be  powerfully  promoted,  particularly  by 
the  salts  of  morphia.  Indeed,  I  have  seen  few  diuretics  act  more  co- 
piously than  this  for  a  short  time ;  and  the  effect  generally  takes  place 
in  the  course  of  the  first  hour  or  two  after  the  administration  of  the 
medicine.  It  is  most  apt  to  occur  when  the  skin  is  kept  cool. 

The  diaphoretic  effects  of  opium  are  well  known.  I  seldom,  however, 
witness  this  effect  when  the  patient  is  walking  about.  When  he  is 
warmly  covered  in  bed,  it  is  extremely  common;  and  sometimes  the  dis- 
charge is  profuse.  It  does  not  usually  come  on  until  the  patient  has 
slept  for  some  time,  and  is  most  copious  towards  the  end  of  the  period 
of  sleep.  It  is  very  common  to  awake  in  the  morning  bathed  in  sweat. 
This  diaphoretic  property  is  greatly  increased  by  the  addition  of  ipecac- 
uanha. 

The  itching  sensation  in  the  skin  which  opium  is  apt  to  produce  may 
be  referred  to  in  this  connection.  It  is  sometimes  attended  with  prick- 
ling, and  may  occur  in  any  part  of  the  body.  It  is  often  very  annoying 
to  the  patient,  and  may  even  prevent  sleep.  In  some  instances,  it  is 
attended  with  a  miliary,  erythematous,  or  ur/icarious  eruption;  but  this 
effect  is  relatively  rare;  at  least  I  have  seldom  noticed  it. 

The  stomach  may  be  at  first  moderately  excited  by  opium ;  but  the 
effect  soon  ceases,  and  is  followed  by  a  marked  diminution  of  its  func- 
tion. The  appetite  is  diminished,  and  the  digestion  impaired.  These 
effects  may  be  ascribed  perhaps  in  part  to  a  diminution  of  the  secretion 
of  gastric  juice  and  mucus ;  but  are  probably  mainly  dependent  on  a  want 


716  GENERAL    STIMULANTS.  [PART  II. 

of  the  accustomed  influence  from  the  nervous  centres,  and  the  dimin- 
ished call  for  food  from  the  nutritive  function. 

The  bowels  are  generally  constipated.  This  is  among  the  most  con- 
stant effects  of  opium,  though  it  is  not  invariable.  It  probably  depends 
on  different  causes,  among  which  may  be  mentioned  the  diminished  se- 
cretion of  bile,  of  pancreatic  liquor,  and  of  mucus,  and  the  diminished 
supply  of  chyme  from  the  stomach ;  but  the  chief  cause  is  probably  a 
deficiency  of  influence  from  the  organic  nervous  centres,  through  which 
the  muscular  coat  becomes  enfeebled,  and,  as  it  were,  partially  paralyzed. 

The  activity  of  the  nutritive  process  is  much  diminished  ;  arid  conse- 
quently less  food  is  required.  This  is  much  more  obvious  from  the 
habitual  use  of  opium,  than  from  a  single  dose  ;  but  there  can  be  no 
doubt  that  the  latter  produces  the  same  effect  in  a  proportionate  degree. 
It  does  not  follow  that  emaciation  must  take  place.  On  the  contrary, 
the  body  often  retains  its  weight,  and  sometimes  even  gains  under  the 
continued  use  of  the  drug,  if  not  taken  in  great  excess.  This  is  explained 
by  the  consideration,  that  the  normal  disintegration  of  the  tissues  is 
diminished  equally  with  nutrition,  and  even  in  a  greater  degree. 

Not  only  the  voluntary  muscles,  and  those  of  the  alimentary  canal, 
suffer  a  diminution  of  their  power  in  the  second  stage  of  the  action  of 
opium,  but  those  of  the  bladder  also,  so  that  there  is  occasionally  some 
difficulty  in  passing  the  urine  from  this  cause;  but  the  effect  is  seldom 
obvious,  unless  from  very  large  doses. 

4.  Action  on  the  Part  to  which  the  Opium  may  be  Applied.  To  what- 
ever part  opium  may  be  applied,  if  vital,  it  is  capable  of  producing  its 
general  effects.     Injected  into  the  rectum,  or  sprinkled  upon  the  skin 
deprived  of  the  epidermis,  it  operates  with  almost  as  much  certainty  as 
when  swallowed.     In  the  lower  animals,  when  introduced  into  the  cel- 
lular tissue,  it  acts  with  great  energy;  in  the  peritoneal  cavity,  produces 
convulsions  and  death;  and  in  the  cavity  of  the  heart,  weakens  or  sus- 
pends its  action.     Through  the  skin,  protected  by  the  epidermis,  it  acts 
very  slowly  and  feebly  upon  the  system. 

Upon  the  part  itself  with  which  it  is  brought  into  contact,  it  produces 
a  series  of  effects  analogous  to  those  upon  the  system  generally.  The 
first  effect  is  slightly  to  stimulate,  the  second  to  diminish  sensibility  and 
the  power  of  action.  Thus,  when  in  contact  with  the  conjunctiva,  the 
mucous  membrane  of  the  nose  and  urethra,  the  blistered  skin,  or  the  sur- 
face of  wounds  or  ulcers,  it  first  occasions  heat,  pain,  and  some  degree 
of  inflammation  ;  and  it  has  already  been  stated  that,  when  long  chewed, 
it  will  sometimes  blister  the  mouth;  but,  after  a  time,  the  pain  cea 
and  the  several  surfaces  become  less  sensible  to  ordinary  impressions 
upon  them.  Kvcn  through  the  cuticle  it  is  capable  of  producing  some 
anodyne  influence. 

5.  Idiosyncrasies.  On  certain  individuals  opium  produces  peculiar  ef- 


CHAP.  I.]  CEREBRAL    STIMULANTS. — OPIUM.  717 

fects,  which  differ  according  to  their  several  idiosyncrasies.  Thus,  in 
some  persons  it  causes  much  more  than  tho  usual  degree  of  excitement, 
intoxicating  them  like  alcohol,  rendering  them  more  or  less  delirious,  and 
even  pi'oducing  convulsions.  It  is  said  to  have  these  effects  frequently 
on  the  negro  and  the  Malay;  but  I  have  not  observed  any  special  pe- 
culiarity of  the  kind  in  negroes  of  this  region.  In  some,  it  gives  rise, 
even  in  large  doses,  to  headache,  restlessness,  and  utter  inability  to  sleep; 
while  in  others  it  acts  with  extraordinary  energy  as  a  soporific,  even  in 
small  doses.  There  are  individuals  who,  when  they  take  it,  always  suf- 
fer excessively  from  nausea  and  vomiting,  and  occasionally  with  spasm 
of  the  stomach.  Not  a  few,  though  they  experience  in  the  same  manner 
as  others  its  direct  influence,  yet  are  so  much  troubled  with  subsequent 
nausea,  and  general  distress,  as  to  preclude  the  use  of  the  medicine  in 
their  cases.  It  is  said  even  to  purge  some  individuals,  and  in  others  to 
produce  colic.  I  have  repeatedly  known  it,  in  merely  stimulant  doses, 
to  provoke  an  attack  of  neuralgic  pain,  in  a  person  liable  to  this  affec- 
tion. The  probability  is,  that  some  of  these  abnormal  effects  are  owing 
to  certain  constituents  of  opium  which  are  generally  productive  of  no 
inconvenience,  or  to  the  peculiar  mode  in  which  the  active  principles  may 
be  combined  or  associated  in  the  drug.  It  is  certain  that  they  may  very 
frequently  be  obviated  by  particular  modes  of  preparing  the  opium  for 
use,  consisting  either  in  separating  from  it  the  obnoxious  matters,  or 
modifying  the  state  of  its  active  matter.  Thus,  morphia,  or  the  black 
drop,  or  the  aqueous  extract,  or  the  deodorized  tincture,  can  be  borne 
well,  when  opium  itself,  or  other  preparations  would  be  rejected  from 
the  stomach,  or,  if  retained,  would  occasion  great  inconvenience. 

6.  Effects  of  Variation  and  Repetition  of  the  Dose.  As  a  general 
rule,  in  reference  to  the  operation  of  opium  connected  with  the  quantity 
administered,  the  stimulant  effect  is  protracted  by  a  diminution,  and 
shortened  by  an  increase  of  the  dose ;  while  exactly  the  reverse  is  true 
of  the  subsequent  narcotic  effect,  the  intensity  of  which  is  proportionate 
to  the  amount  taken. 

There  are  few  medicines  to  which  the  system  becomes  more  rapidly 
habituated  than  this.  By  increasing  the  dose  at  short  intervals,  the 
quantity  which  may  be  swallowed,  with  present  impunity,  may  be  indefi- 
nitely augmented.  An  ounce  or  more  is  frequently  consumed  daily  ;  and 
even  pints  of  laudanum  have  been  taken  in  the  same  time. 

7.  Acute  Poisoning.    It  has  been  said  that  poisonous  quantities  of 
opium  sometimes  occasion  no  stimulant  effect  whatever,  but  are  imme- 
diately sedative.     I  have  never  seen  a  case  which  would  justify  this 
statement,  and  do  not  think  that  the  fact  stated  is  possible.     Opium  is 
not  sufficiently  stimulant  to  overwhelm  the  stomach,  as  enormous  quan- 
tities of  alcohol  may  do,  and  produce  almost  instant  death,  without  di- 
rectly reaching  the  brain.      Before  any  very  powerful  effect  can  take 


718  GENERAL    STIMULANTS.  [PART  II. 

place,  time  must  be  allowed  for  absorption.  The  drug  cannot  all  be  ab- 
sorbed at  once.  A  small  portion  must  first  enter  the  circulation,  and. 
when  this  reaches  the  brain,  it  must  act  upon  it  as  a  stimulant.  And 
such  I  believe  to  be  invariably  the  case,  when  opium  has  been  swal- 
lowed. I  have  no  doubt,  moreover,  that  a  careful  examination  made  at 
the  beginning  will  discover  evidences  of  this  stimulation.  I  have  heard 
of  one  instance  in  which  an  individual,  who  had  taken  a  poisonous  dose, 
walked  a  distance  exceeding  a  mile,  and  back  again,  before  the  narcotic- 
effects  were  experienced.  A  very  powerful  emotion,  wholly  preoccupy- 
ing the  mind,  may  have  the  effect  of  postponing  the  operation  of  the 
poison,  and  in  some  measure  counteracting  it,  as  physical  pain  is  known 
to  do,  for  example,  in  violent  colic  and  tetanus.  But,  generally  speak- 
ing, the  larger  the  quantity  of  the  opium  taken,  especially  in  a  liquid 
form,  the  shorter  is  the  period  of  unmixed  stimulation.  In  a  very  short 
time,  under  a  poisonous  dose,  drowsiness  comes  on,  soon  followed  by 
profound  stupor.  The  patient  becomes  apparently  quite  senseless,  and 
lies  without  other  observable  motion  than  that  of  respiration,  which  is 
very  slow,  and  not  unfrequently  stertorous.  A  dark  suffusion  of  the 
countenance  comes  on,  with  an  utter  want  of  expression.  So  common 
is  this,  that,  by  its  absence,  I  have  been  able  to  detect  a  case  of  pretended 
poisoning  from  opium.  The  eyes  are  closed,  and  the  pupils,  almost  al- 
ways contracted  at  this  stage.  The  pulse  is  slow,  and  generally  full  and 
strong,  not  unlike  that  of  apoplexy,  and  indicating  anything  but  feeble- 
ness in  the  heart's  contractions.  I  have  known  it  to  be  so  extremely 
forcible  as  almost  irresistibly  to  call  for  the  use  of  the  lancet,  lest  injury 
might  be  done  to  the  brain.  The  coma,  however,  is  not  complete  for 

••ral  hours.  The  patients  are  almost  always  capable  of  being  m<; 
and  kept  for  a  time  partially  awake,  by  being  dragged,  half  walking. 
around  the  apartment.  Under  such  circumstances,  however,  they  are 
extremely  desirous  to  be  allowed  to  sleep  ;  and  the  only  motive  by  which. 
in  some  instances,  I  have  been  able  to  induce  them  to  swallow  the  drink 
or  medicine  offered,  has  been  to  assure  them  that,  if  they  would  take  it. 
they  should  be  allowed  to  rest  for  a  time.  During  this  half-awake  con- 
dition, it  is  surprising  to  notice  the  change  in  the  colour  of  the  sui , 
which,  before  almost  purplish  from  the  venous  hue  of  the  blood,  now  n - 
assumes,  in  a  considerable  degree,  its  natural  appearance  ;  but  the  instant 
the  patient  is  permitted  to  lie  down  and  sleep,  the  dark  suffusion  of  face 
returns,  with  the  slow,  laboured  breathing.  Convulsions  are  said  some- 
times to  occur;  but,  though  I  have  seen  numerous  cases  of  poisoning 
from  opium,  I  have  met  with  them  in  no  one  instance.  Tl.e  whole  of  tin- 
voluntary  muscles  appear  relaxed  and  powerless.  The  skin,  too,  is  re- 
laxed, but  not  often  perspiring  at  this  period.  Death  seldom  takes  plat-t- 
in this  stage  of  cerebral  oppression.  After  a  few  hours,  the  coma  becomes 
more  profound,  so  that  the  patient  can  no  longer  be  roused.  The  venous 


CHAP    I.]  CEREBRAL   STIMULANTS. — OPIUM.  719 

suffusion  of  the  countenance  begins  to  give  way  to  paleness.  The  skin 
becomes  cooler  and  more  relaxed.  The  pul.se,  though  in  general  still 
slow,  diminishes  gradually  in  fulness  and  strength.  The  breathing  be- 
comes slower  and  slower,  till  at  length  a  considerable  interval  elapses 
between  the  successive  inspirations.  I  was  once  struck  with  this  state 
of  respiration  in  a  child,  whom  I  had  been  attending  for  catarrhal  fever. 
Suspecting  that  sonic  mistake  had  been  made  in  the  prescription,  and 
that  opium  had  been  given  in  a  large  dose,  I  took  the  parent  of  the  child 
with  me  to  the  shop  of  the  druggist,  and  found  that  a  cough  mixture  had 
been  prepared  with  at  least  twelve  times  the  quantity  of  morphia  di- 
rected. Happily,  though  alarmingly  ill,  the  child  recovered  under  sup- 
porting measures.  At  length  a  condition  of  utter  prostration  ensues; 
the  pulse  reuses  to  be  perceptible  at  the  wrist;  there  is  a  universal  cold 
clammy  sweat  over  the  body:  the  respiration,  occurring  at  lengthening 
intervals,  at  last  ceases;  and  death  apparently  takes  place.  The  heart, 
however,  yet  beats  very  feebly;  and  a  short  period  is  still  allowed  for 
the  application  of  restorative  measures,  before  the  case  becomes  quite 
hopeless. 

The  stage  of  prostration  usually  commences  from  four  to  six  hours 
after  the  swallowing  of  the  poison,  and  sooner  if  it  has  been  removed 
artificially  from  the  stomach;  and  death  generally  occurs  in  from  six  to 
twelve  hours.  If  the  patient  survive  the  twelfth  hour,  he  usually 
recovers,  though  instances  are  on  record  in  which  the  fatal  termination 
has  taken  place  much  later.  It  has  sometimes  also  occurred  before  the 
sixth  hour,  even  so  early,  it  is  asserted,  as  the  third.  In  such  a  case, 
the  patient  dies  from  the  immediate  influence  of  the  opium  on  the  brain, 
as  in  congestive  apoplexy.  Ordinarily,  I  believe,  death  results  from  the 
vast  prostration  of  the  nervous  power,  consequent  upon  the  previous 
excessive  excitement;  and.  if  the  patient  can  be  supported  through  this 
period  of  collapse,  he  will  in  all  probability  recover.  From  a  quantity 
just  insufficient  to  cause  death,  the  prostration  following  the  congestive 
influence  of  the  poi-on  is  extreme;  but,  at  the  lowest  point,  the  system 
begins  to  react,  and  gradually  returns  to  health,  though  frequently 
through  a  series  of  nervous  disorder  and  variously  deranged  function, 
which  mark  the  violent  strain  to  which  the  brain  has  been  subjected. 

The  quantity  of  opium  which  may  prove  fatal  varies  so  much  with 
constitutional  peculiarities,  or  the  existing  state  of  the  system  from  any 
cause,  that  it  is  quite  impossible  even  to  approximate  the  fatal  dose  in 
reference  to  any  particular  individual.  Dr.  Christison,  in  his  treatise 
on  poisons,  mentions  an  apparently  well  Authenticated  case,  in  which 
death  took  place,  in  an  adult  man.  from  four  grains  and  a  half  of 
opium  with  nine  grains  of  camphor;  whereas  half  a  fluidounce  of  laud- 
anum has  been  repeatedly  known  to  be  taken,  by  persons  not  accustomed 
to  the  use  of  opium.  \vit!iout  such  a  result.  Death  often  occurs  from 


720  GENERAL    STIMULANTS.  [PART  II. 

quantities  varying  from  half  a  fluidounce  of  laudanum  to  two  or  three 
fluidounces,  or  from  about  twenty  grains  to  one  or  two  drachms  of 
opium.  Infants  are  peculiarly  susceptible  to  the  poisonous  influence  of 
the  drug.  I  was  once  called  to  see  a  child,  between  one  and  two  years 
old,  in  a  dying  state,  to  whom  its  mother  had  given,  rubbed  up  with 
water,  the  residuary  matter  in  a  teaspoon,  after  the  evaporation  of  some 
laudanum  which  had  been  left  in  it.  She  thought  she  might  be  able  to 
obtain  enough  in  this  way  for  a  dose.  Dr.  Alison,  of  Edinburgh,  has 
seen  death  result  in  a  child,  a  few  weeks  old,  from  four  drops  of  lauda- 
num; and  two  and  a  half  drops  killed  another  child,  three  days  old. 
(Christison  on  Poisons.)  The  inference  to  be  drawn  from  these  facts 
is,  that  great  caution  should  be  observed  in  exceeding  the  ordinary  full 
dose  of  opium,  which  experience  has  shown  to  be  safe.  It  may  be  very 
frequently  done  with  impunity,  but  at  any  time  a  fatal  result  may  occur. 
I  do  not  think  that  it  is  ever  necessary,  under  any  circumstances,  to  give 
more  than  two  grains,  as  a  beginning  dose,  to  an  adult  wholly  unaccus- 
tomed to  the  medicine.  It  can  be  repeated  in  a  short  time,  if  necessary, 
and  may  be  increased  after  testing  the  susceptibility  of  the  patient.  For 
an  infant,  during  the  first  week  or  two,  not  more  than  half  a  drop  of 
laudanum  should  be  given  at  first,  and  to  one  a  year  old  not  more  than 
two  drops. 

In  some  rare  instances,  after  a  poisonous  dose  of  opium  has  been  swal- 
lowed, vomiting  has  come  on  spontaneously,  and  saved  the  life  of  the 
patient  by  discharging  the  poison. 

Opium  may  prove  poisonous,  as  well  when  injected  into  the  rectum  as 
when  given  by  the  mouth;  but  it  is  probable  that  a  larger  quantity 
would  be  required  to  produce  fatal  effects.  Some  doubts,  however,  have 
been  thrown  upon  the  supposed  relative  insusceptibility  of  the  rectum; 
and  cases  have  occurred  in  which  comparatively  small  doses,  exhibited 
by  enema,  have  produced  alarming  effects.  An  instance  has  been  re- 
ported by  Dr.  Anstie,  of  London,  in  which  a  man  died  from  the  effects  of 
three  grains  of  morphia  injected  into  the  rectum.  (Mfd.  T.  and  Gaz.,  Feb. 
1863,  p.  134.)  Still,  such  cases  may  be  regarded  as  exceptional,  depend- 
ing on  idiosyncrasies  of  the  patients;  and  the  opinion  that  more  of  the 
narcotic  is  required  to  produce  a  given  effect  administered  by  the  rectum 
than  by  the  stomach  is  probably  true  as  a  general  rule.  Opium  is 
asserted  to  have  destroyed  life  by  application  to  the  surface  of  the  body. 
A  flaxseed  poultice  saturated  with  laudanum,  and  applied  to  the  leg  of  a 
soldier  affected  with  erysipelas,  is  said  to  have  proved  fatal.  (Christison 
on  Poisons  )  The  case  of  a^young  man  is  reported  in  the  Annuaire  de 
Therapeutique  (A.D.  1843,  p.  5),  who  was  thought  to  have  perished 
through  the  effects  of  a  cataplasm  to  his  epigastrium,  upon  which  tin- 
con  tents  of  a  laudanum  bottle  had  been  poured.  A  medical  friend  of 
my  own,  in  whose  word  I  place  entire  reliance,  reported  to  me  the  case 


CHAP.  I.]  CEREBRAL   STIMULANTS. — OPIUM.  721 

of  a  child  destroyed  by  the  repeated  external  application  of  laudanum. 
In  these  cases,  it  is  not  specially  stated  whether  there  was  or  was  not 
abrasion  of  the  skin ;  but,  if  the  poison  is  fatal  upon  the  sound  skin, 
how  much  more  likely  to  be  so  upon  a  denuded  surface,  or  upon  an 
ulcer  or  wound!  Laudanum  should  never,  therefore,  be  used  recklessly 
even  as  an  external  remedy. 

The  morbid  appearances  after  death  from  laudanum  are,  as  a  gen- 
eral rule,  congestion  of  the  brain,  with  more  or  less  serous  effusion,  con- 
gestion of  the  lungs,  a  livid  hue  of  the  surface,  and  a  liquid  state  of  the 
blood.  In  a  few  instances,  effusion  of  blood  has  been  found. 

Treatment  of  Acute  Poisoning.  There  is  no  antidote  to  opium  which 
can  be  relied  on.  The  important  indications  are  to  evacuate  the  stom- 
ach, and  to  support  the  system  in  the  state  of  prostration  which  follows 
the  direct  influence  of  the  poison.  The  first  indication  is  to  be  met  either 
by  emetics,  or  the  stomach-pump,  or  by  the  two  combined.  If  called  at 
any  period  before  prostration  has  taken  place,  one  of  these  measures 
should  be  resorted  to.  For  various  reasons,  I  prefer  first  the  trial  of 
emetics.  They  are,  in  general,  more  immediately  at  command,  and  time 
is  an  object  of  much  importance.  Besides,  if  solid  opium  has  been  swal- 
lowed, it  must  remain  in  the  stomach,  when  the  pump  is  used,  if  in 
masses  too  large  to  pass  through  the  tube.  I  was  once  cognizant  of  a 
case  of  this  kind.  A  young  man  was  brought  to  my  house,  with  the 
statement  that  he  had  taken  solid  opium.  He  was  sent  immediately  to 
the  hospital,  where,  as  I  afterwards  learned,  the  stomach-pump  was 
promptly  applied,  and  everything  apparently  evacuated.  The  patient, 
however,  died.  I  was  convinced  that  a  portion  of  opium  had  remained 
in  the  stomach,  because  too  large  to  enter  the  tube;  and  from  that  time 
I  determined  never  to  depend  on  the  stomach-pump,  in  any  case  where 
opium  had  been  swallowed  in  mass,  however  small  the  fragment.  Be- 
sides, there  may  be  an  hour-glass  contraction,  which  might  yield  to  an 
emetic,  but  not  to  the  stomach-pump.  I  once  attended  a  case  in  which, 
after  the  contents  of  the  stomach  seemed  to  have  been  completely  dis- 
charged under  the  influence  of  emetics,  a  sudden  gush  of  liquid  was 
thrown  up,  smelling  strongly  of  laudanum.  Had  the  stomach-pump  been 
relied  on  in  this  case,  it  might  have  ended  fatally.  When  emetics  can- 
not be  made  to  act,  this  instrument  should  be  resorted  to  ;  and  it  may 
often  also  be  advantageously  used  in  conjunction  with  emetics,  espe- 
cially when  the  patient  refuses  to  swallow,  as  it  then  affords  the  means 
of  introducing  the  medicine  into  the  stomach. 

The  emetics  I  prefer  are  sulphate  of  zinc  and  ipecacuanha.  The  for- 
mer is  very  prompt  and  energetic,  safer  in  large  doses  than  sulphate  of 
copper,  because  less  corrosive,  and  than  tartar  emetic,  because  less  seda- 
tive or  prostrating  in  its  influence.  The  ipecacuanha  is  also  a  quick  and 
active  emetic,  at  the  same  time  that  it  is  safe  in  almost  any  quantity. 
VOL.  i. — 46 


722  GENERAL    STIMULANTS.  [PART  II. 

Thirty  grains  of  sulphate  of  zinc,  and  a  drachm  of  ipecacuanha  may  be 
given  at  once,  and  repeated  every  twenty  minutes  until  they  operate. 
Indeed,  the  ipecacuanha  may  be  thrown  in  ab  libitum.  I  should  fear  an 
indefinite  repetition  of  the  sulphate  ;  for,  though  it  may  produce  no  per- 
ceptible irritation  at  the  time  of  exhibition,  in  consequence  of  the  want 
of  susceptibility  in  the  stomach,  it  may  yet  leave  an  impression  behind, 
which,  upon  the  occurrence  of  reaction,  may  end  in  inflammation.  In  a 
case  of  opiate  poisoning  in  a  woman,  which  occurred  to  me  many  years 
since,  the  patient,  after  the  evacuation  of  the  poison,  was  reduced  to  the 
lowest  state  of  prostration,  from  which  she  was  saved  with  difficulty. 
Among  the  measures  employed  to  excite  her,  was  a  pair  of  sinapisms 
applied  to  the  legs.  As,  in  the  existing-  insensible  state  of  the  skin,  they 
produced  neither  pain  nor  redness,  they  were  allowed  to  remain  on  for 
three  hours.  When  they  were  taken  off,  no  rubefaction  was  visible. 
Hut  when  the  system  reacted,  violent  inflammation  took  place  in  the  sur- 
face with  which  they  had  been  in  contact,  followed  by  vesication  and 
obstinate  superficial  uleeration,  which  was  long  in  healing.  Applying 
this  observation  to  the  influence  of  irritants  on  the  stomach,  I  felt  con- 
vinced that,  by  giving  largely  of  substances  of  this  kind,  though  they 
might  not  act  at  the  time,  we  might  upon  the  occurrence  of  reaction  have 
violent  and  perhaps  fatal  gastritis.  It  is  probably  not  going  too  far  to 
say,  that  some  of  the  deaths  in  narcotic  poisoning,  which  have  occurred 
notwithstanding  the  complete  evacuation  of  the  poison,  may  have  re- 
sulted from  this  cause.  I  have  never,  therefore,  proceeded  further  with 
the  sulphate  of  zinc  than  to  give  three  doses ;  and  have  not  ventured  on 
sulphate  of  copper  at  all.  Yet  I  have  never  failed  in  evacuating  the 
stomach  by  emetics,  when  I  have  employed  them  in  these  cases. 

The  emetic,  however,  should  be  aided  by  various  accessory  measures. 
Among  the  most  important  of  these  is  the  use  of  large  quantities  of 
warm  water,  or  warm  chamomile  tea,  of  which  the  patient  should  be 
made  to  swallow  tumblerful  after  tumblerful,  until  the  stomach  will  re- 
ceive no  more.  The  throat  also  may  be  tickled  by  a  feather,  in  order  to 
rouse  the  stomach  by  its  sympathies.  The  great  difficulty,  however,  is 
not  so  much  in  the  direct  insusceptibility  of  the  stomach  as  in  that  of 
the  cerebral  centres,  through  an  impression  upon  which  it  is  that  emetics 
are  enabled  to  act.  It  is,  therefore,  important  to  rouse  these  centres,  and 
render  them  more  sensible  to  the  nauseating  impression.  For  this  pur- 
pose, cold  water  may  be  dashed  on  the  face,  head,  or  neck  of  the  patient.* 

*  The  case  of  a  woman  is  recorded  by  Dr.  A.  Le  13.  Monroe,  of  Medway,  Massa- 
chusetts, in  which  life  seems  to  have  been  saved,  after  the  swallowing  of  two  ounces 
of  laudanum,  by  placing  the  patient  on  her  back,  and  pouring  on  the  naked  epi- 
gastrium, from  a  height  of  nine  feet,  a  small  stream  of  water  from  a  pitcher.  Be- 
fore the  second  pailful  was  exhausted,  there  were  signs  of  improvement ;  and  after 
the  third,  she  was  restored  to  consciousness.  She  was  then  kept  walking  about  the 


CHAP.  I.]  CEREBRAL    STIMULANTS. — OPIUM.  723 

If  the  pulse  is  exceedingly  full  or  strong,  some  blood  may  be  taken  from 
the  arm,  in  order  to  lessen,  in  some  measure,  the  pressure  on  the  brain. 
But  this  measure  must  be  used  with  great  caution.  The  prostration  fol- 
lowing the  direct  action  of  the  poison  is  generally  the  greatest  danger  of 
the  case.  Anything  which  may  increase  that  prostration  may  be  haz- 
ardous. My  preceptor,  the  late  Dr.  Joseph  Parrish,  used  to  relate  the 
case  of  a  young  woman  to  whom  he  was  called  in  the  country,  and  who 
had  swallowed  a  poisonous  dose  of  laudanum.  The  physician  in  attend- 
ance, influenced  by  the  state  of  her  pulse,  had  bled  her  largely,  and  I 
believe  more  than  once.  The  consequence  was,  that,  after  the  evacua- 
tion of  the  poison,  though  she  recovered  her  consciousness  perfectly,  she 
fell  into  a  prostrate  condition  from  which  it  was  found  impossible  to  raise 
her.  Another  and,  perhaps,  the  most  important  adjuvant  of  the  emetic, 
is  to  keep  the  patient  in  constant  motion  until  vomiting  is  induced.  For 
this  purpose,  assistants  should  aid  him  in  walking  steadily  about  the 
room,  and,  when  there  is  resistance,  should  use  compulsory  measures  to 
this  end  if  necessary.  It  is  surprising,  sometimes,  to  witness  the  effi- 
ciency of  this  measure  in  relieving  the  cerebral  congestion.  While 
moving,  the  patient  remains  at  least  partially  awake,  the  colour  of  the 
face  brightens,  and  more  or  less  expression  comes  into  his  features ;  but 
the  instant  that  he  is  allowed  to  lie  down,  he  falls  again  into  a  deep,  per- 
haps stertorous  sleep ;  and  the  dark  suffusion  of  face,  and  utter  want  of 
expression  return.  Bouchardat  recommends  that  the  patient  be  kept 
awake  for  twelve  hours,  so  as  to  prevent  the  paralyzing  influence  of  the 
absorbed  narcotic  ou  the  nervous  centre  of  respiration,  until  the  poison 
shall  have  been  discharged  by  the  kidneys.  (Ann.  de  Therap.,  1862,  p.  3.) 

It  is  not  sufficient  to  obtain  a  single  evacuation  of  the  stomach.  After 
vomiting  has  begun,  it  should  be  kept  up  by  free  draughts  of  warm  water, 
until  the  liquor  returns  colourless  and  odourless. 

If  the  stomach-pump  is  employed,  the  same  thorough  evacuation 
should  be  effected.  The  water  injected  should  return  without  smell, 
and  the  last  liquid  contents  should  be  drawn  out  by  means  of  the 
syringe. 

But  the  subsequent  treatment  is  all-important.  It  has  not  fallen  to 
my  lot,  out  of  numerous  cases  of  this  kind  which  I  have  seen,  to  witness 
death  in  a  single  instance,  except  in  that  of  the  infant  before  referred  to, 
and  that  occurred  at  a  period  when  all  the  resources,  now  at  our  corn- 
apartment  for  some  time,  and  ultimately  recovered.  (Boston  Med.  and  Surg.  Journ.. 
May  31,  18Gti,  p.  354.)  Yet  the  direct  influence  of  cold,  except  for  the  shock,  would 
seem  to  be  injurious.  Brown-86qtuurd  recommends  thtit  the  patient  should  be  kept 
warm  :  asserting  that,  if  of  two  animals,  poisoned  with  opium,  one  be  placed  near  a 
fire  and  warmly  covered,  and  the  other  in  some  cold  place,  the  former,  cxteris  pan- 
bus,  will  live,  while  the  latter  will  perish.  (Dublin  Quart  Journ.,  May,  1865,  p. 
4:54.) — A'ote  to  the  third  edition. 


724  GENERAL   STIMULANTS.  [PART  II. 

mand,  had  not  been  made  known.  But  I  am  quite  confident  that,  in  more 
than  one  instance,  if  nothing  had  been  done  after  the  evacuation  of  the 
poison,  the  consequences  would  have  been  fatal.  The  prostration  is 
sometimes  very  great,  and  comes  on  sooner  than  it  otherwise  might  do, 
in  consequence  of  the  evacuation  of  the  poison.  It  must  be  encountered 
by  stimulant  measures  proportioned  to  the  exigencies  of  the  case.  Ex- 
ternal stimulation  by  means  of  heated  Cayenne  pepper  and  brandy  or 
oil  of  turpentine,  and  the  internal  use  of  the  aromatic  spirit  of  ammonia, 
wine-whey,  wine  beat  up  with  the  yolk  of  egg,  brandy  with  milk,  etc., 
are  means,  of  which  one  or  all  may  be  employed,  as  the  degree  of  pros- 
tration may  require.  Rich  soup,  or  essence  of  beef  or  mutton,  may  also 
be  given  as  nourishment.  Should  the  stomach  be  irritable,  a  blister 
should  be  applied  to  the  epigastrium,  and  nutritious  and  stimulating 
enemata  be  employed,  if  the  same  materials  should  be  rejected  when  swal- 
lowed. -In  relation  to  the  use  of  sinapisms,  caution  should  be  observed 
not  to  leave  them  on  longer  than  half  an  hour,  or  at  furthest  one  hour, 
in  any  one  place,  for  fear  of  subsequent  inflammation. 

When  the  patient  is  first  seen  in  the  prostrate  condition,  with  a  cold 
skin,  and  scarcely  perceptible  pulse,  no  time  should  be  lost  in  attempts 
to  evacuate  the  stomach;  but  the  stimulating  and  supporting  plan  should 
be  at  once  resorted  to.  It  is  not  the  direct  action  of  the  poison  that  is 
now  the  source  of  danger;  it  is  the  depression  following  that  action. 
Even  though  respiration  may  have  ceased,  and  the  pulse  no  longer  be 
perceptible  at  the  wrist,  efforts  to  save  the  patient  should  not  be  aban- 
doned. While  stimulants  are  employed  externally  and  internally,  recourse 
should  be  had  to  artificial  respiration  ;  for  the  heart  continues  to  act 
feebly  after  the  occurrence  of  these  phenomena,  and,  if  the  office  of  ins- 
piration can  be  performed,  and  arterialized  blood  sent  to  the  heart,  the 
function  of  circulation  may  be  resumed,  and  life  saved.  Several  instances 
of  this  kind  are  on  record;  and  a  medical  friend  of  mine  is  confident  that 
he  saved  the  life  of  an  infant  about  to  perish,  by  breathing  into  its  lungs. 
It  is  important,  however,  not  too  speedily  to  relinquish  the  process,  after 
the  restoration  of  the  function;  for  the  respiratory  centres  may  not  yet 
Jtave  recovered  from  the  blow,  sufficiently  to  carry  on  their  office  without 
.aid.  The  patient  should  be  carefully  watched  for  several  hours,  and  the 
remedy  reapplied  if  found  to  be  required.  The  case  of  a  woman  is  re- 
corded hi  the  London  Mtidico-chirurgical  Transactions  for  1836,  in 
which,  after  the  restoration  of  animation  through  the  influence  of  artifi- 
cial respiration,  the  patient  was  left  for  an  hour,  and  upon  the  return  of 
the  medical  attendant,  at  the  end  of  that  time,  was  found  relapsing  into 
her  former  pulseless  condition.  A  repetition,  however,  of  the  remedy 
was  followed  by  the  same  success,  and  life  was  saved. 

Another  remedy  which  may  be  had  recourse  to,  under  similar  circum- 
stances, is  galvanism,  or  the  powerful  action  of  the  alternating  currents 


CHAP.  I.]  CEREBRAL    STIMULANTS. OPIUM.  725 

of  the  electro-magnetic  machine.  At  least  three  cases  of  recovery  under 
this  agent  are  on  record.  For  the  method  of  applying  this  remedy,  the 
reader  is  referred  to  the  article  on  Electricity,  page  538. 

Coffee  is  another  remedy  which  may  be  employed  to  qualify  the  effects 
of  opium.  It  acts,  probably,  more  nearly  in  the  capacity  of  an  antidote 
than  any  other  agent.  Its  use  was  suggested  by  its  well-known  tend- 
ency to  produce  wakefulness.  It  should  be  taken  freely,  ai.d  as  strong 
as  possible  ;  never,  however,  to  the  exclusion  of  other  means.  Caffein 
has  been  substituted  for  coffee  in  several  cases,  with  encouraging  results. 

Belladonna  has  recently  acquired  no  little  reputation  from  its  supposed 
antagonistic  powers  to  those  of  opium.  That  there  is,  in  some  respects, 
an  antagonism  between  these  two  narcotics,  I  have  no  doubt;  but  I  do  not 
believe  that  it  extends  to  those  points  in  their  action  which  entitle  them 
both  to  the  name  of  cerebral  stimulants  ;  and  it  would  be  extremely  haz- 
ardous to  trust  the  poisonous  action  of  opium  to  the  antidotal  powers  of 
belladonna.  But  in  the  advanced  stage  of  the  poisoning,  when  the  im- 
mediate effects  of  the  opium  are  passed,  and  the  chief  danger  consists  in 
the  prostration  of  the  nervous  power,  belladonna  may  be  used  with  great 
propriety ;  and  I  can  readily  conceive  that,  under  these  circumstances,  it 
may  sometimes  save  the  life  of  the  patient.  This  subject  will  be  more 
fully  discussed  under  the  head  of  belladonna. 

Chronic  Poisoning.  The  extremely  grateful  effects  of  opium  on  most 
persons,  in  its  first  stimulant  action,  and  in  the  calming  influence  which 
follows,  has  led  to  an  enormous  abuse  of  the  drug,  which,  though  less 
injurious  either  to  the  individual  or  to  society  than  a  similar  abuse  of 
alcohol,  is  often  very  pernicious  in  its  effects  on  the  health  of  those  who 
give  way  to  it.  Like  the  alcoholic  beverages,  though  employed  habit- 
ually, provided  its  use  be  restrained  within  certain  limits,  it  does  little 
apparent  injury,  even  through  a  long  course  of  years,  and  does  not  seem, 
obviously,  at  least,  to  shorten  life.  We  are  told,  on  the  most  reliable 
nuthorit  v,  that  in  India  and  China,  in  the  mode  in  which  it  is  commonly 
employed  by  those  of  respectable  position,  who  have  a  character  to  main- 
tain, its  effects  are  in  general  not  such  as  to  produce  any  seeming  unfit- 
ness  for  the  ordinary  duties  of  life,  or  materially  to  shorten  its  duration. 
In  our  own  country,  the  apothecaries  inform  us  of  sales  of  opium  or  its 
preparations  to  a  vast  amount,  beyond  any  possible  calls  for  it  as  a  medi- 
cine ;  yet  the  number  of  instances  are  comparatively  few,  in  which  its 
ill  effects  are  brought  under  the  notice  of  the  physician.  The  vice  is  in- 
dulged secretly,  and  does  not  betray  itself  by  any  disorder  in  the  acts, 
or,  so  far  as  known,  in  the  health  of  the  individual;  and  the  best  British 
writers  make  the  same  statements  relative  to  the  abuse  of  the  drug  in 
their  country.  But  the  danger  is  that,  as  its  pleasing  effects  ce*M  to 
be  felt,  at  least  with  the  same  zest,  from  the  original  dose,  the  temptation 
is  always  present  to  increase  the  quantity  used,  and  to  go  on  increasing 
it  until  it  becomes  a  source  of  great  and  undeniable  evil. 


726  GENERAL   STIMULANTS.  [PART  II. 

If  the  ordinary  operation  of  opium  be  compared  with  that  of  alcohol, 
the  cause  will  be  obvious  why  life  is  so  much  less  endangered  by  the 
former  than  the  latter.  The  stimulant  influence  of  opium,  either  on  the 
part  to  which  it  is  applied,  or  generally  on  the  circulation,  is  very  much 
less  than  that  of  alcohol ;  nor  does  it  equally  excite  the  functions  of  the 
lungs,  liver,  and  kidneys.  Hence  it  is  much  less  liable  to  induce  either 
chronic  inflammation  of  the  different  organs,  or  that  organic  degenera- 
tion, which  almost  necessarily  attends  the  debility  consequent  upon  ex- 
cessive vascular  excitement.  Operating  mainly  on  the  functions,  the 
disordering  influence  of  opium  is  witnessed  chiefly  in  the  functions. 

Occasionally  the  medical  man  is  consulted  in  this  country  by  the  slaves 
of  opium,  and  has  the  opportunity  of  witnessing  the  consequences  of  its 
excessive  abuse.  In  his  own  therapeutic  observation,  he  also  witnesses 
frequent  disturbance  of  the  functions  from  its  medicinal  employment,  and 
necessarily  infers  that  the  same  disturbances  must  exist  in  those  who  use 
it  as  a  luxury  within  the  same  limits.  The  greatest  sufferings  expe- 
rienced by  the  opium-eater  are  those  which  attend  the  state  of  nervous 
depression,  always  existing  when  its  direct  influence  is  no  longer  felt. 
There  are  excessive  restlessness,  a  universal  and  indescribable  uneasi- 
ness, feelings  of  intolerable  distress,  especially  in  the  epigastrium  and 
lower  extremities,  an  irksome  sense,  moreover,  of  incapacity  both  for  in- 
tellectual exertion,  and  for  mental  or  emotional  enjoyment,  constituting 
together  a  state  of  exquisite  misery,  from  which  the  only  relief  is  by  re- 
newed recourse  to  the  stimulus,  which,  if  taken  in  an  increasing  dose, 
renders  him  happy  again,  and  again  capable  of  exertion  ;  and  thus  he 
goes  on,  in  an  alternation  of  lessening  comfort  and  increasing  misery,  to 
the  end.  At  the  same  time,  there  is  a  gradual  depravation  of  the  func- 
tions, which  impairs  the  degree  of  health,  though  it  may  not  very  mate- 
rially shorten  life,  unless  the  indulgence  be  carried  to  great  excess.  Tin- 
ordinary  derangements  of  the  organic  functions  are  impaired  appetite 
and  digestion,  habitual  constipation,  and  defective  action  of  the  liver ; 
those  of  the  animal  functions,  tremors,  wakcfulness,  weakened  memory 
and  intellect,  and  loss  of  interest  in  the  usual  concerns  of  life  and  social 
relations.  The  lowest  stage  of  degradation  has  been  attained,  when  the 
indulgence  ends  in  a  total  loss  of  self-respect,  and  indifference  to  the  opin- 
ions of  the  community;  and  everything  is  sacrificed  to  the  insatiable  de- 
mands of  the  vice.  Not  unfrcquently,  this  habit  of  excess  has  been 
engendered  by  the  supposed  necessity  gf  obtaining  relief  from  painful  affec- 
tions, such  as  cancer,  and  certain  incurable  cases  of  neuralgia;  but,  though 
some  palliation,  this  is  no  satisfactory  excuse ;  for,  by  proper  manage- 
ment, considerable  relief  of  pain  can  generally  be  obtained,  without  an' 
excess  sufficient  to  degrade  the  mind,  or  even  materially  the  general 
health ;  and  it  is  rather  a  weak  yielding  to  the  seductive  pleasures  of 
opium,  than  any  necessity  for  its  anodyne  influence,  that  leads  to  the 
lowest  depths  of  the  evil. 


CHAP.  I.]  CEREBRAL   STIMULANTS. — OPIUM.  727 

The  effects  of  the  vice  of  opium-eating,  and  opium-smoking,  among 
the  lower  class  of  the  Orientals,  have  been  frequently  described,  and 
with  such  warm  colouring  that  a  suspicion  is  apt  to  arise  of  some  inter- 
ference of  the  imagination  in  the  pictures  given ;  especially  as  we  do  not 
meet  their  exact  counterparts  among  those,  who  perhaps  equally  aban- 
don themselves  to  the  vice  among  ourselves.  It  is  possible  that  the 
fumes  of  opium  inhaled  may  exercise  a  more  deleterious  influence  on 
the  health  than  the  drug  taken  into  the  stomach  ;  and  this  may  explain 
the  incompatibility  of  the  descriptions  of  travellers  with  our  own  obser- 
vation. Dr.  Oppenheim,  one  of  the  most  recent  and  reliable  observers, 
gives  the  following  account  of  what  he  has  himself  witnessed  in  Eu- 
ropean and  Asiatic  Turkey.  The  opium-eater  usually  begins  with  from 
half  a  grain  to  two  grains,  and  gradually  increases  to  two  drachms  and 
sometimes  more  in  a  day.  He  is  readily  recognized  by  his  appearance. 
"  A  total  attenuation  of  body,  a  withered  yellow  countenance,  a  lame 
gait,  a  bending  of  the  spine  frequently  to  such  a  degree  as  to  assume  a 
circular  form,  and  glossy  deep-sunken  eyes,  betray  him  at  the  first  glance. 
The  digestive  organs  are  in  the  highest  degree  disturbed,  the  sufferer 
eats  scarcely  anything,  and  has  hardly  one  evacuation  in  a  week ;  his 
mental  and  bodily  powers  are  destroyed  ;  he  is  impotent."  Finding  the 
stimulant  effect  of  the  poison  at  length  almost  lost,  he  conjoins  with  it 
the  use  of  corrosive  sublimate,  gradually  increasing  the  latter  till  it 
amounts  to  ten  grains  daily.  He  becomes  subject  finally  to  neuralgic 
pains,  to  which  the  opium  yields  no  relief;  and,  if  he  has  begun  the  use 
of  the  drug  early  in  life,  seldom  attains  the  age  of  forty.  (Brit,  and  For. 
Med.  Rev.,  iv.  394.)  It  is  unnecessary  to  state,  that  the  corrosive  sub- 
limate has  probably  quite  as  much  to  do  with  the  fatal  result  as  the 
opium. 

It  is  satisfactory  to  know  that  this  evil  habit  may  be  corrected,  with- 
out great  difficulty,  if  the  patient  is  in  earnest ;  and,  as  the  disorders 
induced  by  it  are  mainly  functional,  that  a  good  degree  of  health  may 
be  restored.  It  will  not  answer  to  break  off  suddenly.  No  fortitude  is 
sufficient  to  support  the  consequent  misery,  and  life  might  be  sacrificed 
in  the  effort.  Of  the  particular  phenomena  which  might  result  I  have 
no  experience ;  for  I  have  met  with  no  case  in  which  the  attempt  has 
been  made,  or  at  any  rate  more  than  momentarily  persevered  in.  Dr.  B. 
H.  Coates,  however,  states  that  he  has  seen  well  characterized  cases,  in 
which  delirium  tremens  occurred  (N.  Am.  Med.  and  Surg.  Journ.,  iv. 
34)  ;  and  this  result  might  be  reasonably  anticipated.  The  proper 
method  of  correcting  the  evil  is  by  gradually  withdrawing  the  cause;  a 
diminution  of  the  dose  being  made  every  day,  so  small  as  to  be  quite 
imperceptible  in  its  effects.  Supposing,  for  example,  that  a  fluidounce 
of  laudanum  is  taken  daily,  the  abstraction  of  a  minim  every  day  would 
lead  to  a  cure  in  somewhat  more  than  a  year ;  and  the  progress  might 


728  GENERAL   STIMULANTS.  [PART  II. 

he  much  more  rapid  than  this.  Time,  however,  must  be  allowed  for  the 
system  gradually  to  regain  the  healthy  mode  of  action,  which  it  had 
gradually  lost. 

4.  Mode  of  Operating. 

Opium  probably  acts  simply  by  an  influence  upon  the  vital  properties 
of  the  tissues,  without  any  chemical  reagency  whatever.  Hence  the 
long  comparative  impunity  under  its  abuse.  At  one  time  I  was  dis- 
posed to  think  that  its  first  stimulating  action  on  the  heart  and  brain 
might  be  owing  to  a  sympathetic  impression  extended  from  the  stomach  ; 
but  the  correctness  of  this  opinion  seems  to  me  more  than  doubtful,  now 
that  we  know  how  rapidly  it  is  absorbed,  and  how  quickly  it  may  be 
conveyed  with  the  blood  to  all  parts  of  the  system.  That  it  is  absorbed 
is  proved  by  the  fact  that,  in  fatal  cases  of  poisoning,  it  frequently  hap- 
pens, even  when  there  has  been  no  vomiting,  that  none  of  it  is  found  in 
the  stomach.  Besides,  the  smell  of  opium  is  sometimes  observable  in 
the  breath  and  excretions  of  persons  who  have  taken  it  largely,  and  has 
been  noticed  in  the  blood.  Barruel  asserts  that  he  has  detected  morphia 
in  the  lood  and  urine  of  a  person  poisoned  with  opium.  (Pereira,  Mat. 
Med.,  3d  ed.,  p.  2120.)  The  milk  of  nurses  under  its  influence  has  pro- 
duced its  peculiar  effects  on  the  sucking  child.  When  introduced  into 
the  jugular  vein,  it  has  been  found  to  produce  the  same  effects  as  when 
taken  by  the  stomach.  Finally,  if  applied  to  a  nerve,  without  access  to 
the  blood-vessels,  it  does  not  act  on  the  brain. 

From  its  slightly  stimulating  effect  on  the  surfaces  with  which  it  is 
observably  brought  into  contact,  it  may  be  supposed,  when  in  the  cir- 
culation, to  exercise  a  similar  influence  wherever  it  is  carried,  and  thus 
to  produce  the  moderate  excitement  of  the  heart  which  accompanies  its 
primary  operation.  But  its  influence  is  felt  especially  by  the  nervous 
centres  in  the  brain,  and  more  particularly  by  those  of  the  cortical  por- 
tion of  the  cerebrum,  through  which  the  intellectual  and  emotional  func- 
tions of  the  mind  are  probably  exercised.  The  sensory  centres,  and 
the  respiratory  centre  in  the  medulla  oblongata,  appear  also  to  be  spe- 
cially affected.  But  if  the  cerebellum  be,  as  supposed  by  Flourens,  the 
.-••at  of  the  power  of  combining  motions,  and  as  Gall  and  Spur/heim 
maintain,  that  of  the  sexual  propensity,  it  probably  participates  little  in 
the  original  stimulant  impression.  The  operation  of  op'um  upon  the 
nervous  centres  I  maintain  to  be  essentially  stimulant.  The  primary 
mental  excitement  may  thus  be  readily  accounted  for,  as  well  as  the  more 
rapid  respiration,  and  increased  muscular  power.  It  is  not  improbable 
that  the  stimulation  of  the  heart  may  really  proceed  from  a  similar  cause, 
and  not  from  the  direct  contact  of  the  opium  or  its  active  principles. 
But  how  account  for  the  subsequent  calm  in  all  these  functions,  and  the 
remarkable  diminution  and  almost  suspension  which  follow,  as  indicated 


CHAP.  I.]  CEREBRAL   STIMULANTS. — OPIUM.  729 

by  the- impaired  sensibility  and  power  of  motion,  and  the  soporose  con- 
dition more  or  less  profound?  Are  these  the  result  of  a  direct  sedative 
or  depressing  influence  following  the  stimulant?  I  think  not.  The  real 
depression  takes  place  long  subsequently,  after  the  direct  action  of  the 
medicine  has  ceased.  They  are  readily  explicable  upon  the  general  doc- 
trine of  irritation,  which  I  have  maintained  in  this  work  and  elsewhere. 
Irritation  is  stimulation  beyond  the  healthy  point,  The  two  terms  may 
be  considered  as  synonymes  in  reference  to  our  present  purpose.  When, 
then,  a  part  is  stimulated,  it  receives  an  additional  supply  of  blood,  and 
the  supply  increases  with  the  stimulation  until  it  ends  in  inflammation. 
Now  the  first  effect  of  the  blood  entering  the  part  is  to  supply  the  means 
for  an  increase  of  its  healthy  function  ;  a  larger  supply  interferes  with  the 
due  action  of  the  part,  though  the  excitement  may  still  continue;  a  still 
further  quantity  overwhelms  it,  and  impairs  or  suspends  altogether  the 
exercise  of  its  function.  In  other  words,  the  effects  of  stimulation  upon 
any  part  are  first  to  augment,  then  to  <  derange,  and  lastly  to  impair  its 
function;  and  all  this  through  the  direct  influence  of  the  stimulant.  Ap- 
ply this  law  to  the  action  of  opium  on  the  cerebral  centres.  It  first 
moderately  stimulates  and  moderately  congests  them ;  thus  increasing 
their  function,  and  giving  rise  to  the  elevated  intellectual,  emotional,  and 
sensory  phenomena,  and  perhaps  to  the  circulatory  and  respiratory  ex- 
citement, which  characterize  the  early  period  of  its  operation;  it  con- 
tinues to  stimulate,  and  thus  further  congests  them,  and  in  this  way 
occasions  the  disordered  sounds  and  other  sensations,  and  the  derange- 
ment of  the  intellectual,  emotional,  and  motor  functions  which  some- 
times come  on  at  this  period;  it  still  continues  to  stimulate,  and  yet 
further  to  congest  the  centres,  the  functions  of  which  are  now  diminished 
or  suspended,  causing  first  a  sensorial  calm,  and  ultimately  sleep.  If 
the  quantity  of  the  opium  is  very  large,  the  congestion  is  hastened  and 
increased  with  the  more  prompt  and  powerful  stimulation;  and  hence 
the  speedy  occurrence  of  profound  sleep  or  coma.  The  influence  upon 
the  circulation  and  respiration  corresponds  with  this  view.  In  active 
congestion  of  the  brain  the  pulse  usually  becomes  slower,  fuller,  and 
stronger,  and  the  respiration  slower  and  deeper;  and  thus  it  is  in  the 
early  stage  of  the  soporose  effect  of  opium,  showing  that  the  sensorial 
phenomena  proceed  from  a  similar  influence.  Indeed,  there  is  a  marked 
resemblance  between  the  effects  of  opium  and  a  gradually  increasing 
active  congestion  of  the  brain.  In  the  latter,  as  in  the  former,  the  cere- 
bral functions  are  first  somewhat  excited,  then  they  are  discomposed,  as 
shown  by  abnormal  sounds,  etc.,  in  the  head,  and  then  diminished  or 
suppressed,  as  proved  by  the  drowsiness  and  stupor  which  supervene ; 
and  the  resemblance  is  extended,  as  already  stated,  to  the  respiratory 
and  circulatory  functions. 

Thus  far  we  have  been  attending  to  the  direct  influence  of  the  opium. 


730  GENERAL   STIMULANTS.  [PART  II. 

The  condition  which  follows  is  in  accordance  with  another  general  path- 
ological law,  that  every  over-excitement  must  be  followed  by  a  cor- 
responding depression.  The  cerebral  centres,  no  longer  stimulated  by 
the  opium,  fall  necessarily  into  a  depressed  state.  No  more  blood  is  now 
attracted  to  them.  They  have  not  even  the  power  of  expelling  the  ex- 
cess which  has  overwhelmed  them.  Hence,  a  failure  of  all  the  depend- 
ent functions,  and  the  universal  prostration  that  ensues. 

I  consider  the  above  question  as  not  purely  theoretical,  but  highly 
practical  in  its  bearing,  and  therefore  important  to  be  decided  correctly. 
If  opium  is  a  real  sedative  to  the  nervous  centres  in  its  second  and  most 
powerful  action,  then  it  must  be  the  great  remedy  in  all  cases  of  over- 
excitement  of  the  brain,  from  slight  vascular  irritation  of  that  organ  up 
to  apoplectic  congestion,  and  even  inflammation ;  for  the  sedative  in- 
fluence would  vastly  overbalance  the  stimulant,  especially  if  the  medi- 
cine should  be  given  largely,  and  would  thus  produce  much  more  good 
than  harm.  But  every  experienced  practitioner  knows  that  these  are 
exactly  the  conditions  in  which  opium  is  calculated  to  do  harm.  If,  on 
the  contrary,  it  be  altogether  a  stimulant  to  the  brain  throughout  its 
direct  action,  whether  during  the  excitement  or  suppression  of  the  cere- 
bral functions,  then  it  is  contraindicated  in  the  conditions  just  referred 
to,  and  would  be  most  appropriate  in  all  cases  of  functional  depression 
or  debility  of  the  brain  ;  and  this  is  really  the  case.  Upon  the  princi- 
ple here  stated,  opium  may  be  prescribed  rationally;  upon  the  other, 
that,  namely,  which  considers  it  sedative  to  the  brain,  it  must  be  given 
empirically. 

But  another  important  point,  in  reference  to  therapeutics,  is  that,  while 
opium  is  a  powerful  cerebral  stimulant,  it  operates  really  as  a  sedative 
upon  many  of  the  functions  and  organs  of  the  body,  which  are  sustained 
in  their  due  state  by  influence  from  the  nervous  centres.  By  the  over- 
stimulation  of  these  centres,  it  disables  them  from  extending  their  proper 
influence  to  other  organs,  and  thus  acts  as  a  positive,  though  indirect  se- 
dative to  the  latter.  Hence,  opium  may  often  be  prescribed  with  great 
advantage  as  a  sedative  in  various  disordered  conditions  of  the  system, 
provided  the  brain  be  either  sound,  so  as  not  to  be  materially  injured  by 
its  action,  or  depressed,  so  as  to  be  bcnclited  Cy  it.  -  Under  the  thera- 
peutic head,  there  will  be  frequent  opportunities  of  illustrating  the  prin- 
ciple here  laid  down. 

It  is  highly  probable  that,  upon  all  the  nervous  centres,  those  of  the 
spinal  marrow  and  the  sympathetic  ganglia,  for  example,  and  upon  all 
the  force-generating  nervous  matter  as  distinguished  from  the  mere  con- 
veying structure,  wherever  it  may  exist,  opium  acts  in  the  same  manner 
as  upon  the  brain,  though  in  a  less  degree.  Sufficient  investigation, 
however,  has  not  been  made  upon  this  point,  to  justify  a  positive  con- 
clusion. 


CHAP.  I.]  CEREBRAL   STIMULANTS. — OPIUM.  731 


5.   Therapeutic  Application. 

Opium  has  been  known,  and  probably  used,  from  the  earliest  period 
of  Grecian  history.  It  ranks  among  the  most  important  medicines,  and, 
in  the  variety  of  its  applications,  and  extent  of  its  employment,  stands 
at  the  very  head  of  the  catalogue.  I  shall  first  treat  briefly  of  the  indi- 
cations it  is  calculated  to  fulfil,  and  afterwards,  more  at  length,  of  its 
special  uses. 

a.   Indications  for  the  Use  of  Opium. 

1.  As  a  General  Stimulant.   It  will  be  remembered  that  opium,  in  its 
primary  action,  stimulates  the  circulation  moderately,  and  the  nervous 
system  energetically.     In  reference  to  these  properties,  it  is  indicated 
in    most    acute   affections  in   which   the   vital   powers   and   functions 
generally  are  enfeebled,  as  in  low  fevers,  etc.     An  important  considera- 
tion, in  this  application  of  opium,  is  that  its  stimulant  operation   con- 
tinues longer,  in  quantities  just  insufficient  to  produce  its  narcotic  effects, 
than  in  the  full  anodyne  and  soporific  dose.    Hence,  as  a  mere  stimulant, 
it  should  be  given  iu  rather  small  doses,  which  should  be  repeated  at 
.such  intervals  as  to  sustain  a  steady  operation,  without  allowing  the 
effects  of  successive  doses  to  accumulate,  and  thus  to  bring  about  the 
indirect  sedative  influence  of  the  medicine.     One-eighth,  one-quarter,  or 
one-half  a  grain  may  be  given  for  this  purpose  every  two,  four,  or  six 
hours,  the  smaller  quantity  being  given  at  the  shorter,  and  the  larger  at 
the  longer  interval.     This  rule  applies  to  cases  possessing  the  ordinary 
healthy  susceptibility  to  the  action  of  opium.     Should  the  susceptibility 
be  materially  diminished  by  the  disease,  the  dose  must  be  increased 
accordingly. 

2.  As  a  Nervous  Stimulant.  In  quantities  insufficient  to  produce  any 
material  or  very  sensible  impression  on  the  brain,  opium  acts  precisely 
like  the  nervous  stimulants,  and  may  be  employed  for  similar  purposes. 
Through  the  general  equalizing  influence  upon  the  nervoifb  functions 
which  characterizes  this  class  of  medicines,  it  acts  very  happily  in  a 
great  number  of  slight  nervous  derangements  and  vascular  irritations. 
It  is,  however,  only  in  slight  affections  that  it  acts  on  this  principle  ;  for, 
when  given  in  doses  calculated  to  produce  an  energetic  impression,  it 
ceases  to  be  a  mere  general  nervous  stimulant,  and  concentrates  its  direct 
action  mainly  upon  the  brain.     General  or  local  uneasiness,  restlessness, 
moderate  wakefulness,  slight  pains  and  spasms,  nausea,  etc.,  are  illus- 
trative examples. 

3  AH  a  Special  Stimulant  of  the  Brain.  The  indication  founded  on 
this  property  of  opium  is  highly  important.  Not  a  few  disorders  consist 
essentially  in  a  depressed  or  debilitated  condition  of  the  cerebral  nervous 


732  GENERAL    STIMULANTS.  [PART  II. 

centres ;  and  it  is  often  important  to  be  able  to  apply  to  these  centres  a 
stimulant,  which  shall  not  also  materially  excite  the  circulation.  Thus, 
in  the  collapse  sometimes  attendant  upon  the  cold  stage  of  fevers,  there 
is  not  unfrequently  vast  depression  of  the  nervous  centres;  yet,  as  high 
febrile  reaction  may  soon  supervene,  the  indication  is  very  obvious  for  a 
medicine  which,  while  it  may  rouse  the  depressed  centres,  and  for  a 
time  may  stimulate  the  heart,  shall  cease  to  produce  the  latter  effect  be- 
fore reaction  is  established.  Exactly  such  a  medicine  is  opium,  the 
excitant  action  of  which  upon  the  heart,  at  all  times  moderate,  is  com- 
paratively brief,  and  is  not  likely  in  any  degree  to  aggravate  the  coming 
fever.  It  is  obvious,  however,  that,  in  such  cases,  the  medicine  must 
be  given  in  its  full  dose,  on  account  not  only  of  the  insusceptibility  apt 
to  exist,  but  also  of  the  relative  brevity  of  its  stimulant  operation  on  the 
heart.  Delirium  tremens,  certain  conditions  of  insanity,  and  various 
other  nervous  disorders  call  for  this  cerebral  stimulation  of  opium. 

The  antiperiodic  action,  which  is  often  strongly  evinced  by  opium, 
may  be  considered  as  dependent  directly  upon  its  stimulant  operation  on 
the  cerebral  centres.  In  all  regular  periodical  diseases,  it  is  highly  prob- 
able that  the  paroxysm  makes  its  first  approaches  through  the  nervous 
centres,  and  that,  if  anticipated  in  its  attack  by  a  sufficiently  strong  pre- 
occupation of  those  centres,  it  may  be  warded  off,  and  set  aside  al- 
together; and  it  is  a  law  of  these  diseases  that,  if  the  regularity  of  the 
succession  be  broken,  the  complaint  itself  will  cease,  at  least  for  a  time. 
Now  opium,  through  its  stimulant  operation  upon  the  cerebrum  and 
medulla  oblongata,  is  capable  of  effecting  the  required  preoccupation; 
and,  if  given  so  as  to  be  in  full  action  at  the  time  for  the-  expected  re- 
turn of  the  paroxysm,  will  often  set  it  aside.  The  fullest  dose  of  opium 
is  generally  required  to  answer  this  indication.  Not  only  intermittent 
fever,  but  all  other  regularly  intermittent  diseases,  may  very  often  be 
interrupted  in  this  way. 

4.  As  an  Indirect  Arterial  Sedative.  Allusion  has  been  repeatedly 
made  to  the  diminished  frequency  of  pulse  which  follows,  in  a  short  time, 
the  excitement  produced  by  a  full  dose  of  opium.  A  diminution  in  its 
force,  also,  comes  on  after  a  time  ;  and  a  positive  depression  of  the  cir- 
culation is  thus  effected.  The  larger  the  quantity  of  opium  taken,  the 
more  quickly  is  this  effect  produced;  and  the  inference  is  that,  for  the 
fulfilment  of  the  present  indication,  the  medicine  should  be  given  in  its 
fullest  regular  dose.  It  is  in  inflammations,  and  vascular  irritations  that 
opium  is  called  for  upon  this  ground.  Its  first  stimulant  action,  however, 
is  in  the  way;  and  it  should  not  be  employed  until  the  force  of  the  cir- 
culation has  been  subdued  by  suitable  preliminary  measures,  or  has 
somewhat  subsided  in  the  course  of  the  disease.  The  opium  should 
also,  as  a  general  rule,  be  associated  with  some  other  medicine  calcu- 
lated to  modify  its  stimulant  action;  and  ipecacuanha  or  tartar  emetic  is 


CHAP.  I.]  ,       CEREBRAL  STIMULANTS. — OPIUM.  733 

usually  selected  for  the  purpose.  The  diaphoretic  tendency  of  such  a 
combination,  independently  of  the  depressing  properties  of  the  adjuvant, 
contributes  much  to  the  desired  object. 

5.  As  an  Indirect  Nervous  Sedative.  For  its  action  in  this  way  opium 
is  indicated  in  all  kinds  of  disorder  throughout  the  system,  which  consists 
in  or  depends  on  nervous  irritation.  When  the  capacity  to  feel,  and  the 
power  to  act  fail  in  the  centres,  there  must  be  a  corresponding  depres- 
sion of  their  dependent  functions,  and  an  irritated  or  over- excited  state 
of  these  functions  must  be  diminished  or  cease.  The  particular  affec- 
tions which  may  thus  be  relieved  or  remedied  are  extremely  numerous. 
They  include  pain  in  all  its  varieties,  abnormal  special  sensations,  irreg- 
ular muscular  contraction  of  all  kinds,  restlessness,  wakefulness,  dys- 
pnoea, etc.  The  most  important  therapeutic  effects,  however,  may  be 
ranked  under  the  three  following  heads. 

a.  Fur  the  Relief  of  Pain,  or  the  Anodyne  Effect.  Opium  probably 
relieves  pain  by  an  active  congestion  of  the  cerebral  centres,  which,  ac- 
cording to  the  law  already  stated,  at  length  diminishes  or  suppresses 
their  sensorial  function,  or,  in  other  words,  renders  them  insensible  to 
irritant  impressions  sent  to  them  from  other  parts  of  the  body.  It  is  not 
the  condition  of  the  suffering  part  itself  that  is  modified  by  the  opiate, 
but  mainly  that  of  the  corresponding  nervous  centre  or  centres.  The 
same  relief  would  be  obtained,  by  cutting  off  the  nervous  communication 
between  the  centre  and  the  diseased  part  where  the  source  of  the  pain 
may  exist.  As  the  congestion,  in  the  degree  necessary  to  the  suspen- 
sion of  the  sensibility  of  the  centres,  comes  on  only  after  the  symptoms 
of  excitement  have  subsided,  it  follows  that  the  anodyne  operation  of 
opium  cannot  be  among  its  first  effects;  and  the  fact  is,  that  it  is  not 
until  after  the  lapse  of  a  considerable  time  that  the  relief  from  pain  is  ex- 
perienced. Neuralgia,  inflammation,  and  cancer,  are  among  the  affec- 
tions in  which  opium  is  given  to  fulfil  the  present  indication.  The  occa- 
sions for  its  use  on  this  score  are  almost  innumerable  ;  and,  if  it  were 
capable  of  no  other  application,  it  would  be  an  invaluable  remedy.  Some- 
thing more  is  often  gained  by  the  relief  of  pain  than  a  mere  abatement 
of  the  sufferings  of  the  patient.  The  affection  is  itself  injurious  to  health, 
disturbs  all  the  functions,  interferes  with  sleep,  and  may  even,  if  con- 
tinued, destroy  life.  Opium,  therefore,  must  be  considered  as  not  only 
palliative,  but  frequently  also  as  remedial,  even  in  its  relation  to  pain 
alone. 

In  cases  of  severe  injury,  as  of  a  compound  fracture,  lacerated  gun- 
shot wound,  etc.,  the  relief  afforded  by  opium,  and  the  support  which  it 
yields  to  the  nervous  system,  are  often  so  great  as  to  spare  the  necessity 
of  amputation,  and  thus  to  save  a  limb,  if  not  life  itself,  on  the  battle- 
field. (J.  J.  Chisholm,  Lancet,  July  7,  1866,  p.  14.) 


734  GENERAL   STIMULANTS.  [PART  II. 

b.  For  the  Relief  of  Spasm  or  Irregular  Muscular  Contraction. 
Spasm  is  of  two  kinds,  that  attended  with  severe  pain  commonly  called 
cramp,  and  that  which  occurs  with  little  pain  or  none  whatever,  as  in 
convulsions.  The  observations  in  relation  to  the  anodvne  operation  of 
opium  apply  to  cramps  so  far  as  the  relief  of  pain  is  concerned.  But  it 
does  not  follow  that  the  spasmodic  contraction  should  be  relieved  at  the 
same  time  with  the  pain.  The  probability  is  that  the  spasm,  in  all  cases 
in  which  the  involuntary  muscles,  and  often  where  the  voluntary  muscles 
are  concerned,  depends  upon  impressions  made,  not  through  the  cere- 
bral, but  the  spinal  or  ganglionic  centres  ;  as  in  spasm  of  the  stomach, 
bowels,  etc.,  and  in  tetanus.  Now  opium,  though  it  acts  on  the  nervous 
centres  of  organic  life,  does  so  less  powerfully  than  on  the  cerebral ;  and 
it  might  be  expected  to  relieve  the  pain  more  readily  than  the  spasm,  and 
sometimes  the  former  without  the  latter;  and  this  is  really  the  case. 
Nevertheless,  it  has  the  effect  of  relaxing  the  muscular  contraction  in 
very  many  instances,  and  is  among  the  most  efficient  remedies  in  painful 
spasms.  Larger  doses,  however,  are  in  general  required  for  this  condi- 
tion than  either  for  pain,  or  for  convulsive  movements  of  cerebral  origin, 
as  might  be  anticipated  from  the  less  influence  of  opium  over  the  spinal 
and  ganglionic  than  the  cerebral  centres.  Thus,  spasm  of  the  stomach 
demands  larger  doses  of  opium  than  gastrodynia;  and  tetanus  often  ten 
times  the  quantity  that  would  be  required  to  relieve  severe  rheumatic 
pain,  in  the  same  muscles. 

The  relaxation  of  the  involuntary  muscular  contraction  produced 
through  the  cerebral  centres,  as  in  subsultus  tendinum,  and  various  con- 
vulsive affections,  is  probably  occasioned  partly,  in  the  saaie  manner  as 
the  relief  of  pain,  by  the  diminution  of  the  susceptibility  of  the  cerebral 
centres  through  which  the  irritant  cause  acts,  and  partly  by  the  dimin- 
ished power  of  action  in  the  centres,  which  prevents  them  from  trans- 
mitting to  the  muscles  the  influence  that  induces  contraction. 

c.  For  the  Production  of  Sleep.  To  produce  sleep  is  another  most 
important  indication,  which  opium  is  capable  of  fulfilling  beyond  all 
other  medicines.  It  may  do  this  in  two  modes  altogether  distinct.  When 
wakefulucss  is  caused  by  some  slight  nervous  disorder,  as  not  unfre- 
quently  happens,  small  doses  of  opium,  acting  in  this  respect,  as  a  mere 
nervous  stimulant,  like  assafetida  or  Hoffmann's  anodyne,  occasion  sleep 
by  simply  relieving  this  disorder.  The  patient  goes  to  sleep  naturally, 
because  he  is  not  kept  awake ;  and  the  dose  of  opium,  requisite  for  this 
effect,  would  not  exercise  the  slightest  soporific  influence  upon  a  person 
in  health.  This  is  not,  however,  the  method  of  producing  sleep  to  which 
reference  is  made  at  present.  The  soporific  action,  now  under  consider- 
ation, is  the  result  of  a  direct  influence  of  the  narcotic  upon  the  brain, 
and  is  another  example  of  the  indirect  sedative  influence  of  opium.  The 
sensorial  centres  are  more  deeply  congested,  under  the  stimulation  of  the 


CHAP.  I.]  CEREBRAL   STIMULANTS. — OPIUM.  735 

medicine,  than  is  consistent  with  the  performance  of  their  functions, 
which  are  for  a  time  nearly  or  quite  suspended.  The  capacity  to  feel,  to 
think,  and  to  act,  is  alike  impaired  or  suspended  ;  though  the  spinal  cen- 
tres and  those  of  the  medulla  oblongata  still  operate.  This  condition 
constitutes  sleep.  It  is  a  higher  degree  of  the  same  condition  in  which 
pain  is  relieved.  The  centres  are  rendered  insensible  to  pain ;  while 
still  susceptible  to  impressions  from  the  special  senses,  the  memory,  and 
the  intellect.  A  little  further  congestion ;  and  these  latter  susceptibilities 
cease  more  or  less  completely,  and  sleep,  more  or  less  complete,  takes 
place. 

The  loss  of  rest  is,  in  many  instances,  a  most  serious  complication  of 
disease,  aggravating,  and  probably  rendering  fatal,  cases  which  might, 
but  for  it,  end  in  recovery.  Whenever  it  is  not  attended  with  high  vas- 
cular excitement  or  inflammation  of  the  brain,  it  may  almost  always  be 
advantageously  treated  with  opium.  The  full  dose  of  the  medicine  is 
usually  required;  and,  in  some  cases,  this  must  be  greatly  increased 
beyond  the  Quinary  amount.  .  In  febrile  and  inflammatory  diseases, 
opium  is  often  indicated  in  reference  to  this  effect;  and  in  delirium  tre- 
mens,  and  certain  conditions  of  insanity,  in  which  obstinate  wakeful- 
ness  is  one  of  the  most  prominent  symptoms,  it  is  the  remedy  chiefly 
relied  on. 

6.  For  the  Suppression  of  Morbid  Discharges.  It  has  been  stated 
that  opium  has  a  powerful  influence  in  diminishing  the  secretions,  espe- 
cially those  from  the  mucous  membrane  and  liver.    This  property  serves 
as  the  ground  of  its  employment  in  various  diseases,  consisting  in,  or 
connected  with  a  morbid  increase  of  these  secretions.     Hence  its  use  in 
diarrhoea,  cholera  morbus,  and  epidemic  cholera.     A  similar,  though  less 
reliable -influence  on  the  kidneys,  renders  it  sometimes  useful  in  morbid 
increase  of  the  urinary  secretion.     It  checks  also  excessive  salivation. 
By  an  action,  probably  of  an  analogous  character,  it  often  proves  useful 
in  hemorrhages.     The  precise  principle  on  which  opium  produces  either 
of  these  effects,  that  is,  a  diminution  of  the  secretions  referred  to,  or  of 
hemorrhage,  is  not  certainly  known.     But  it  may  be  conjecturally  as- 
cribed to  the  same  indirect  sedative  influence  overthe  capillaries,  which 
is  exercised  over  the  heart  itself,  and,  indeed,  more  or  less  over  the  whole 
system,  through  the  over-excited  and  congested  state  of  the  cerebral 
centres  on  which  it  acts. 

7.  As  a  Diaphoretic.  The  increase  of  perspiration  produced  by  opium, 
especially  when  combined  with  ipecacuanha  or  tartar  emetic,  is  among 
the  most  useful  of  its  therapeutic  effects.     But  in  this  relation,  the  med- 
icine will  be  treated  of  among  the  diaphoretics. 

Not  unfrequently  several  of  these  indications  for  the  use  of  opium 
exist  conjointly  in  the  same  disease,  of  which  frequent  examples  will  be 
given  when  we  cuuie  to  treat  of  its  special  applications. 


736  GENERAL  STIM PLANTS.  [PART  II. 

b.  Contraindications  to  the  Use  of  Opium. 

Opium  is  contraindicated  by  a  high  stale  of  febrile  excitement  with  a 
full  strong  pulse,  by  determination  of  blood  to  the  head  threatening 
apoplexy,  by  hemorrhage  in  the  brain,  by  acute  inflammation  of  (he 
brain  and  its  meninges,  and  in  the  early  stage  of  all  acute  inflamma- 
tions with  a  strong  pulse,  before  sufficient  preliminary  reduction.  Its 
direct  stimulant  properties  render  it  inapplicable  to  conditions  of  high 
vascular  excitement  in  general ;  and  its  special  action  on  the  brain,  to 
those  most  emphatically,  in  which  the  cerebral  centres  are  already 
actively  congested. 

Another  special  contraindication  is  acute  inflammation  of  the  mucous 
membranes,  particularly  th at  of  the  bronchial  tubes,  before  secretion  has 
become  established.  Here  there  is  risk  that  its  property  of  checking  the 
secretion  from  these  membranes  may  tend  to  aggravate  the  inflamma- 
tion, by  interfering  with  the  process  which  nature  has  intended  lor  the 
cure. 

Nor  should  opium  in  general  be  given-  in  parenchymatous  hepatitis. 
in  consequence  of  its  strong  influence  in  arresting  the  secretion  of  bile, 
and  thus  locking  up  the  disease  in  the  substance  of  the  gland. 

Excessive  sweating,  constipation  of  the  bowels,  a  feeble  digestion  and 
want  of  appetite,  and  defective  biliary  secretion,  are  all  more  or  less  in 
opposition  to  the  use  of  opium ;  but,  when  the  indications  for  its  use  are 
decided,  they  should  not  be  allowed  to  interfere;  as  means  may  be  read- 
ily found  to  correct  its  ill  effects  in  these  conditions. 

I  think  I  have  observed  that  opium  sometimes  aggravates  cutaneous 
eruptions,  through  the  direction  which  it  frequently  gives  of  irritation  to 
the  surface  of  the  body. 

We  have  been  cautioned  in  relation  to  the  use  of  opium  in  nursing  and 
pregnant  women,  under  the  apprehension  that,  in  the  former,  the  im- 
pregnation of  the  milk  with  its  active  matter  might  prove  injurious  to  the 
infant,  and,  in  the  latter,  that  the  drug  might  prove  poisonous  to  the  foetus. 
I  have  myself  noticed  neither  of  these  effects;  but  do  not  wish  by  this 
statement  to  invalidate  the  caution  urged  by  others. 

c.  Special  Therapeutic  Applications. 

1.  Idiopathic  Fevers.  Several  indications  for  the  use  of  opium  are 
offered  in  different  varieties  and  conditions  of  fever.  As  a  stimulant  it 
is  very  useful  in  the  low  or  typhoid  state  of  fever,  when  the  pulse  is  fee- 
ble, and  the  blood  impaired.  Not  only  is  the  circulation  weak,  but  the 
cerebral  centres  also,  in  consequence  either  of  the  depressing  effect  of  the 
cause,  or  of  the  depraved  blood.  Stupor  or  delirium  does  not,  in  these 
cases,  constitute  a  contraindication,  when  the  low  muttering  character 
of  the  latter,  and  the  capability  of  being  roused  from  the  former,  taken 
in  connection  with  the  general  condition  of  the  system,  show  that  the 


CHAP.  I.]  CEREBRAL    STIMULANTS. — OPIUM.  737 

brain  is  suffering  rather  from  debility  than  from  over-excitement.     In- 
deed, opium,  by  stimulating  the  cerebral  centres,  often  operates  favour- 
ably in  relieving  the  two  conditions  referred  to.     The  tremors,  subsultus 
tendinum,  general  uneasiness,  occasional  wakeful  ness,  and  other  nervous 
disorder  afford  other  indications  for  the  use  of  opium,  which  is,  in  fact. 
among  our  best  remedies  in  the  typhoid  condition  of  fever.     By  this 
expression  I  do  not  wish  to  designate  a  special  febrile  disease,  as  typhus 
or  enteric  fever,  though  these  afford  the  best  characterized  type  of  the 
condition;  but  a  peculiar  state  of  febrile  disease,  which  may  attend  any 
one  of  the  idiopathic,  and,  indeed,  even  of  the  symptomatic  fevers,  and 
may  be  known,  wherever  it  exists,  by  a  feeble  pulse,  dryness  and  dark- 
ness of  the  tongue  or  a  tendency  to  them,  a  dusky  hue  of  the  surface,  and 
more  or  less  of  the  nervous  derangements  just  mentioned.      It  is  sel- 
dom met  with  at  the  commencement  of  the  special  fever  which  it  accom- 
panies ;  and  opium,  therefore,  is  not  usually  indicated   at  that  stage. 
The  medicine  may  be  combined  with  ipecacuanha  when  the  skin  is  dry ; 
and  a  little  blue  mass  may  often  be  added  to  the  two,  with  a  view  to  its 
stimulant  influence  on  the  various  secretions.    They  should  all  be  given, 
as  a  general  rule,  in  these  cases,  in  small  doses  frequently  repeated.     A 
favourite  combination  of  my  own,  under  these  circumstances,  consists  of 
one- sixth  of  a  grain  of  opium,  the  same  quantity  of  ipecacuanha,  and 
half  a  grain,  or  a  grain  of  the  mercurial  pill,  to  be  given  every  two 
hours.     This  is  especially  adapted  to  the  condition  as  it  occurs  in  enteric 
or  typhoid  fever.      When  opium,  in  cases  of  this  character,  increases 
stupor,  delirium,  heat  of  skin,  dryness  of  mouth,  or  frequency  of  pulse, 
it  is  acting  injuriously,  and  should  be  omitted.     But  when  it  quiets  deli- 
rium, gives  a  disposition  to  natural  sleep,  lessens  the  frequency  but 
increases  the  fulness  and  force  of  pulse,  and  moistens  the  skin,  it  is  act- 
ing beneficially,  and  should  be  persevered  in. 

Without  having  the  typhoid  character,  fevers  are  not  unfrequently  at- 
tended with  nervous  disorder,  such  as  twitchings  of  the  muscles,  sudden 
start  ings,  general  uneasiness,  restlessness,  want  of  sleep,  and  sometimes 
slight  delirium,  which  will  often  yield  to  a  full  doge  of  opium,  with  an 
equal  quantity  of  ipecacuanha,  or  a  proportionate  amount  of  tartar  emetic, 
given  at  bedtime.  But,  in  determining  as  to  the  propriety  of  adminis- 
tering it  in  such  cases,  reference  should  always  be  had  to  the  contraindi- 
cations mentioned  in  page  736. 

There  is  another  condition  of  fever  in  which  opium  is  strongly  indi- 
cated, with  a  view  to  its  stimulant  influence,  especially  on  the  cerebral 
centres.  I  allude  to  the  cold  stage  at  the  commencement  of  fevers,  when 
it  assumes  a  violent  character,  either  simply  of  collapse,  or  of  this  with 
intense  disturbance  of  the  functions.  Such  a  condition  characterizes  the 
onset  of  pernicious  miasmatic  fever;  but  it  is  also  not  unfrequently  met 
with  in  other  malignant  fevers,  as  in  malignant  typhus,  yellow  fever, 
VOL.  i. — 47 


738  GENERAL   STIMULANTS.  [PART  II. 

smallpox,  ery*ii>e,lo.<,  etc.;  and,  in  a  less  degree,  in  febrile  diseases  not 
malisrnant.  In  the  chill  of  common  intermittent  feoer,  the  depression 
is  often  so  great  and  so  lasting  as  to  call  for  the  same  treatment.  In 
all  these  cases,  the  original  depression  is  in  the  nervous  centres.  It  i> 
through  them  that  the  cause  of  the  fever  first  acts,  and,  prostrating  them 
by  its  shock,  produces  the  general  prostration  as  a  secondary  result. 
Opium  is  obviously  indicated  by  its  highly  stimulant  action  upon  these 
centres ;  and  is  preferable  to  alcohol,  because  the  excitement  of  the  cir- 
culation which  it  produces  is  sooner  over,  and  does  not,  therefore,  con- 
tinue forward  into  the  stage  of  reaction,  as  the  alcoholic  stimulation 
does.  Ardent  spirits  might  equally  excite  the  nervous  centres,  though 
even  in  this  respect  their  operation  is  less  favourable  than  that  of  opium  : 
but  they  also  endanger  an  increase  of  the  fever  to  follo\v.  which  opium, 
properly  used,  does  not.  The  latter  medicine  is.  indeed,  of  the  utmost 
importance  in  the  condition  now  under  consideration,  and  perhaps,  on  the 
whole,  superior  to  all  other  remedies.  It  should  always  be  given  in  full 
doses,  being  quite  inadequate  to  the  desired  effect  in  small  quantities. 
The  only  contraindication  is  an  active  congestion  or  inflammation  of  the 
brain  ;  but,  happily,  this  is  comparatively  rare  under  the  circumstances 
referred  to.  In  doubtful  cases,  great  contraction  of  the  pupil  might  add 
some  weight  to  that  of  other  symptoms  marking  the  contraindicating 
condition  of  the  brain  ;  but  alone  it  is  of  little  value. 

Still  another  condition  common  in  fevers,  and  indicating  the  use  of 
opium,  is  sickness  at  the  stomach.  When  this  does  not  depend  on  acute 
gastric  inflammation,  it  will  often  yield  promptly  to  opium  or  its  prepa- 
rations, administered  by  the  mouth,  the  rectum,  or  endermically  at  the 
epigastrium. 

The  special  fevers  occasionally  offer  special  indications  for  opium  be- 
sides those  mentioned.  Thus,  it  is  often  useful  in  the  enteric  or  typhoid 
fever,  by  putting  a  check  to  exhausting  diarrhu-a.  and  aiding  in  the  sup- 
pression of  hemorrhage  from  the  bowels  in  the  advanced  stage. 

In  smallpox  it  is  very  serviceable  in  the  stage  of  maturation,  and  sub- 
sequently by  modeling  the  irritative  reaction  of  the  disease  .if  the 
surface  upon  the  system  generally.  This  it  does  by  diminishing  the 
susceptibility  of  the  nervous  centres,  ami  consequently  their  power  of 
receiving  impressions  from  the  surface,  and  transmitting  them,  in  the 
form  of  irritation,  to  the  heart,  lungs,  etc.  The  same  remark  is  applica- 
ble to  er>/x//>c!ax ;  hut  caution  is  more  necessary  in  this  affection,  not  to 
aggravate  any  existing  disposition  to  cerebral  congestion. 

in  intermittent  fevt99,  opium  will  often  effect  cures,  and  may  lie  very 
beneficially  resorted  to  in  the  absence  of  quinia.  or  as  an  adjuvant  to  that 
medicine.  To  he  most  efficient,  it  must  be  given  in  the  intermission. 
and  so  that  it  shall  be  in  full  action  at  the  time  of  the  expected  return  of 
the  paroxysm,  its  operation  is  strictly  antiperiodic,  ami  has  already  been 


CHAP.  I.]  CEREBRAL    STIMULANTS. — OPIUM.  739 

explained  under  the  indications  for  the  use  of  opium.  (See  page  732.) 
Somewhat  more  than  the  medium  full  dose  may  be  given  in  this  case. 

2.  Inflammations,  Much  apprehension  has  'been  entertained  of  the 
effects  of  opium  in  acute  inflammations.  The  medicine  is  a  stimulant : 
inflammation  is  essentially  a  state  of  over-excitement;  and  the  two  have 
consequently  been  by  some  considered  as  almost  incompatible.  But  the 
fact  is  otherwise.  Experience  has  shown  that  opium  is  a  highly  useful 
remedy,  when  properly  administered,  in  acute  inflammations.  In  cer- 
tain cases,  given  in  full  dose,  at  the  very  first  approach  of  the  dis- 
ease, it  will  often  set  it  aside  entirely,  especially  if  taken  with  ipecac- 
uanha at  bedtime,  and  aided  in  its  operation  by  draughts  of  some  warm 
tea,  as  the  infusion  of  balm.  It  seems  to  preoccupy  the  nervous  centres 
so  as  to  arrest  the  irritant  influence  of  the  cause,  while  it  carries  off 
the  morbid  tendencies  through  the  skin,  by  its  diaphoretic  action.  The 
special  inflammations  in  which  opium  is  most  efficient  in  this  way  are 
those  of  the  respiratory  passages,  as  coryza,  angina,  and  bronchitis,  and 
different  forms  of  rheumatism,  particularly  the  subacute.  There  is 
sometimes,  however,  danger,  if  it  should  fail  of  its  effects,  that  it  may 
somewhat  aggravate  the  affection;  and  the  method  is  not  generally 
advisable. 

After  the  inflammation  has  become  established,  especially  if  it  is 
severe,  opium  is  at  first,  in  general,  contraindicated.  Its  stimulating 
properties  are  as  yet  in  too  strong  contrast  with  the  wants  of  the 
disease.  Before  commencing  with  it,  the  activity,  both  of  the  inflam- 
matory action  and  of  the  attendant  fever,  should,  in  general,  be  reduced 
by  depletory  methods,  as  by  purgatives,  the  lancet,  the  antinionials,  et<-  ; 
but.  at  the  end  of  two  or  three  days,  a  sufficient  reduction  may  ordina- 
rily be  accomplished,  sometimes  even  sooner,  and  the  opiate  be  safely 
administered. 

It  operates  very  usefully  in  various  ways.  In  the  first  place,  it  alle- 
viates pain,  thereby  preventing  the  injurious  reaction  of  that  morbid 
condition  on  the  system,  as  well  as  diminishing  the  sufferings  of  the 
patient.  But  the  practitioner  must  take  care  not  to  mistake  the  relief 
thus  obtained  for  a  positive  amendment,  or  he  may  be  led  into  serious 
practical  error.  ,  He  must  learn  to  estimate  the  real  state  of  the  inflam- 
mation by  other  symptoms  than  the  pain.  In  the  second  place,  opium 
enables  the  patient  to  sleep,  and  obviates  the  exhausting  effects  of  long 
wakefulness  upon  the  resources  of  the  system,  and  its  direct  injury  to  the 
brain.  But,  thirdly,  it  is  still  more  influential  for  good,  by  reducing  at 
once  the  inflammation  and  the  febrile  excitement,  through  its  indirect 
sedative  action.  In  the  inflamed  part,  the  nervous  constituent  suffer.- 
irritation  as  well  as  the  vascular;  and  the  former,  reacting  on  the  latter, 
aids  in  sustaining  the  excitement  in  the  vessels,  and  the  consequent  in- 
flammatory phenomena.  This  property  of  the  nerves,  when  irritated,  to. 


740  GENERAL   STIMULANTS.  [PART  II. 

propagate  irritation  to  the  blood-vessels,  is  obvious  even  in  pure  neural- 
gia. In  this  affection,  though  the  seat  of  pain  may  be  at  first  colour- 
less, it  soon  evinces  signs  of  vascular  congestion,  by  redness,  heat,  etc. 
I  fence,  in  cases  of  inflammation,  if  we  can  diminish  the  nervous  irrita- 
tion in  the  part,  we  diminish  also  the  inflammatory  action.  Opium  pro- 
duces, this  effect  under  the  same  circumstances  as  those  in  which  it 
relieves  pain,  and  through  the  same  influence.  Again,  the  local  disease 
produces  fever,  partly  at  least,  if  not  exclusively,  by  operating  on  the 
system  at  large  through  the  nervous  centres.  If  these  are  rendered  ob- 
tuse or  insensible,  so  as  not  to  be  susceptible  to  impression  from  the  in- 
flamed part,  the  reaction  on  the  system  must  be  diminished,  and  more  or 
less  in  the  same  proportion.  In  this  way  opium  has  a  tendency  to  lessen 
the  fever  in  inflammation,  and,  as  the  fever  reacts  again  on  the  local  dis- 
ease, to  diminish  that  also. 

Bat,  to  do  good  in  inflammation,  the  medicine  must  be  given  in  full 
doses,  so  as  to  act  energetically  as  an  indirect  sedative.  The  plan 
which  I  generally  pursue  in  acute  inflammation  is,  after  sufficient  deple- 
tion, which  may  usually  be  effected  in  two  or  three  days,  to  give  opium 
at  bedtime,  combined  with  ipecacuanha  and  calomel,  in  a  dose  large 
enough  to  put  the  patient  to  sleep.  Two  grains  of  opium,  two  of  ipe- 
cacuanha, and  from  two  to  four  of  calomel  may  be  made  into  four  pills, 
two  to  be  given  at  once,  a  third  at  the  end  of  an  hour,  if  sleep  is  not 
produced,  and  the  fourth  at  the  end  of  another  hour,  in  a  similar  contin- 
gency. This  plan  may  be  continued  regularly  till  no  longer  required; 
the  bowels  being  opened  daily.  The  basis  of  a  mercurial  treatment  is 
thus  laid,  which,  if  deemed  advisable  from  the  threatening  character  of 
the  inflammation,  maybe  carried  into  effect  about  the  fifth  or  seventh 
day,  by  giving  two  of  the  pills  every  six  or  eight  hours,  or  one  at  half 
the  interval,  till  the  gums  are  touched.  The  opiate  should  be  gradually 
withdrawn  when  no  longer  needed;  so  that,  when  the  patient  has  quite 
recovered,  the  want  of  it  may  not  be  felt.  Inflammation  occurring  in 
different  organs  requires  some  modification  of  this  treatment. 

In  acute  </a.s/ ?•///«,  the  opium  and  calomel  should  generally  be  given 
without  the  ipecacuanha,  which  is  apt  to  occasion  nausea. 

In  severe  cases  of  enteritis  and  dysentery,  the  above  treatment  is  spe- 
cially useful;  anodyne  enemata  being  additionally  employed  in  the  latter 
affection,  when  found  upon  trial  to  allay  the  tenesmus.  In  tli/watery, 
opium  has  by  some  been  considered  as  contraindicated,  in  consequence  of 
its  constipating  effects;  but  experience  has  not  confirmed  these  appre- 
hensions. It  is,  indeed,  if  properly  timed  and  used,  one  of  the  n 
effectual  remedies  in  that  complaint,  especially  when  combined  as  above 
recommended.  It  relieves  the  spasmodic  pains  of  the  complaint,  and 
does  not  interfere  with  the  action  of  cathartics,  but  probably  rather  facil- 
itates it.  But  the  caution  must  be  observed  of  keeping  the  bowels  duly 
•open  during  the  day. 


CHAP.  I.]  CEREBRAL    STIMULANTS. — OPIUM.  741 

In  peritonitis  opium  and  calomel  are  invaluable,  when  further  deple- 
tion is  out  of  the  question,  and  in  cases  which  will  not  admit  of  depletion 
at  all.  In  the  peritonitis  from  perforation  of  the  bowels,  opium  is  the 
only  remedy  upon  which  reliance  can  be  placed.  In  the  same  affection, 
without  perforation,  occurring  in  the  course  of  low  febrile  diseases. 
or  attended  from  the  beginning  with  the  same  condition  of  system,  the 
opiate  plan  with  mercury  should  be  commenced  immediately  after  a  thor- 
ough evacuation  of  the  bowels;  the  opium  being  freely  administered, 
and  the  bowels  afterwards  left  undisturbed,  except  by  the  occasional 
exhibition  of  a  cathartic  enema,  to  evacuate  the  rectum  and  lower  colon. 
Prof.  A.  Clark,  of  Xew  York,  has  found  large  doses  of  opium  the  most 
effectual  remedy  in  puerperal  fever,  when  peritonitis  is  "a  prominent  ele- 
ment" in  the  disease.  (New  York  Journ.  of  Med  ,  March,  1855.) 

In  hepatitis,  opium  should  be  used  with  more  reserve,  in  consequence 
of  its  property  of  checking  the  secretion  of  bile.  Still,  if  it  be  combined 
with  calomel,  this  effect  may  be  in  a  considerable  degree  obviated ;  and 
I  should  not  hesitate  to  employ  it,  if  necessary  to  procure  sleep.  It  is, 
however,  better  adapted  to  those  cases  in  which  the  investing  membrane 
is  affected.  In  the  parenchymatous  inflammation  of  the  gland,  it  would 
be  best,  on  the  whole,  not  to  use  it;  and  as  the  pain  is  in  this  case  less 
severe,  there  is  not  the  same  occasion  for  its  use. 

In  inflammations  of  the  internal  urinary  and  genital  organs,  the 
general  rule  as  to  the  use  of  opium  holds  good  ;  but,  as  the  stomach  is 
very  apt  to  be  irritable  in  nephritis,  it  is  often  necessary  to  omit  the  ipe- 
cacuanha; and,  in  all  these  cases,  the  opiate  is  in  general  most  effica- 
ciously administered  by  enema, 

All  (he  inflammatory  affections  of  the  chest,  whether  of  the  respira- 
tory or  circulatory  organs,  come  under  the  general  rule,  with  the  excep- 
tion of  the  different  forms  of  acute  bronchitis,  in  which  opium  should 
ordinarily  not  be  given  until  secretion  has  been  thoroughly  established; 
as  it  tends  to  prevent  this  result,  and  thus  to  increase  the  pectoral  op- 
pre-sion,  and  to  aggravate  the  disease.  lUit,  when  the  acuteness  of  the 
inflammation  has  been  subdued,  and  expectoration  has  become  free, 
opium  in  moderate  doses  is  often  very  useful,  in  connection  with  expecto- 
rants, in  relieving  the  harassing  cough,  and  enabling  the  patient  to  rest. 
The  same  rule  applies  also  to  the  chronic  form  of  the  complaint. 

After  what  has  lieen  already  stated,  under  the  head  of  contraindica- 
tions to  the  use  of  opium,  it  is  scarcely  necessary  to  repeat  that  it  i> 
altogether  unsuitable  to  the  treatment  of  acute  inflammation  of  the  brain, 
and  of  very  doubtful  advantage  even  in  the  chronic;  though  cases  some- 
times occur,  in  which,  from  the  particular  seat  of  the  affection,  as,  for 
example,  when  confined  exclusively  to  the  meninges,  the  indications  for 
its  use  more  than  balance  the  contraindications.  To  procure  rest  is 
sometimes,  under  these  circumstances,  all-important;  and  opium  may  be 


742  GENERAL    STIMULANTS.  [PART  II. 

cautiously  used,  when  no  symptoms  of  acuteness  in  the  inflammation 
are  present. 

In  erysipelatous  inflammation  of  the  skin,  opium  may  be  given  when 
not  forbidden  by  stupor  or  coma. 

But  of  all  the  inflammatory  affections  there  is  no  one  to  which  it  is 
better  adapted  than  acute  rheumatism.  After  two  or  three  days  given 
to  depletory  measures,  opium  and  ipecacuanha,  or  the  Dover's  powder, 
may  be  used  very  freely :  and,  if  associated  with  calomel,  so  as  to  affect 
the  system  in  the  course  of  the  second  week,  will  in  general  be  found 
adequate  to  the  cure.  In  subacute  rheumatism,  the  remedy  is  indicated 
from  the  commencement ;  and,  in  the  chronic  form,  a  Dover's  powder 
at  bedtime  may  enter  into  almost  every  plan  of  treatment  adopted  in  that 
complaint. 

In  acute  gout,  too,  it  is  highly  useful  at  bedtime,  in  relieving  pain  and 
enabling  the  patient  to  sleep,  and,  so  far  as  I  have  seen,  does  no  harm. 
It  is,  however,  in  this  complaint  better  associated  with  colchicum ;  mid 
the  mercurial  addition  is  not  advisable  unless  merely  to  stimulate  the 
liver  when  torpid. 

In  the  suppurative  stage  of  inflammation,  opium,  in  moderate  stimu- 
lant doses,  is  of  great  use  in  supporting  the  system,  and  comforting  the 
patient;  and  should  generally  be  given  with  the  tonics  and  stimulants 
employed. 

Ulceration,  when  painful,  and  indisposed  to  the  healing  process  in  con- 
sequence of  an  irritated  condition,  connected,  it  maybe,  with  an  irrita- 
ble state  of  the  system  at  large,  may  be  advantageously  treated  with 
opium,  both  given  internally,  and  applied  topically.  M.  Ilodet  has  de- 
rived great  advantage  from  it  in  the  phagedenic  serpiginous  ulcerationx 
of  syphilis,  in  which  mercury  is  altogether  contraindicated.  (Med.  Times 
andGaz.,  Aug.  1856,  p.  170.)  Mr.  Skey,  of  St.  Bartholomew's  Hos- 
pital, London,  considers  no  treatment  equal  to  the  opiate,  in  very  old 
and  obstinate  ulcers  of  the  limbs  or  other  parts,  in  which  it  seems  to  act 
with  a  restorative  power,  wholly  independent  of  its  mere  sedative  influ- 
ence. (Banking's  Abstract,  No.  xxiii.  p.  120.) 

When  inflammation  is  attended  with  gangrene,  opium  is  an  invaluable 
remedy,  relieving  the  pain  often  attendant  on  that  affection,  and  sup- 
porting the  nervous  centres  under  its  prostrating  influence.  Indeed, 
opium  is  indicated  in  mortification  under  almost  any  circumstances; 
and,  in  the  last  stage  of  acute  inflammation  of  the-  alimentary  canal, 
iriven  in  combination  A\  ith  oil  of  turpentine,  it  affords,  in  some  instances, 
almost  the  only  remaining  chance  lor  the  patient. 

After  all  that  has  been  stated  above,  I  wish  not  to  be  understood  as 
recommending  opium  in  all  cases  of  Inflammation,  when  no  positive  con- 
traindication may  exist.  In  slight  or  even  moderate  cases,  and  in  the 
chronic  (onus  generally,  it  ,-hould  lie  employed  with  irreat  caution,  from 
the  fear  of  leading  the  patient  into  its  habitual  and  excessive  use. 


CHAP.  I.]  CEREBRAL    STIMULANTS. — OPIUM.  743 

3.  Vascular  Irritation.    In  this  condition,  opium  is  often  of  great  ad- 
vantage, by  diminishing  the  susceptibility  of  the  nervous  tissue  of  the 
part,  and  of  the  nervous  centres,  and  thus  obviating  their  injurious  reac- 
tion upon  the  vascular  tissue  and  the  heart. 

In  nausea  and  vomiting  from  this  cause,  it  is  an  admirable  remedy, 
applied  either  by  the  stomach,  the  rectum,  or  endermically  to  the  epi- 
gastrium; the  t\vo  latter  methods  being  resorted  to,  severally  or  con- 
jointly, upon  failure  with  the  first.  The  subcutaneous  exhibition  also  of 
the  medicine  is  strongly  indicated  under  these  circumstances. 

When  any  medicine  has  a  tendency  to  irritate  the  stomach,  this  may 
generally  be  corrected  by  conjoining  the  medicine  with  a  little  opium, 
which  is  very  much  used  for  the  purpose,  and  may  always  be  employed 
unless  when  specially  contraindicated.  Thus,  it  may  be  given  with 
nitrate  of  silver  in  chronic  gastritis,  and  sulphate  of  copper  in  chronic 
enteritis;  but  should  not  generally  be  exhibited  with  cathartics,  which  it 
tends  to  counteract,  nor  with  tonics  in  dyspepsia,  because  it  rather 
weakens  than  invigorates  the  digestive  function. 

In  slight  diarrhoeas,  resulting  from  vascular  irritation,  opium  is  often 
the  only  remedy  required,  when  there  is  no  indication  for  evacuating  the 
bowels;  and,  when  such  an  indication  is  offered  by  the  presence  of  irri- 
tating matters,  no  remedy  is  so  promptly  effectual  as  fifteen  or  twenty 
drops  of  laudanum  with  a  full  dose  of  castor  oil.  In  acrid  poisoning, 
after  the  evacuation  of  the  irritating  agent  both  from  the  stomach  and 
bowels,  opium  is  the  chief  remedy  required;  and  it  may  often  be  used 
advantageously  in  connection  with  the  special  antidote  of  the  poison. 
Emetics  and  acrid  cathartics  frequently  leave  an  irritation  behind  them, 
which  is  promptly  relieved  by  opiates  either  by  the  stomach  or  the  rec- 
tum. In  irritations  of  the  urinary  and  genital  organs  they  are  no  less 
promptly  useful,  and  often  afford  almost  instant  relief  to  great  distress, 
as,  for  example,  in  the  strangury  from  blisters.  In  these  affections,  the 
opium  is  most  effectual  when  given  by  injection,  or  used  as  a  suppository. 

4.  Nervous  irritation.   This  exhibits  itself  in  a  great  diversity  of  forms, 
which  require  a  separate  consideration. 

Neuralgic  pain  is  among  the  most  frequent.  Wherever  this  occurs, 
and  under  whatever  name,  opium  is  at  least  a  most  efficient  palliative, 
sometimes  absolutely  indispensable  from  the  suffering  of  the  patient, 
Not  unfrequently  it  will  set  the  disease  aside  entirely  for  the  time,  espe- 
cially when  occurring  periodically.  Given  so  as  fully  to  affect  the  sys- 
tem, it  will  often  wholly  supersede  the  paroxysm,  and  by  thus  breaking 
the  chain  of  morbid  association,  effect  at  least  a  temporary  cure.  The 
quantity  necessary  to  produce  relief  varies  greatly  with  the  violence  of 
the  pain,  and  the  constitutional  susceptibility  of  the  patient.  Sometimes 
an  ordinary  full  dose  w*  answer ;  but  it  will  often  be  found  necessary  to 
double,  triple,  or  quadruple  it,  before  relief  can  be  procured.  AY  hen 


744  GENERAL    STIMULANTS.  [PART  II. 

local  application  will  answer  the  purpose,  it  should  be  preferred,  as  inter- 
fering less  with  the  functions  of  the  stomach  and  bowels.  With  the  skin 
unbroken,  little  effect  can  generally  be  obtained;  but,  by  means  of  the 
eudermic  method,  or  by  injection  into  the  subcutaneous  areolar  tissue, 
the  medicine  may  generally  be  used  with  prompt  and  powerful  effect,  in 
the  form  of  one  of  the  salts  of  morphia.  Not  unfrequently  a  specially 
tender  spot  may  be  discovered  in  the  track  of  the  nervous  trunk,  sup- 
plying the  painful  part.  In  this  case,  the  remedy  should  be  applied  to 
the  point  of  tenderness ;  the  cuticle  having  been  first  removed  by  a  blister. 
But  a  great  objection  to  the  use  of  opium  in  neuralgia  is  the  increasing- 
dose  in  which  it  must  be  successively  employed  in  order  to  procure  relief, 
and  the  consequent  danger  of  augmenting  the  quantity  indefinitely,  until 
the  effects  of  the  remedy  become  almost  as  pernicious  as  the  disease  it- 
self. This  objection  applies  especially  to  oases  in  which  the  affection  is 
incessant  in  its  attacks,  and  probably  incurable.  Yet  the  patient  will 
seldom  submit  to  severe  suffering,  when  an  agent  of  present  relief  is  at 
hand  ;  and  the  duty  of  the  physician  is  so  to  regulate  the  remedy  as  to 
obviate  its  ill,  and  protract  its  beneficial  effects  as  far  as  possible.  This 
is  to  be  done  by  allowing  the  dose  to  be  increased  only  when  absolutely 
necessary ;  by  varying  the  surface  of  application  between  the  stomach, 
the  rectum,  the  skin,  and  the  areolar  tissue;  by  occasionally  intermitting 
the  use  of  the  medicine,  and  endeavouring  to  obtain  a  similar  effect  by 
anodynes  acting  on  different  principles,  as  by  chloroform  or  conium  ;  and 
by  correcting  any  resulting  disorder  of  the  functions  by  proper  means,  as 
constipation  by  laxatives,  deficient  action  of  the  liver  by  mild  mercurials 
or  nitromuriatic  acid,  and  enfeebled  digestion  by  tonics,  taking  care  not 
to  do  injury' by  the  excessive  use  of  the  counteracting  measures.  By  this 
plan,  in  incurable  cases,  the  patient  may  be  rendered  more  comfortable, 
and  his  life  prolonged  ;  whereas,  if  left  to  his  own  unrestrained  propen- 
sities, he  might  soon  exhaust  the  susceptibility  of  his  system,  and  thus 
render  the  remedy  almost  useless. 

Even  in  occasional  sit  tacks  of  neuralgia,  occurring  at  considerable  in- 
tervals, the  physician  should  always  bear  in  mind  the  danger  of  laying 
the  foundation  of  an  evil  habit,  and  should  guard  the  use  of  opiates  with 
such  precautions  as  may  tend  to  obviate  this  result.  Sometimes,  in  per- 
sons of  feeble  intelligence,  or  deficient  power  of  self-control,  it  may  be 
proper  to  disguise  the  medicine,  so  that  the  patient  may  not  know  what 
lie  is  taking;  and  generally  it  is  best  to  confine  the  use  of  opium,  when 
the  recurrence  of  the  pain  is  frequent,  to  the  severest  attacks. 

Besides  the  external  attacks  of  neuralgia,  which  may  occur  in  any 
sensitive  part  of  the  body,  from  the  crown  of  the  head  to  the  joints  of 
the  great  toe,  there  are  various  internal  Conns  of  it,  which  are  sometimes 
even  more  imperious  in  their  demands  for  reliefs  angina  pectoris,  gas- 
tralgia,  enleralgia,  nephralgia,  and  dysmenorrhcea,  the  last  of  which 


CHAP.  I.]  CEREBRAL    STIMULANTS. OPIUM.  745 

is,  I  believe,  often  nothing  but  a  neuralgic  form  of  rheumatism,  and  may 
be  most  effectually  relieved  by  this  anodyne  given  by  the  rectum.  In 
nervous  toothache,  and  earache,  opium  may  often  be  applied  locally  with 
effect;  being  introduced  into  a  carious  cavity,  should  a  cavity  exist. 
in  the  former  case,  and  in  a  liquid  form  into  the  rneatus  externus,  in  the 
latter. 

Neuralgia  is  often  nothing  more  than  a  form  of  nervous  gout  or 
rheumatism,  in  which  cases  the  opiate  may  be  associated  with  the  wine 
or  extract  of  colchicura,  and  frequently  also  advantageously  with  a 
saline  cathartic. 

Nervous  headache,  or  sick-headache,  will  often  yield  happily  to  a  full 
dose  of  opium  or  morphia,  which  is  most  effectual,  however,  in  the  latter 
affection,  when  it  perseveres,  after  evacuation  of  the  stomach.  But  care 
must  be  taken  not  to  confound  this  complaint  with  headache  from  vas- 
cular irritation,  or  active  congestion  of  the  brain. 

In  cancerous  affections  it  is  often  necessary  to  have  recourse  to  ano- 
dynes; and  the  observations  above  made,  in  relation  to  the  precautions 
necessary  to  guard  against  the  abuse  of  the  medicine  in  incurable  neu- 
ralgia, and  to  obtain  the  greatest  amount  of  good  from  it,  are  equally 
applicable  to  this  ca.-e. 

The  same  remark  may  be  made  of  aneurisms  and  all  other  tumours. 
which,  though  not  painful  in  themselves,  often  become  extremely  so  by 
pressure  on  the  trunks  of  neighbouring  nerves,  or  in  other  modes  inter- 
fering with  the  healthy  structure  near  them. 

Painful  spasms  afford  still  stronger  indications  for  the  use  of  opium 
than  simple  neuralgia,  because  often  more  dangerous  in  their  conse- 
quences, and  because,  also,  being  only  occasional,  and  generally  occurring 
at  distant  intervals,  there  is  less  danger  of  an  abuse  of  the  remedy. 
These  spasms  may  be  either  external,  affecting  the  voluntary  muscles, 
or  internal,  affecting  the  muscles  of  organic  life.  Of  the  former  we 
have  examples  in  ordinary  cramps  of  the  limbs,  in  the  intensely  painful 
cramps  of  cholera,  and  in  tetanus.  It  is  in  the  two  latter  affections 
chiefly  that  opium  is  used;  and  in  both  it  is  certainly  among  the  most 
efficient  remedies.  In  tetanus,  the  insusceptibility  of  the  cerebral  centres 
U  such,  that  much  larger  doses  are  required  than  under  ordinary  circum- 
stances. Two  grains  may  be  given  at  first  every  two  hours,  and,  if  neces- 
sary to  bring  about  relief,  the  close  may  be  increased  to  four,  five,  or  six 
grains,  or  an  equivalent  proportion  of  morphia  or  one  of  the  liquid  pre- 
parations, repeated  as  often,  until  some  degree  of  narcotic  effect  is  expe- 
rienced; but  the  quantity  of  half  a  drachm  of  opium  in  twelve  hours 
should  in  no  case,  I  think,  be  exeeeded  ;  as,  if  the  disease  should  sud- 
denly give  way,  poisonous  effects  might  ensue  from  the  portion  remaining 
un absorbed  in  the  stoi^)feh.  The  internal  painful  spasms  are  those  of 
the  stomach,  of  the  bowels  in  the  different  forms  of  colic,  of  the  ureters 


7-46  GENERAL    STIMULANTS.  [PART  II. 

and  ducts  of  the  liver  from  the  passage  of  calculi,  of  the  bladder,  of  the 
uterus,  and  finally  of  the  diaphragm  and  the  heart.  In  all  these  affec- 
tions the  pain  is  often  exquisitely  severe,  and  in  some  of  them  life  is 
endangered  by  the  continuance  of  the  spasm.  All  of  them  afford  the 
clearest  indications  for  the  use  of  opium,  which  may  in  general  be  given 
unhesitatingly,  and  in  quantities  requisite  to  obtain  relief,  beginning  with 
a  full  dose,  and  increasing  until  the  pain  is  alleviated,  or  narcotic  effects 
induced.  The  same  insusceptibility  to  the  influence  of  the  anodyne  ex- 
ists as  in  tetanus,  though  usually  in  a  much  less  degree  ;  and  it  is  seldom 
necessary  to  exceed  two  grains  of  opium,  or  an  equivalent  quantity  of 
its  preparations,  at  one  dose.  The  liquid  preparations  are  preferable  to 
solid  opium,  as  they  operate  more  speedily.  In  these  several  affections, 
it  is  necessary  to  combine  special  modes  of  treatment  with  the  anodyne, 
which,  however,  this  is  not  the  proper  place  to  detail.  As  examples,  it 
may  be  mentioned  that,  in  gouty  spasm  of  the  stomach,  colchicuin  may 
be  combined  with  the  opiate ;  in  ordinary  colic,  castor  oil ;  in  bilious 
colic,  calomel ;  in  spasm  of  the  heart  or  diaphragm,  ether  or  chloroform  ; 
in  spasm  of  the  hepatic  ducts,  ether  and  oil  of  turpentine ;  in  that  of  the 
ureters,  the  alkaline  bicarbonates ;  that  in  all  of  them  sinapisms  and  the 
warm  bath  are  efficient  adjuvants ;  and  that,  when  not  contraindicated 
by  debility,  the  lancet  may  often  be  used  with  powerful  effect  in  pro- 
ducing relaxation.  The  spasmodic  pain  attending  enteritis,  cholera,  dys- 
entery, and  peritonitis,  affords  an  indication  for  the  use  of  opium  ;  but 
those  founded  on  other  effects  than  the  merely  anodyne  are  much  more 
important. 

Various  spasmodic  and  convulsive  affections,  not  painful  in  their 
character,  or  but  slightly  so,  belong  to  the  category  of  nervous  irritations, 
and  are  more  or  less  benefited  by  opium.  Such  is  the  paroxysm  of 
spasmodic  asthma,  in  which  opium  will  often  afford  relief,  though  it  is 
liable  to  the  objection  of  checking  bronchial  secretion,  and  is,  on  the 
whole,  much  less  efficient  than  some  other  narcotics  and  nervous  stimu- 
lants or  sedatives.  In  epilepsy  it  may  sometimes  be  used  as  a  pallia- 
tive ;  but,  on  the  whole,  is  better  avoided,  both  from  its  liability  to  abuse, 
and  from  its  congestive  influence  on  the  brain.  In  hooping-cough  it  is 
liable  to  the  same  objection  as  in  asthma,  and  should  be  used  only  as  a 
palliative  of  the  cough,  in  connection  with  expectorants.  To  chorea  it 
is  scarcely  appropriate,  unless  to  obviate  occasional  intercurrent  affec- 
tions. In  the  various  spasmodic  all'oefions  of  hysteria  it  is  for  a  time  an 
almost  sovereign  remedy;  but,  on  moral  grounds,  requires  to  be  pre- 
scribed with  caution.  In  the  convulsions  of  infa»/x,  depending  on  in- 
tesiinal  spasm,  opium  is  an  excellent  adjuvant  of  other  remedies. 

To  the  list  of  nervous  irritations  relieved  by  opium  may  be  added 
ohsfinale  wakefulnesa,  general  uneasiness,  rdQlfssness,  Ian <j nor  and 
faintness,  palpitations,  nervous  cough,  and  all  the  protean  derangements 


CHAP.  I.]  CEREBRAL    STIMULANTS. — OPIUM.  7-il 

of  hysteria ;  but,  as  a  general  rule,  it  is  better  to  seek  relief,  in  these 
affections,  when  not  associated  with  other  serious  diseases,  from  reme- 
dies less  accordant  with  the  propensities  of  our  nature,  and  less  liable 
to  abuse. 

5.  Nervous  Depression.  In  affections  of  this  nature,  the  stimulant  in- 
fluence of  opium  on  the  nervous  system  renders  it  peculiarly  efficacious. 
Perhaps  under  this  head  we  might  rank  the  collapse  of  the  initial  stage 
or  chill  of  certain  febrile  diseases ;  but  enough  has  been  said  on  that 
subject  already. 

Insanity  often  presents  conditions  in  which  this  influence  of  opium  is 
"Xtremely  useful. 

There  is  a  species  of  delirium  resulting  from  extreme  fatigue,  long 
watching,  exhausting  indulgences,  excessive  study,  etc.,  for  which  this 
is  the  most  efficient  remedy,  combined  with  measures  calculated  to  re- 
store strength.  Such  attacks  of  delirium  occasionally  supervene  upon 
acute  diseases,  especially  those  of  a  febrile  character,  and  are  very  liable 
to  be  mistakenly  ascribed  to  active  congestion  or  irritation  of  the  brain. 
I  have  seen  it  occur  in  acute  rheumatism,  and  cause  serious  apprehen- 
sions of  rheumatic  meningitis.  I  have  also  seen  such  a  condition  occur 
in  erysipelas,  with  a  sudden  disappearance  of  the  local  inflammation, 
and  with  signs  of  great  prostration.  The  relief  obtained,  in  all  such 
cases,  from  full  doses  of  opium,  is  a  sufficient  proof  of  their  nature.  It 
is  usually  advisable  to  combine  the  opium  with  ipecacuanha,  so  as  to 
modify  its  stimulant  effect,  should  the  diagnosis  prove  to  have  been 
erroneous. 

Delirium  tremenx  is  an  example  of  the  same  condition  of  the  brain, 
induced  in  drunkards  by  the  abstraction  of  their  wonted  stimulus.  In 
this  affection,  I  regard  opium  as  the  most  valuable  remedy  in  our  pos- 
session. Given  in  the  dose  of  about  two  grains,  repeated  every  two 
hours,  it  will  almost  always,  in  the  uncomplicated  cases,  induce  sleep 
from  which  the  patient  will  awake  improved,  if  not  quite  cured.  Some- 
times two  or  three  days  may  elapse  before  the  effect  is  produced  ;  but  no 
injury  results,  if  the  opium  is  withheld  upon  the  first  occurrence  of  nar- 
cotic symptoms.  It  is  seldom  necessary  to  exceed  the  amount  stated. 
Injurious  cerebral  effects  have  been  ascribed  to  the  use  of  opium  in  deli- 
rium tremens;  but  I  have  not  seen  them,  though  much  of  the  disease 
has  come  under  my  notice.  Whore  they  have  occurred,  I  presume  that 
the  meningitis  of  drunkards  has  been  mistaken  for  pure  delirium  tre- 
mens; a  mistake  which  maybe  readily  made,  as  the  symptoms  of  the 
latter  disease  are  almost  always,  and  necessarily  intermingled  with  it. 
But,  while  the  opium  is  given  as  the  main  remedy,  sufficient  alcoholic 
drink  should  be  administered  to  prevent  prostration.  I  have  seen  death 
result  apparently  from'  neglect  of  this  precaution. 

Most  of  the  affections  already  referred  to,  as  the  result  of  nervous  irri- 


748  GENERAL    STIMULANTS.  [PART  II. 

tation,may  proceed  also  from  debility  or  depression  of  the  nervous  cen- 
tres ;  and,  as  the  former  yield  to  the  indirect  sedative  property  of  opium, 
so  do  the  latter  to  its  direct  stimulant  action.  Muscular  tremors,  spas- 
modic and  convulsive  affections,  wakef illness,  general  uneasiness,  rest- 
lessness, depression  of  spirits,  palpitation  of  the  heart,  dyspnoea,  various 
abnormal  sounds  and  visual  disorders,  vertigo,  and  headache,  are  some 
of  the  affections  referred  to.  As  a  proof  that  they  are  really  the  effects 
of  weakness  or  depression,  they  come  on  frequently  as  the  direct  conse- 
quences of  a  debilitated  state  of  system,  as  in  convalescence  from  ex- 
hausting diseases,  after  hemorrhages  or  copious  bleeding,  and  under  the 
direct  influence  of  sedative  poisons,  as  tobacco  and  hydrocyanic  acid. 
They  generally  yield,  at  least  temporarily,  to  moderate  doses  of  opium. 

Ci.  Morbid  Discharges.  In  these  affections  opium  is  one  of  the  most 
efficient  means  employed,  and,  whatever  other  remedies  may  be  used,  is 
very  often  combined  with  them.  It  probably  operates,  through  its  indi- 
rect sedative  agency,  in  allaying  irritation  in  the  part  affected,  and  dimin- 
ishing the  activity  of  the  capillaries.  The  morbid  discharges  are  either, 
in  the  first  place,  secretory  or  excretory,  or  secondly,  hemorrhag'c.  To 
the  first  category  belong  diarrhoea,  the  different  forms  of  cholera,  diuresis 
and  diabetes,  gastrorrhoea,  cystirrhcea,  bronchorrhcea,  and  ptyalism. 

In  diarrhoea  and  cholera  opium  acts  not  only  by  restraining  secretion. 
but  also  by  diminishing  the  activity  of  the  peristaltic  movement,  probably 
through  a  sedative  agency  in  relation  to  the  organic  nervous  centres. 
Of  its  use  in  diarrhoea  dependent  on  acute  inflammation  or  vascular  irri- 
tation of  the  alimentary  mucous  membrane  enough  has  been  said  already. 
But  there  is  no  form  of  that  affection  in  which  it  may  not  be  usefully 
employed,  except,  simply,  in  cases  in  which  the  affection  is  acting  bcne- 
ficiall}',  either  by  diverting  disease  from  some  part  where  it  might  do  more 
harm,  relieving  plethora,  or  promoting  the  absorption  of  effused  fluid,  as 
in  dropsy.  In  all  these  cases,  opium  may  prove  injurious  by  prematurely 
arresting  the  discharge,  and  should  be  resorted  to  only  to  regulate  the 
amount  of  it,  and  to  control  it  when  likely  to  do  more  injury  by  exhaust- 
ing the  patient,  than  good  in  either  of  the  modes  mentioned.  In  hi  I  ion* 
diarrhcea,it  acts  upon  the  liver  as  well  as  on  the  bowels  ;  but  in  general 
should  not  be  used  alone,  as  the  excess  of  the  bilious  secretion  is  proba- 
bly relieving  hepatic  congestion,  and  its  suppression  might  endanger  an 
attack  of  hepatitis.  Under  such  circumstances,  it  should  always  be 
associate:!  with  small  doses  of  calomel,  which,  while  the  opium  re- 
strains the  secretory  function  of  the  liver,  has  the  effect  of  preventing  its 
entire  suspension,  and,  at  the  same  time,  acts  as  an  alteratives  upon  the 
gland.  The  best  method  of  administering  the  two  remedies,  in  tlii.- 
affection,  is  to  give  very  small  doses  of  each,  very  frequently  repeated  : 
SO  that  their  operation  may  not  be  too  powerful  at  once,  ;ind  may  be 
more  conveniently  watched,  and  timely  checked,  if  desirable.  One-sixth 


CHAP.  I.]  CEREBRAL    STIMULANTS. — OPIUM.  749 

of  a  grain  of  each  may  be  given  every  hour  or  two,  till  the  desired  effect 
is  produced,  or  a  grain  or  two  have  been  administered;  and  it  is  often  a 
good  plau  to  intermit  the  treatment  every  other  day,  resorting,  in  the 
intermediate  day,  if  the  discharges  have  been  arrested,  to  a  mild  laxa- 
tive. In  the  diarrhcea  attended  with  copious  light-coloured  discharges, 
which  are  sometimes  very  profuse  and  exhausting,  opium  is  equally  in- 
dicated as  in  the  former  case;  and  there  is  a  still  stronger  call  for  the 
conjoint  use  of  calomel,  in  order  to  restore  the  hepatic  function,  and  thus 
unload  the  portal  veins  through  tlieir  natural  outlet.  In  chronic  diar- 
rhoeas, whether  dependent  on  relaxation,  mere  habit,  or  chronic  inflam- 
mation or  ulceration,  opium  in  small  doses,  though  it  cannot  be  depended 
on  for  the  cure,  is  an  almost  essential  adjuvant  of  the  astringents  and 
alteratives  employed;  and,  in  full  dose,  combined  with  ipecacuanha  at 
night,  operates  very  usefully  by  superadding  to  its  direct  influence  on 
the  peristaltic  movement  a  revulsive  influence  towards  the  surface. 

In  cholera,  opium  is  no  less  efficient.  The  ordinary  bilious  cholera, 
or  cholera  morbu^,  may  lie  treated  with  it  in  the  manner  above  recom- 
mended for  bilious  diarrhoea  ;  the  two  diseases  being,  in  fact,  identical  in 
character.  l>ut  the  dose  should  be  more  frequently  repeated,  as  often 
as  every  half  hour  till  relief  is  obtained  ;  and,  when  the  pains  are  very 
severe,  and  the  discharges  exhausting,  the  opiate  should  be  considerably 
increased,  and  administered  by  enema  if  rejected  from  the  stomach  ; 
calomel  being  at  the  same  time  moderately  exhibited  as  before,  to  guard 
against  a  total  suspension  of  the  hepatic  secretion.  The  discharges  of 
bile  in  cholera  morbus  are  no  doubt  intended  to  relieve  a  congestive  irri- 
tation of  the  liver  and  whole  portal  circulation,  which  without  this  outlet 
might  end  in  serious  inflammation  or  fever.  The  use  of  calomel  ensures 
a  sufficient  action  of  the  liver  to  prevent,  ultimate  evil,  while  the  opium 
prevents  immediate  mischief  by  arresting  the  excessive  discharge. 

Epidemic  cholera  I  believe  to  be  a  different  affection  from  ordinary 
cholera  morbus.  and  to  depend  on  a  different  cause.  Nevertheless,  there 
is  the  same  indication  for  the  combined  use  of  opium  and  calomel.  In 
the  stage  of  diarrhoea,  or  the  joint  discharge  from  the  stomach  and  bowels 
called  cholerine,  which  generally  precedes  the  distinctive  rice-water  evac- 
uations of  the  fully  formed  disease,  opium  is  the  remedy  mainly  to  be 
relied  on.  With  or  without  camphor  and  the  aromatics,  and  in  small 
doses  frequently  repeated,  it  almost  always  arrests  the  discharges,  and 
thus  probably  averts  cholera  itself.  I  have  usually  preferred  the  ordinary 
paregoric,  or  camphorated  tincture  of  opium  of  the  Pharmacopoeias,  of 
which  a  lltiidrachm  may  be  given  three  or  four  times  a  day  if  necessary. 
Should  the  evacuations  from  the  bowels  be  destitute  of  bile,  small  d< 
of  calomel  and  opium  should  be  employed  as  above  advised.  Sometimes 
it  may  be  necessary  to  give  the  opiate  more  largely,  and  to  combine  with 
it  an  anodyne  enema,  and  a  sinapism  over  the  abdomen.  When  the 


750  GENERAL    STIMULANTS.  [PART  II. 

cholera  is  fully  formed,  opium  is  still,  I  think,  the  sheet-anchor  in  this 
disease.  It  should  now  be  given  in  the  dose  of  a  grain  or  two  at  first, 
and  afterwards  repeated  at  intervals  of  half  an  hour  or  an  hour,  in  one- 
quarter,  or  one-half  the  dose,  till  the  discharges  are  arrested,  and  the 
pains  relieved,  or  till  some  evidence  of  narcotism  is  produced.  After 
this,  it  is  of  no  use  to  push  its  effects  further.  Indeed,  it  can  do  only 
harm,  by  aggravating  the  general  prostration  through  its  secondary  sed- 
ative effects.  The  great  rule  is  not  to  allow  it  to  render  the  patient 
stupid,  or  comatose;  but.  within  this  point,  to  continue  its  use,  at  longer 
or  shorter  intervals,  so  long  as  indicated  by  the  spasms  and  the  evacua- 
tions. But  it  should  never  be  relied  on  exclusively.  With  the  quantity 
of  opium  above  mentioned,  from  two  to  four  grains  of  acetate  of  lead, 
and  a  grain  or  two  of  calomel  should  be  given,  to  be  repeated  afterwards 
along  with  it  in  proportionately  diminished  doses.  At  the  same  time,  an 
anodyne  enema  should  be  exhibited,  and  a  sinapism  applied  over  the 
whole  abdomen  ;  warmth  and  rubefaction  to  the  extremities  being  addi- 
tionally used,  if  these  should  be  cold  and  bloodless.  In  the  collapse  of 
cholera,  opium  is  of  little  or  no  use.  In  the  stage  of  reaction,  its  em- 
ployment must  be  governed  by  the  same  principles  as  in  low  fevers  and 
inflammations. 

Cholera  infantum  does  not  offer  equally  strong  indications  for  the  use 
of  opium.  The  head  is  so  apt  to  suffer  in  infants,  that  anything  which 
tends  to  congest  the  cerebral  centres  must  be  used  with  caution.  Never- 
theless, if  the  vomiting  cannot  be  otherwise  restrained,  this  remedy  may 
be  cautiously  administered,  and  should  be  preferably  used  by  injection; 
great  care  being  taken  to  proportion  the  dose  to  the  age.  In  the  subse- 
quent stages,  when  the  affection  has  assumed  rather  the  character  of 
diarrhrea,  and  the  indication  exists  for  checking  the  evacuations,  very 
small  doses  of  opium,  .or  one  of  its  preparations,  may  be  added  to  the 
cretaceous,  astringent,  or  alterative  medicines  employed. 

In  excessive  secretion  of  urine  or  diuresi*.  especially  when  connected 
with  nervous  disorder,  or  an  irritable  state  of  the  system,  opium  is  one 
of  the  most  efficient  remedies.  In  diabetes,  strictly  so  called,  it  is  an 
excellent  palliative,  diminishing  frequently  the  amount  of  excretion. 
moderating  the  wear  of  the  system,  and  greatly  comforting  the  patient : 
but  it  is  wholly  inadequate  to  the  cure.  It  should  be  used  in  this  com- 
plaint, in  full  doses,  and  preferably  at  night.  In  small  doses,  frequently 
repeated,  so  as  to  produce  its  stimulant  effects,  I  have  often  known  it 
greatly  to  increase  the  secretion  of  urine. 

In  i-xcessive  mercurial  salivation,  opium  is  very  useful,  not  only  by 
checking  the  discharge,  but  by  relieving  pain,  and  diminishing  nervous 
irritability. 

In  the  rxi-r.-ixive  mucous  secretion  from  the  stomach,  bladder,  and 
bronchial  tubes,  called  respectively  gaslrorrhcea,  cystirrhcea,  and  bron- 


CHAP.  I.]  CEREBRAL    STIMULANTS. — OPIUM.  751 

chorrhcea.  opium  may  be  usefully  employed  as  an  adjuvant  or  corrective 
of  other  medicines;  but  cannot  be  relied  on  exclusively,  or  even  as  the 
chief  remedy.  Under  this  head  may  be  mentioned  the  use  of  opium  in 
combination  with  other  medicines,  where  it  may  be  desirable  to  prevent 
their  operation  upon  the  bowels.  For  this  purpose,  it  is  almost  con- 
stantly given  with  calomel,  and  frequently  with  the  blue  mass,  when  the 
object  is  to  obtain  the  peculiar  effects  of  mercury  on  the  system. 

Hemorrhages  constitute  the  second  division  of  morbid  discharges.  In 
most  of  these  opium  is  indicated,  both  from  its  effects  upon  the  capilla- 
ries, and  for  its  influence  in  quieting  various  attendant  irritations,  which 
often  serve  to  aggravate  the  main  affection.  Thus,  in  hemorrhage  from 
the  lungs,  or  air-passages,  it  proves  serviceable  by  allaying  the  irritative 
cough,  which,  by  agitating  the  parts,  tends  to  sustain  the  bleeding.  In 
hemorrhage  from  the  stomach,  after  the  full  evacuation  of  its  contents, 
an  irritated  condition  often  remains,  which  provokes  vomiting  unneces- 
sarily, and  prevents  the  retention  of  medicines  that  may  be  indicated. 
Opium  by  the  mouth  or  rectum,  or  endermically  to  the  epigastrium,  is 
very  useful  in  such  a  condition.  So  also  in  hemorrhage  from  the  bowels, 
bladder,  and  uleru.f,  it  tends  to  control  the  irritative  movements,  which, 
beyond  what  may  be  necessary  for  the  mere  evacuation  of  the  effused 
blood,  can  act  only  disadvantageous!}"  on  the  affection.  For  these  pur- 
poses, it  is  usually  sufficient  to  employ  small  doses,  in  conjunction  with 
the  other  medicines  indicated.  For  the  direct  influence  of  the  opium  on 
the  bleeding  vessels,  it  should  be  given  in  full  doses,  and  combined  with 
ipecacuanha  ;  the  patient  being  confined  to  bed,  and  well  though  not  hotly 
covered,  so  as  to  favour  the  perspiration  which  is  apt  to  be  induced. 
But  for  this  purpose,  opium  is  not  indicated  in  all  the  hemorrhages,  nor 
in  all  conditions  of  any  one  of  them.  It  should  not  be  used  when  the 
pulse  is  full  and  strong,  with  a  general  febrile  movement,  and  an  active 
congestion  of  the  bleeding  organ.  This  condition  should  be  removed  by 
depletory  and  refrigerant  methods,  before  recourse  is  had  to  opium.  The 
remedy,  in  full  do.<e.  is  of  doubtful  propriety  in  any  case  of  hemoptysis, 
in  consequence  of  its  tending  to  check  bronchial  secretion,  and  thus  rather 
to  promote  than  relieve  congestion  of  the  vessels.  Nor  can  it  be  given, 
as  a  general  rule,  in  connection  with  ipecacuanha  in  hasmatemesis.  But 
in  intestinal,  renal,  and  uterine  hemorrhages,  after  a  suitable  prepara- 
tion of  the  system,  or  in  cases  which  have  at  no  time  presented  any 
contraindication,  it  is  often  an  excellent  remedy.  In  menorrhagiait  is 
especially  useful,  and,  with  rest,  will  often  itself  be  quite  adequate  to  the 
cure.  In  the  purely  passive  hemorrhages,  whether  dependent  on  me- 
chanical obstruction,  or  on  that  disorganized  state  of  the  blood  which 
permits  it  to  ooze  out  through  the  unresisting  coats  of  the  capillaries, 
opium  can  be  of  little  service  as  a  mere  haemostatic.  As  a  stimulant,  it 
may  be  useful  in  the  conditions  of  system  attendant  upon  the  state  of 
the  blood  referred  to. 


752  GENERAL    STIMULANTS.  [PART  II. 

6.  Administration. 

The  dose  of  opium  varies  extremely  with  the  purpose  to  be  fulfilled, 
the  idiosyncrasies  and  habits  of  the  patient,  and  the  modification  of 
susceptibility  produced  by  disease.  For  full  anodyne,  and  soporific 
effect,  the  medium  dose  is  one  grain.  Less  than  half  a  grain  will  sel- 
dom produce  these  effects  fully ;  and  more  than  two  grains  should  very 
rarely  if  ever  IK-  given,  as  a  commencing  dose,  to  an  individual  whose  pe- 
culiar susceptibilities  are  unknown  to  the  prescriber.  For  the  jntrc  stimu- 
lant effect,  in  persons  quite  unaccustomed  to  the  use  of  the  medicine,  and 
in  diseases  in  which  the  susceptibility  is  not  impaired,  the  dose  may  vary 
from  one-eighth  to  one-half  a  grain,  which  should  be  repeated,  according 
to  the  quantity  given,  every  two,  four,  or  six  hours,  so  as  to  sustain  a 
steady  impression.  As  a  mere  nervous  stimulant,  in  the  sense  in  which 
that  expression  is  used  in  this  work,  to  designate,  namely,  a  certain  class 
of  medicines,  having  peculiar  properties  and  applications,  the  dose  is 
from  one-twelfth  to  one-quarter  of  a  grain.  For  this  purpose,  the  liquid 
preparations  are  generally  to  be  preferred.  But  it  must  be  remembered, 
in  regulating  the  dose  of  opium,  that  some  persons  are  naturally  ex- 
tremely susceptible,  and  others  perhaps  equally  insusceptible  to  its 
effects;  that,  under  the  influence  of  habit,  an  individual  becomes  gradu- 
ally less  and  less  susceptible,  and  to  an  indefinite  extent ;  and,  lastly, 
that,  in  certain  diseases,  in  which  the  cerebral  centres  are  vasth"  de- 
pressed, and  in  others  in  which  the  whole  energies  of  the  nervous  system 
are  concentrated  in  some  violent  local  affection,  the  dose  required  to 
produce  a  given  effect  is  greatly  augmented,  and  sometimes  almost  in- 
definitely. Among  the  former  affections  are  delirium  tremens.  and  the 
collapse  at  the  commencement  of  certain  fevers;  among  the  latter,  spa*m 
of  the  stomach,  severe  colic,  and,  above  all  others,  tetanus. 

The  commencing  dose  for  an  infant  at  birth,  and  for  two  or  three 
weeks  afterwards,  should  not  exceed  one-fortieth  of  a  grain;  and  not 
more  than  from  one-twentieth  to  one-tenth  of  a  grain  should  be  given  to 
a  child  within  the  year.  After  this  age,  the  dose  may  be  regulated 
according  to  the  rule  of  Dr.  Young.  (See  pages  33-4.)  The  liquid 
preparations  are  generally  preferable  for  infants. 

Opium,  in  substance,  may  tie  taken  in  powder,  pill,  lozenge,  or  elec- 
tuary. The  form  of  pil{  is  almost  always  preferred.  For  ordinary 
purposes,  the  pill  should  be  made  from  powdered  opium,  and  should  not 
be  kept  very  long  before  being  used.  .But,  when  it  is  desirable,  on  any 
account,  that  it  should  operate  very  slowly,  either  an  old  pill,  or  one 
made  directly  from  the  plastic  mass  may  lie  employed.  The  form  of 
lozenge  is  used  only  when  it  is  desirable  that  the  medicine  should  be  held 
in  the  mouth,  and  allowed  slowly  to  dissolve ;  so  as  to  act  specially  on 
the  mouth  and  fauces,  as  may  sometimes  be  desirable  in  coughs. 


CHAP.  I.]  CEREBRAL    STIMULANTS. — OPIUM.  753 

By  the  rectum,  opium  is  used  in  the  form  of  a  suppository,  or  in  that 
of  an  enema.  The  suppository  may  be  made  by  rubbing  the  opium  up 
with  soap,  or  with  cacao  butter,  and  forming  the  mass  into  a  cylindrical 
shape.  The  dose  given  by  the  rectum  should  not,  at  first,  exceed  twice  the 
quantity  administered  by  the  mouth.  A  triple  dose  has  not  unfrequentlv 
been  given,  and  even  more,  without  injury ;  but  there  is  thought  to  be 
some  risk  from  this  larger  quantity  ;  at  least,  effects  much  greater  than 
were  anticipated  or  desired  have  sometimes  been  produced.  The  dose, 
then,  in  this  way,  at  the  first  trial,  may  vary  from  one  to  four  grains. 
In  persons  habituated  to  large  doses  of  opium  by  the  mouth,  there  might 
possibly  be  some  danger  from  giving  by  the  rectum  twice  the  quantity 
usually  taken  in  the  former  way.  The  susceptibility  and  absorbent  power 
of  the  rectum  may  not  bear  the  same  relation  to  those  of  the  stomach 
as  before  the  habit  was  acquired.  It  would  be  safest,  under  these  cir- 
cumstances, to  begin  with  a  relatively  very  small  dose,  and  increase,  if 
necessary.  For  enema,  one  of  the  liquid  preparations  should  generally 
be  used,  and  administered  in  a  wineglassful  of  pure  water,  or  of  some 
mucilaginous  or  amylaceous  liquid,  as  flax-seed  tea  or  solution  of  starch. 
The  purposes  for  which  opium  is  specially  employed  in  this  way,  are,  1. 
to  affect  the  system  when  the  stomach  will  not  retain  the  medicine ;  2. 
to  allay  irritability  of  the  stomach  ;  3.  to  check  evacuations  from  the 
bowels ;  and  4.  to  relieve  pain  or  other  irritation  in  the  rectum  itself  or 
neighbouring  parts,  as  the  genito-urinary  apparatus.  Thus  strangury, 
spasm  of  the  ureters,  bladder,  and  urethra,  dysmenorrhoea,  priapism, 
chordee,  etc.,  are  more  effectually  and  speedily  relieved  by  opium,  when 
given  by  the  rectum,  than  by  the  mouth. 

Opium,  or  one  of  its  liquid  preparations,  is  sometimes  injected  into  the 
urethra  or  vagina,  to  relieve  pain  or  irritation,  or  suppress  discharges. 
It  is  also  introduced  into  the  cavity  of  a  carious  tooth  to  relieve  tooth- 
ache, and  into  the  external  meatus  in  earache.  One  of  its  liquid  pre- 
parations is  not  unfrequently  dropped  into  the  eye,  to  allay  irritability 
of  the  conjunctiva  in  ophthalmia.  In  the  form  of  lotion,  embrocation, 
cataplasm,  or  plaster,  it  is  applied  to  various  parts  of  the  surface,  to  re- 
lieve pain,  as  in  neuralgic  affections,  gouty  and  rheumatic  pains  or  swell- 
ings, erysipelatous  inflammation,  various  cutaneous  eruptions,  and  irri- 
tated ulcers.  But  caution  is  always  necessary,  in  these  cases,  not  to  use 
it  so  largely  that,  if  absorbed,  it  might  produce  poisonous  effects  on  the 
system ;  and  special  caution  is  necessary  in  infantile  cases. 

7.  Preparations  of  Opium. 

These  are  very  numerous,  but  scarcely  more  so  than  desirable,  when 
the  great  diversity  of  circumstances  is  considered  under  which  the  medi- 
cine is  used,  the  different  purposes  it  is  calculated  to  fulfil,  according  to 
VOL.  i. — 48 


754  GENERAL    STIMULANTS.  [PART  II. 

the  method  or  form  in  which  it  is  employed,  and  the  variable  idiosyncra- 
sies which  require  that,  if  one  preparation  may  not  happen  to  agree  with 
the  individual,  we  may  have  recourse  to  another,  or  to  many  succes- 
sively, until  one  is  found  to  answer. 

PILLS  OF  OPIUM.  — PILULE  OPII.  U.S. 

These  are  prepared  by  simply  incorporating  opium  with  soap,  which 
answers  no  other  purpose  than  that  of  a  convenient  excipient  Each 
pill  contains  a  grain  of  opium. 

COMPOUND  PILLS  OF  SOAP.  — PILULE  SAPONIS  COMPOSITE.  U.S. 

—  PILULA  OPII.  Br. 

In  these  pills,  as  in  the  preceding,  there  is  a  mere  mixture  of  opium 
and  soap ;  but  the  proportions  are  so  arranged,  that  five  grains  of  tin- 
mass  contain  one  grain  of  opium.  The  preparation  affords  a  ready 
method  of  obtaining  small  fractions  of  a  grain  of  opium,  when  wanted, 
as  they  frequently  are,  for  children.  Another  advantage  is  that  they 
may  be  prescribed,  without  a  knowledge,  on  the  part  of  the  patient,  of 
what  has  been  directed  for  him.  The  London  College,  upon  the  same 
grounds,  formerly  directed  the  Compound  Pills  of  Storax,  in  which 
storax  and  saffron  were  employed,  not  only  to  dilute  the  opium,  but  to 
cover  its  taste  and  smell ;  but  the  preparation  has  been  omitted  in  the 
Br.  Pharmacopoeia.  The  proportion  of  opium  was  the  same  as  in  the 
U.  S.  preparation,  namely,  one  grain  in  five  of  the  mass. 

POWDER  OF  IPECACUANHA  AND  OPIUM.  — PULVIS  IPECACU- 
ANHA ET  OPII.  U.  S.  1850.  —  PULVIS  IPECACUANHA:  COMPOSITUS.  U.S. 

—  Compound  Powder  of  Ipecacuanha.  —  PULVIS  IPECACUANHA  CUM 
OPIO.  Br.  —  Dover1  s  Powder. 

This  is  an  excellent  diaphoretic  preparation  of  opium,  but  will  be  more 
fully  tceated  of  with  the  diaphoretics.  I  do  not  think  that  the  change 
in  the  name  of  this  preparation,  made  in  the  recent  edition  of  our  Phar- 
macopoeia, was  judicious.  If  made  in  order  that  the  title  might  be  in 
accordance  with  that  of  the  London  College,  it  was  unfortunate ;  for  our 
own  old  title,  essentially,  has  been  adopted  in  the  British  code  in  prefer- 
ence to  that  of  the  London  Pharmacopoeia ;  and  the  same  discrepancy 
exists  as  before. 

CONFECTION  OF  OPIUM.  —  CONFECTIO  OPII.  U.  S. 

This  i.s  prepared  by  rubbing  opium  up  with  honey  and  the  officinal 
aromatic  powder,  consisting  of  cinnamon,  cardamom,  and  nutmeg.  It 
has  the  advantage,  through  the  stimulating  property  of  the  aromatics, 
of  counteracting  the  depressing  effects  of  opium  upon  the  digestive  func- 
tion, and  may  sometimes  be  received  by  an  irritable  stomach,  when 
opium  would  be  rejected.  The  possession  of  this  property  sufficiently 
indicates  the  circumstances  under  which  it  may  be  used.  It  is  supposed. 


CHAP.  I.]  CEREBRAL   STIMULANTS. — OPIUM.  755 

when  given  with  Peruvian  bark  and  sulphate  of  quinia,  to  increase  their 
efficacy  in  obstinate  intermittents.  One  grain  of  opium  is  contained  in 
about  thirty-six  grains  of  the  composition;  so  that  it  affords  a  convenient 
form  for  prescribing  small  doses  for  infants. 

EXTRACT  OF  OPIUM.—  EXTRACTUM  OPII.  U.S.,  Br. 

This  is  an  aqueous  extract  of  opium,  and  of  course  consists  exclu- 
sively of  the  principles  soluble  in  water.  Opium  contains  ingredients  in- 
soluble in  water,  which,  however,  it  yields  to  an  alcoholic  solvent,  either 
vinous  or  distilled  ;  and,  as  these  principles  may  possibly  be  not  without 
some  influence  upon  the  system,  the  effects  of  the  opium  may  be  some- 
what modified  in  the  extract,  and  different  from  those  obtained  from 
opium  itself,  its  tinctures,  or  the  wine.  Hence  this  preparation  is  sup- 
posed to  agree  with  certain  individuals,  with  whom  opium  and  its  other 
preparations  disagree.  It  has  the  advantage  also  of  affording  a  ready 
means  of  preparing  a  solution  of  the  active  matter  of  opium  in  water, 
which  is  sometimes  desirable,  particularly  for  application  to  the  eye,  and 
other  external  inflamed  surfaces,  and  for  injection  into  inflamed  or  irritated 
mucous  passages,  as  the  rectum,  urethra,  or  vagina,  in  all  of  which  cases, 
the  stimulant  properties  of  the  tincture,  derived  from  the  alcohol  it  con- 
tains, are  contraindicated.  The  dose  is  one-half  that  of  opium. 

In  dysenteric  cases,  an  injection  of  the  extract  of  opium,  dissolved  in 
water,  will  sometimes  be  retained,  and  afford  relief,  when  laudanum 
would  be  rejected ;  and  it  is  not  impossible  that  the  same  remark  may 
be  true  of  its  use  in  irritable  states  of  the  stomach.  A  solution  of  the 
extract,  in  the  proportion  of  from  one- quarter  to  one-half  of  a  grain  to  the 
fluidounce,  is  sometimes  administered  in  the  form  of  spray,  to  relieve 
cough  ;  being  thrown  into  the  air-passages  by  means  of  the  atomizer. 

In  a  former  edition  of  this  treatise,  it  was  suggested  that  an  Elixir 
of  Opium  might  be  prepared  from  the  watery  extract,  by  treating  it  with 
diluted  alcohol,  using  only  half  as  much  of  the  extract  in  proportion  as 
there  is  of  opium  employed  in  the  preparation  of  the  tincture.  An  elixir 
thus  made  would  have  the  same  strength  as  laudanum,  and  would  be 
destitute  of  whatever  matter,  insoluble  in  water,  alcohol  may  extract 
from  opium.  This  suggestion  has  been  more  than  met  by  the  Deodorized 
Tincture  of  Opium  of  the  present  U.  S.  Pharmacopeia. 

OPIUM  PLASTER.— EMPLASTRUM  OPII.  U.  S.,  Br. 

Opium  plaster  is  made  by  mixing  powdered  opium,  or  still  better  the 
extract  in  half  the  quantity,  with  boiling  water,  incorporating  the  mix- 
ture with  melted  Burgundy  pitch  and  lead  plaster,  and  then  evaporating 
the  moisture.  It  may  be  used,  spread  on  leather,  as  an  anodyne  appli- 
cation in  fixed  pains,  of  a  rheumatic  character  or  otherwise. 


7-"0  GENERAL   STIMULANTS.  [PART  II. 

TINCTURE  OF  OPIUM.  — TINCTURA  OPII.  U.S.,  Br.  — Laudanum. 
—  Thebaic  Tincture. — Tinctura  Thebaica. 

Laudanum  is  prepared,  according  to  the  U.  S.  Pharmacopoeia,  by 
macerating  two  ounces  and  a  half  of  powdered  opium  first,  for  three 
days,  with  a  pint  of  water,  then,  for  three  days  longer,  with  the  same 
menstruum  increased  by  the  addition  of  a  pint  of  alcohol ;  submitting  the 
whole  to  percolation  ;  and,  when  the  liquid  ceases  to  pass,  pouring  in  di- 
luted alcohol,  until  two  pints  of  tincture  are  obtained.  When  it  is  prop- 
erly made,  the  virtues  of  the  opium  may  be  considered  as  wholly  ex- 
tracted by  the  menstruum.  The  pulverization  of  the  opium  ensures  the 
previous  drying  of  the  drug,  which  is  important;  for  crude  undried  opium 
always  contains  water,  and  often  in  considerable  though  variable  pro- 
portion ;  and,  if  it  were  employed  in  the  process,  would  render  the  re- 
sulting tincture  weaker  than  the  officinal,  and  of  uncertain  strength. 
Happily,  though  the  British  process  differs  somewhat  from  our  own,  the 
resulting  tincture  is  so  nearly  the  same,  that  the  two,  for  all  practical 
purposes,  may  be  considered  as  identical.  Laudanum  should  be  kept  in 
well-stopped  bottles,  as  the  alcohol  evaporates  on  exposure,  and  the 
liquid  is  rendered  turbid  by  the  deposition  of  the  dissolved  matter.  Not 
unfrequently  flakes  of  solid  extract  may  be  seen  at  the  bottom  of  old 
laudanum  bottles;  and  it  maybe  readily  conceived  that,  if  this  should  be 
dropped  out  with  the  liquid,  the  narcotic  effects  of  it  would  be  very 
greatly  increased.  Death  in  infants  has  resulted  from  this  cause ;  and  I 
suspect  that  the  cases  of  unexpectedly^  violent  effects  in  young  children 
from  a  drop  or  two  of  laudanum,  which  we  find  related  by  writers,  might, 
if  carefully  investigated,  have  been  traced  to  this  cause.  Every  practi- 
tioner should  be  aware  of  this  fact,  and  guard  against  the  use  of  lauda- 
num rendered  turbid  by  evaporation,  especially  when  prescribing  for  the 
very  young. 

This  tincture  is  very  much  used  for  obtaining  the  effects  of  opium,  the 
properties  of  which  it  may  be  considered  as  fully  representing.  It  has 
the  advantage  of  operating  more  quickly  than  the  opium  in  substance, 
and  of  facilitating  the  exhibition  of  the  medicine  in  minute  doses;  but 
it  is  sometimes  less  acceptable  to  an  irritated  stomach,  probably  in  con- 
sequence, in  part,  at  least,  of  the  alcohol  it  contains.  The  same  cause 
renders  it  less  suitable  than  the  infusion  of  opium,  or  a  solution  of  the 
extract,  for  application  to  tender  surfaces,  as  to  the  conjunctiva,  rectum, 
urethra,  and  even  sometimes  the  skin,  when  highly  irritated  or  inflamed. 

The  dose  of  laudanum  equivalent  to  a  grain  of  opium  is  thirteen  min- 
ims, or  about  twenty-five  drops.  It  should  be  remembered  that  a  flui- 
drachm  or  teaspoonful  contains  on  the  average  about  120  drops,  and  that 
one  minim  is  about  equal  to  two  drops.  The  mistake  has  often  been 
made  of  directing  a  teaspoonful  of  laudanum  by  enema,  under  the  im- 
pression that  it  contained  only  60  drops,  or  between  twice  and  three 


CHAP.  I.]  CEREBRAL   STIMULANTS. — OPIUM.  757 

times  the  amount  of  the  ordinary"  dose  by  the  mouth,  whereas  it  is  about 
quintuple  that  dose.  Hence,  profound  narcotism  has  often  been  induced, 
when  only  gentle  sleep  was  wanted.  I  have  known  of  a  fatal  case  of 
coma,  occurring  immediately  after  an  enema  of  laudanum,  and  have  not 
been  without  my  suspicions  that  this  was  the  cause  of  death.  Not  more 
than  fifty  or  sixty  drops  should  be  given  at  first  by  injection.  Tincture 
of  opium  is  often  used  as  a  local  anodyne ;  being  employed  as  a  lotion, 
or  added  to  cataplasms,  or  in  conjunction  with  other  anodynes  or  with 
rubefacients  in  the  form  of  a  liniment.  It  may  be  added  to  the  common 
soap  liniment  (Linimenlum  Saponis,  U.  S. ,  Br  ),  in  the  proportion  of 
one  part  by  measure  to  three,  according  to  the  late  London  Pharmaco- 
peia, or  in  equal  measure  according  to  the  British  ;  and  this  mixture  is 
usually  called  the  Anodyne  Liniment  (Liniment  of  Opium,  LINIMEN- 
TUM OPII,  Br.}.  Laudanum  may  be  introduced  into  the  external  audi- 
tory meatus,  or  into  the  cavity  of  a  carious  tooth,  upon  a  little  raw  cot- 
ton. From  five  to  ten  drops  of  it  in  a  fluidounce  of  water  may  be  inhaled 
in  the  form  of  spray,  in  irritative  affections  of  the  throat  and  lungs. 

DEODORIZED  TINCTURE  OF  OPITJM.  —  TINOTUEA  OPII   DEODO- 
RATA.    U.S. 

This  is  a  new  preparation  of  opium,  introduced  into  our  Pharmaco- 
poeia at  the  late  revision.  It  is  made  by  macerating  opium  in  water  so 
as  thoroughly  to  exhaust  it  of  all  matter  soluble  in  that  liquid ;  evapo- 
rating the  infusion  thus  obtained  to  a  certain  measure,  and  agitating  the 
residue  thoroughly  with  ether ;  then  pouring  off  the  ether  which  sepa- 
rates on  standing,  and  completely  evaporating  what  remains,  of  it ;  finally, 
adding  first  water,  and  subsequently,  after  filtration,  half  of  its  measure 
of  alcohol.  It  will  be  seen  that,  in  this  process,  all  substances  in  opium 
soluble  in  alcohol  and  not  in  water,  some  of  which  are  believed  to  be 
noxious,  are  got  rid  of;  while,  by  washing  with  ether,  the  narcotina  and 
the  offensive  odorous  principle  are  separated,  and  alcohol  is  added  at  the 
end  sufficient  for  its  preservation.  It  is  an  excellent  preparation,  and, 
if  properly  made,  may  be  relied  on  for  whatever  advantages  may  be 
possessed  by  certain  empirical  elixirs,  which  have  acquired  popularity 
through  the  want  of  an  officinal  preparation  like  this.  It  may  be  used 
for  all  the  purposes  for  which  laudanum  is  prescribed,  and  in  the  same 
dose ;  and  may  be  preferred  to  it,  whenever  found  not  to  agree  with  the 
patient,  in  consequence  of  constitutional  peculiarities. 

CAMPHORATED  TINCTURE  OF  OPIUM.  —  TINCTURA  OPII  CAM- 
PHORATA.  U.S.  —  TINCTURA  CAMPHORS  CUM  OPIO.  Br.  —  Paregorn- 
Elixir.  — Paregoric. 

This  very  useful  and  popular  preparation  is  made  by  macerating  pow- 
dered opium,  camphor,  benzoic  acid,  oil  of  anise,  and  honey,  in  diluted 
alcohol.  Opium  is  the  chief  active  ingredient,  and  camphor  next  in  im- 


758  GENERAL    STIMULANTS.  [PART  II. 

portance.  The  others  may  be  considered  merely  as  adjuvants,  to  im- 
prove the  flavour,  and  render  the  tincture  more  acceptable  to  the  stomach. 
Liquorice  was  formerly  used  in  its  preparation,  and  still  is  used  by  some 
apothecaries,  though  it  has  been  omitted  in  the  process  of  the  Pharma- 
copeia, in  consequence  of  the  strong  resemblance  it  occasions  in  the 
colour  of  the  tincture  to  that  of  laudanum,  and  of  the  fatal  errors  that 
have  originated  in  this  cause.  Certainly  a  little  doubtful  improvement 
in  the  taste  should  not  be  put  into  competition  with  life. 

This  tincture  may  be  used  when  small  doses  of  opium  are  indicated, 
and  especially  when  its  operation  as  a  nervous  stimulant  is  wanted.  It 
is  somewhat  more  stimulating  than  laudanum,  and  usually  very  accept- 
able to  the  stomach.  It  is  much  used  in  cough  mixtures,  but  should  not 
be  given  in  the  early  stages  of  catarrhal  affections,  nor  until  expectoration 
shall  have  been  established.  It  is  better  adapted  to  chronic  catarrh, 
phthisis,  asthmatic  disease  with  copious  expectoration,  and  pertussis  at 
an  advanced  period,  than  to  acute  bronchial  affections,  except  in  their 
declining  or  suppurative  stage.  In  slight  diarrhoea,  when  the  indication 
is  simply  to  arrest  the  discharges,  it  is  very  useful;  and  it  is  an  admirable 
remedy  in  the  affection,  as  it  occurs  during  the  prevalence  of  epidemic 
cholera.  It  may  also  be  usefully  employed  in  slight  gastric  and  intesti- 
nal pains  or  spasms,  as  an  anodyne  and  carminative.  To  fulfil  this  indi- 
cation it  may  often  be  used  advantageously  in  infancy ;  but  great  care 
should  be  taken  not  to  abuse  it. 

Containing  only  about  one  grain  of  opium  in  half  a  fluidounce,  this 
tincture  is  not  calculated  to  produce  the  full  anodyne  or  soporific  effects 
of  that  medicine.  The  dose  of  it,  for  the  purposes  for  which  it  is  usually 
employed,  is  a  fluidrachm  for  an  adult,  and  from  three  up  to  twenty  drops 
for  an  infant,  during  the  first  and  second  year,  being  graduated  to  the 
age.  It  is  rendered  turbid  by  the  addition  of  water,  in  consequence  of 
the  precipitation  of  the  camphor. 

Care  must  be  taken  not  to  confound  this  preparation  with  the  ammo- 
niated  tincture  of  opium,  which  has  been  used  in  Scotland  under  the  name 
of  paregoric,  though  very  different  from  the  above.  It  is  readily  distin- 
guished by  its  ammoniacal  odour  and  taste,  and  is  seldom  if  ever  pre- 
pared in  this  country. 

ACETATED  TINCTURE  OF  OPIUM.  —  TINCTURA  OPII  ACETATA. 
U.S. 

This  is  peculiar  to  the  U.  S.  Pharmacopoeia,  having  been  introduced 
into  it  as  a  substitute  for  the  vinegar  of  opium  or  black  drop.  It  is 
made  by  macerating  opium  in  a  mixture  of  vinegar  and  alcohol.  The 
only  advantage  that  is  claimed  for  it  over  laudanum  is  that  it  is  some- 
what weaker  in  alcohol,  and  that  the  active  principles  of  the  opium  un- 
modified by  the  acetic  acid  of  the  vinegar.  The  only  known  method  in 


CHAP.  I.]  CEREBRAL    STIMULANTS. — OPIUM.  759 

which  such  a  modification  could  be  produced,  is  that  the  acetic  acid  may 
take  the  place  of  the  meconic  acid,  and  form  an  acetate  instead  of  meco- 
nate  of  morphia  and  the  other  alkaloids  of  opium.  But,  whatever  may 
be  the  theory  in  the  case,  the  preparation  appears  to  agree  with  certain 
patients,  who  cannot  take  laudanum  conveniently,  in  consequence  of  the 
headache,  delirium,  nausea,  or  other  nervous  disorder  which  it  produces. 
It  was  a  favourite  with  the  late  Dr.  Joseph  Hartshorne,  of  Philadelphia, 
who  introduced  it  into  notice,  and  whose  large  experience  entitles  hin 
recommendation  to  great  weight.  The  dose  of  it,  equivalent  to  a  grain 
of  opium,  is  ten  minims,  or  about  twenty  drops. 

WINE  OF  OPIUM. —ViNUM  OPII.  U.  S.,  Br.—  Sydenham's  Laudan- 
um. 

This  is  a  vinous  tincture,  made  by  macerating  powdered  opium,  cin- 
namon, and  cloves  in  sherry  wine.  After  maceration  with  a  portion  of 
the  wine  employed,  the  U.  S.  Pharmacopoeia  completes  the  process  by 
percolation  with  the  remainder ;  thereby  ensuring  a  more  complete  exhaus- 
tion of  the  powders  than  by  maceration  alone.  The  proportion  of  opium 
employed  is  such  as  to  saturate  the  wine.  The  preparation  differs  from 
laudanum  in  having  less  alcoholic  strength,  and  an  addition  of  aromatic 
properties,  which  render  it  more  agreeable  to  the  smell  and  taste,  and,  in 
certain  cases,  more  acceptable  to  the  stomach.  Some  notice  has  been 
attracted  to  it  as  an  application  to  the  eye  in  ophthalmia,  by  the  recom- 
mendation of  Mr.  Ware,  who  found  it  very  useful.  When  dropped  into 
the  eye,  it  produces  at  first  smarting  pain,  and  a  copious  flow  of  tears ; 
but  these  effects  are  soon  followed  by  relief  from  the  previous  suffering, 
and  considerable  abatement  of  inflammation.  The  dose  is  about  twenty 
drops. 

VINEGAR  OF  OPIUM ACETUM  OPII.  U.S.  — Black  Drop. 

The  U.  S.  Pharmacopoeia  directs  this  preparation  to  be  made  by  macer- 
ating opium,  nutmeg,  and  saffron  in  diluted  acetic  acid,  and  afterwards 
subjecting  the  mixture  to  percolation  with  the  same  menstruum,  taking 
care  that  the  strength  shall  be  uniform  by  adding  sufficient  diluted  acetic 
acid  to  make  a  certain  volume.  Some  sugar  is  added  previously  to  the 
diluted  acid.  The  vinegar  of  opium  was  introduced  as  a  substitute  for 
the  Lancaster  or  Quaker's  black  drop,  and  is  believed  to  be  preferable 
to  opiurn  in  substance  or  tincture,  in  certain  cases  in  which  the  two  lat- 
ter forms  disagree  with  the  stomach  or  nervous  system.  This  modifica- 
tion of  effect  may  be  owing  to  the  absence  of  certain  principles  of  opium 
soluble  in  alcohol,  but  not  in  water,  or  to  the  change  of  the  natural 
meconate  of  morphia  and  of  the  other  alkaloids  into  the  acetate,  or  to 
both  these  causes.  It  is  much  stronger  than  laudanum,  and  may  be 
given,  for  its  full  anodyne  and  soporific  effects,  in  the  dose  of  from 
seven  to  ten  drops. 


760  GENERAL    STIMULANTS.  [PART  II. 

MORPHIA.  U.  S. 

There  are  several  methods  of  extracting  morphia  from  opium.  The 
U.  S.  officinal  process  consists  essentially  in  macerating  opium  in  water 
to  exhaustion,  adding  alcohol  to  the  infusion,  precipitating  the  morphia 
by  solution  of  ammonia,  and  purifying  the  precipitate  by  solution  in 
boiling  alcohol,  and  filtration  while  hot  through  animal  charcoal.  On 
cooling,  the  alcohol  deposits  the  morphia  in  crystals.  The  object  in  add- 
ing alcohol  to  the  infusion  is  that  it  may  retain  the  colouring  matter 
when  the  morphia  is  precipitated,  which  it  does  to  a  considerable  degree. 
Thus  procured,  morphia  contains  a  proportion  of  narcotina,  from  which, 
if  deemed  advisable,  it  may  be  separated  by  the  agency  of  ether,  which 
dissolves  the  narcotina,  and  leaves  the  morphia  pure.  For  the  prepara- 
tion of  the  sulphate  or  muriate,  however,  this  is  not  necessary;  as  the 
narcotina  remains  in  the  mother  waters,  upon  the  crystallization  of  these 
salts.  As  the  acetate  is  usually  prepared  by  evaporating  its  solution  to 
dryness,  the  narcotina  will  contaminate  it,  unless  previously  separated 
from  the  morphia. 

Properties.  Morphia  is  in  small,  shining,  colourless  crystals,  which 
are  without  smell,  of  a  bitter  taste,  scarcely  soluble  in  cold  water, 
slightly  so  in  boiling  water,  also  slightly  in  cold  alcohol,  but  freely  in  that 
liquid  when  hot,  and  almost  insoluble  in  ether.  Chloroform,  the' fixed 
and  volatile  oils,  and  aqueous  solutions  of  potassa  and  soda  dissolve  it, 
and  solution  of  ammonia  has  the  same  effect,  but  in  much  less  degree. 
When  heated  in  the  open  air,  morphia  burns,  leaving  a  carbonaceous 
residue,  which  is  wholly  dissipated  if  placed  on  red-hot  iron.  Morphia 
affects  test-paper  like  the  alkalies,  and  forms  soluble  suits  with  most  of 
the  acids.  When  either  the  alkaloid,  or  one  of  its  salts,  is  touched  witli 
strong  nitric  acid,  it  assumes  a  deep-red  colour,  which  after  a  time 
changes  to  yellow.  In  the  state  of  crystals,  or  in  strong  solution,  both 
it  and  its  salts  are  rendered  blue  by  sesquichloride  of  iron.  Ammonia, 
added  to  a  mixture  of  solutions  of  chlorine,  and  of  morphia  or  its  salts, 
develops  a  dark-brown  colour,  which  is  removed  by  a  further  addition  of 
chlorine.  Precipitates  are  produced  in  solutions  of  the  salts  of  morphia 
by  the  pure  alkalies  and  their  carbonates;  but,  when  the  alkali  is  added 
in  great  excess,  the  morphia  is  redissolved.  Ammonia  has  the  latter 
effect  much  less  than  potassa  or  soda.  Astringent  Hibstances  throw  down 
from  solutions  of  the  salts  of  morphia  a  tannate  of  the  alkaloid,  which  is 
soluble  in  acetic  acid.  Morphia  consists  of  1  equivalent  of  nitrogen,  35 
of  carbon,  20  of  hydrogen,  and  6  of  oxygen,  to  which  are  added  2  equiv- 
alents of  water  in  the  er\>lalline  state. 

Medical  Properties  and  Uses.  Morphia  is  undoubtedly  the  main  active 
principle  of  opium ;  but  that  it  is  not  the  only  one  is  proved  by  the  fact, 
that  a  certain  quantity  of  opium  produces  a  much  greater  e fleet  than 
all  the  morphia  which  can  be  obtained  from  it,  though  it  may  be  entirely 


CHAP.  I.]  CEREBRAL   STIMULANTS. — OPIUM.  761 

exhausted.  Thus,  opium  must  be  very  good  which  will  yield  one  part 
in  ten  of  pure  morphia.  If  the  latter,  therefore,  were  the  only  active 
principle  of  opium,  one  part  of  morphia  should  produce  an  equal  effect 
with  ten  parts  of  opium;  while,  in  reality,  it  is  equivalent  to  no  more 
than  six  parts.  Which  of  the  principles  of  opium  it  is  that  supplies  this 
deficiency  in  the  power  of  morphia  has  not  been  decisively  ascertained. 
Nor  are  the  effects  of  morphia  precisely  the  same  in  character  as  those 
of  opium.  So  far  as  I  have  been  able  to  decide  from  observation  and 
trial,  I  believe  that  morphia  has  precisely  the  same  anodyne  and  sopo- 
rific effects  as  opium,  and  closely  resembles  it  in  its  stimulant  influence 
on  the  brain.  Like  opium,  also,  it  is  apt  to  produce  perspiration,  though 
perhaps  in  a  less  degree ;  and  is  quite  as  much  disposed  to  cause  itching 
of  the  surface.  But  it  is  less  stimulant  to  the  circulation,  less  disposed 
to  constipate,  has  less  restraining  effect  on  the  secretions,  and  cannot  be 
so  well  relied  on  for  the  suppression  of  morbid  discharges.  I  am  confi- 
dent that  it  in  general  agrees  better  with  the  stomach,  and  is  less  apt  to 
be  followed  by  nausea,  vomiting,  and  headache.  It  has  appeared  to  me 
also  to  be  less  liable  to  provoke  irregularities  of  mental  action,  and,  with 
an  equal  excitant  influence  on  the  faculties  and  feelings,  to  derange  them 
less  frequently,  and  in  a  less  degree. 

Morphia  itself  is  perhaps  less  certain  in  its  effects  than  its  salts ;  as, 
being  insoluble  or  nearly  so  in  water,  it  probably  depends  for  its  absorp- 
tion, and  consequent  effects  on  the  system,  in  some  degree  at  least,  upon 
the  presence  of  acid  in  the  stomach,  and  might  operate  more  slowly,  and 
feebly  in  the  absence  of  acids.  Hence  it  is  that  the  salts  are  alway% 
employed,  and  morphia  itself  never.  The  salts  most  used  are  the  sulphate, 
acetate,  and  muriate.  So  far  as  can  be  inferred  from  observation,  there 
is  positively  no  difference  in  the  remedial  effects  of  these  salts  upon  the 
system  ;  and  one  may  be  substituted  for  the  other  without  disadvantage. 
All  of  them  have  one  great  advantage  over  opium,  and  those  of  its  pre- 
parations the  strength  of  which  is  determined  by  that  of  the  opium,  in 
their  uniformity  of  dose.  We  know  exactly  how  much  of  the  narcotic 
principle  we  are  giving  when  we  prescribe  a  salt  of  morphia,  while,  in 
relation  to  opium,  laudanum,  etc.,  we  are  very  far  from  this  certainty, 
and  may  at  one  time  give  the  medicine  perhaps  twice  as  strong  as  at 
another;  for  different  parcels  of  opium,  even  bearing  the  same  commer- 
cial name,  not  unfrequently  have  this  diversity  of  strength. 

The  salts  of  morphia  may  be  given  in  all  cases  in  which  the  indication 
i*  to  relieve  pain,  to  procure  sleep,  or  to  quiet  nervous  irritation  in  any 
of  its  forms  But  they  are  less  efficient  as  stimulants  to  the  circulation 
in  low  forms  of  fever,  and  cannot  be  equally  relied  on  for  producing  dia- 
phoresis, for  checking  diarrhoea,  or  arresting  profuse  secretion  or  hemor- 
rhage. They  are  preferable  to  opium  in  irritated  states  of  the  stomach, 
and  in  catarrhal  affections,  as  they  probably  have  less  effect  in  producing 


762  GENERAL    STIMULANTS.  [PART  II. 

dryness  of  the  mouth  and  air-passages,  and  consequently  in  impeding 
expectoration.  They  often  agree  well  with  individuals  on  whom  opium 
produces  disagreeable  effects.  Thus,  I  have  had  under  my  care  a  female 
patient,  whom  a  full  dose  of  opium  always  kept  awake  during  the  whole 
night,  but  with  whom  the  salts  of  morphia,  in  equivalent  quantities,  had 
their  usual  soporific  effect.  I  believe,  moreover,  that  there  is  less  danger 
of  giving  them  in  over-doses.  Though  undoubtedly  capable  of  fatal 
poisoning,  they  appear  to  be  less  so  relatively  than  opium.  A  case  was 
related  to  me  by  Dr.  Charles  Foulke,  of  New  Hope,  Pennsylvania,  in 
which  a  woman  took  by  mistake  eleven  grains  of  morphia,  equivalent 
to  about  sixty-six  grains  of  opium  in  anodyne  effect,  and  yet  recovered 
without  having  discharged  any  of  the  poison  from  her  stomach.  She  be- 
came profoundly  insensible,  and  during  this  state  was  delivered  of  a  child, 
of  the  birth  of  which  she  was  quite  unconscious,  and  which  survived.  A 
case  was  recorded,  some  years  ago,  in  one  of  the  London  journals,  of 
which  I  made  a  note  at  the  time,  though  I  neglected  to  make  the  precise 
reference,  in  which  a  young  man  was  believed  to  have  taken  somewhere 
between  twenty  and  thirty  grains  of  one  of  the  salts  of  morphia,  and 
yet  escaped  with  life  without  evacuating  measures,  though  the  symptoms 
were  very  alarming. 

Another  advantage  of  the  salts  of  morphia  is  the  facility  with  which 
they  can  be  applied  endermically,  and  their  great  efficiency  in  this  mode 
of  application.  They  may  be  used  in  this  way  either  for  obtaining  the 
general  effects  of  opium,  or  to  relieve  some  local  affection,  as  neuralgic 
pain,  and  obstinate  vomiting.  Perhaps  no  remedy  is  more  effectual,  for 
the  latter  purpose,  than  one  of  the  salts  of  morphia  sprinkled  upon  a 
blistered  surface  in  the  epigastrium,  denuded  of  the  epidermis. 

The  salts  of  morphia  are  also  specially  fitted  for  the  hypodermic 
method  of  administration ;  in  other  words,  for  injection  into  the  subcu- 
taneous areolar  tissue,  as  recommended  by  Dr.  Alexander  Wood.  In 
this  method,  they  not  only  more  rapidly  and  effectually  relieve  neuralgic 
pains  in  the  neighbourhood  of  their  application  than  by  any  other  mode 
of  using  them,  but  also,  according  to  Mr.  Charles  Hunter,  of  London, 
more  quickly  affect  the  system,  and  through  this,  even  though  applied 
at  a  distance  from  the  seat  of  disease,  remove  the  pain  quite  as  effect- 
ually as  if  injected  in  its  immediate  vicinity.  Sleep  is  induced  by 
morphia  thus  used  in  a  very  short  time,  sometimes  so  soon  as  five 
minutes.  In  this  mode  of  exhibition  it  is  said  to  constipate  less  than 
when  given  by  the  mouth.  Another  advantage  is  that  it  can  be  admin- 
istered, in  some  instances,  where  any  other  mode  of  exhibition  is  difficult 
or  impossible.  There  are  few  affections  in  which  opium  is  indicated,  in 
which  the  salts  of  morphia  have  not  been  advantageously  given  in  this 
way.  Delirium  tremens,  violent  adynamic  delirium  from  whatever  source, 
severe  spasm  of  the  diaphragm,  stomach,  and  bowels,  commencing  te- 


CHAP.  I.]  CEREBRAL   STIMULANTS. — OPIUM.  763 

tanus,  violent  hysterical  convulsions,  and  the  eclampsia  of  puerperal 
women,  are  among  the  severer  forms  of  disease  in  which  it  is  said  to 
have  proved  effectual.  For  the  mode  of  using  this  and  other  medicines 
by  hypodermic  injection,  the  reader  is  referred  to  the  general  remarks  on 
the  subject,  at  page  78  of  this  volume.  Unless  under  urgent  circum- 
stances, not  more  than  about  one-half  of  the  dose  should  be  given  at  first, 
which,  under  similar  circumstances,  would  be  required  by  the  mouth  for 
full  effect ;  and  it  may  afterwards  be  increased  if  found  necessary.  This 
caution  has  been  rendered  advisable  by  unexpectedly  violent  effects, 
which  have  sometimes  originated  from  narcotic  medicines  administered 
hypodermically  in  ordinary  doses.  Any  of  the  salts  of  morphia  maybe 
employed,  and  they  should  be  given  in  solution  ;  each  dose  being  dis- 
solved in  from  twenty  minims  to  half  a  fluidrachm  of  water.  Perhaps, 
on  the  whole,  the  acetate  may  be  preferable,  as  least  liable,  when  perfectly 
dissolved,  to  cause  irritation. 

The  dose  of  either  of  the  salts  of  morphia,  equivalent  in  anodyne  effect 
to  a  grain  of  opium,  is,  as  near  as  I  have  been  able  to  determine,  one-sixth 
of  a  grain.  One-eighth  of  a  grain,  I  am  quite  sure,  is  less  powerful  than 
a  grain  of  good  opium  ;  and  one-fourth  of  a  grain,  I  think,  somewhat 
more  so.  Endermically,  one-half  of  a  grain  may  be  used  at  first,  and 
afterwards  increased,  if  found  necessary,  to  a  grain  or  more.  About  one- 
third  of  a  grain  may  be  given,  for  a  commencing  dose,  by  enema,  or  as 
a  suppository.  Hypodermically,  not  more  than  a  twelfth,  or,  at  the  out- 
side, an  eighth  of  a  grain,  should  be  administered  as  a  beginning  dose, 
under  ordinary  circumstances.  As  a  liniment,  morphia  may  be  em- 
ployed, dissolved  in  one  of  the  fixed  oils.  The  solution  is  most  readily 
effected  by  first  dissolving  it  in  a  little  chloroform,  and  adding  the  solu- 
tion to  olive  or  almond  oil. 

SULPHATE  OF  MORPHIA. — Morphias  Sulphas.  U.  S. — This  salt  is  most 
used  in  the  United  States.  It  is  prepare*!  by  mixing  morphia  with  water, 
gradually  dropping  in  diluted  sulphuric  acid  till  the  powder  is  dissolved, 
and  then  evaporating  and  crystallizing.  It  is  in  beautifully  white,  minute, 
soft,  feathery  cr}rstals,  very  bitter,  readily  soluble  in  water,  and  slightly 
so  in  alcohol.  It  is  known  to  be  a  sulphate  by  yielding  with  chloride  of 
barium  a  white  precipitate  insoluble  in  nitric  acid.  It  may  be  given  in 
pill  or  solution,  in  the  dose  of  from  one-eighth  to  one-quarter  of  a  grain. 

Solution  of  Sulphate  of  Morphia  (LIQUOR  MORPHINE  SULPHATIS, 
U.  S.)  is  directed  by  our  officinal  code  to  be  prepared  by  dissolving  eight 
grains  of  the  sulphate  in  half  a  pint  of  distilled  water.  It  of  course 
contains  one  grain  of  the  salt  in  each  fluidounce.  Though  the  solution 
becomes  gradually  coloured  by  time,  I  have  found  it  perfectly  efficient, 
upon  trial,  after  having  been  kept  a  year  or  longer.  It  has  the  great 
advantage  of  easy  divisibility,  as  regards  the  dose,  to  any  desirable 
minuteness.  For  full  anodyne  and  soporific  effect,  the  dose  is  from  one 


764  GENERAL    STIMULANTS.  [PART  II. 

to  two  fluidrachms.  From  one-quarter  to  one-half  the  quantity  maybe 
inhaled  in  the  form  of  spray,  to  relieve  irritation  of  the  air-passages. 
The  solution  is  too  feeble  for  subcutaneous  exhibition;  as  from  ten  to 
twenty  or  at  most  thirty  minims  of  the  menstruum  should  contain  the 
quantity  of  the  salt  to  be  injected. 

It  is  to  be  regretted  that  this  solution,  as  kept  in  the  shops,  is  not 
always  of  the  officinal  strength.  In  some  parts  of  the  country,  a  solu- 
tion containing  16  grains  to  the  fluidounce  has  been  habitually  employed. 
This  may  readily  lead  to  serious  mistakes.  The  physician  should  always 
specially  designate  the  stronger  solution  when  he  intends  it;  and  the 
officinal  solution  should  always  be  put  up  by  the  apothecary,  when  the 
simple  officinal  name  is  used. 

ACETATE  OF  MORPHIA. — Morphias  Acetas.  TJ.  S. — To  prepare  this  salt, 
the  U  S.  Pharmacopoeia  directs  morphia,  deprived  of  narcotina  by  mean> 
of  ether,  to  be  mixed  with  water,  and  acetic  acid  to  be  gradually  dropped 
in  till  the  morphia  is  dissolved.  The  solution  is  then  evaporated,  by 
means  of  a  water-bath,  to  the  consistence  of  syrup,  dried  by  a  gentle 
heat,  and  rubbed  into  powder.  As  thus  obtained,  it  is  amorphous, 
slightly  coloured,  and  in  general  not  wholly  soluble  in  water.  This  is 
owing  to  the  escape,  during  the  drying,  of  a  small  portion  of  acetic  acid, 
which  leaves  a  corresponding  portion  of  the  morphia  unsaturated,  and  of 
course,  insoluble.  All  that  is  necessary  to  effect  a  perfect  solution  is  to 
add  a  little  distilled  vinegar  or  diluted  acetic  acid.  This  salt  is  soluble 
in  alcohol.  It  is  known  to  be  an  acetate  by  giving  forth  an  acetous 
odour  on  the  addition  of  sulphuric  acid.  It  may  be  given  in  pill  or  solu- 
tion, and  in  the  same  dose  as  the  sulphate.  It  is  sometimes  preferred 
for  endermic  and  hypodermic  application,  under  the  impression  that  it  is 
less  irritant,  and  more  readily  absorbed. 

MURIATE  OF  MORPHIA. — Morphise  Murias.  U.  S. — Morphise  Hydro- 
chlora*.  Br. — Hydrochlorate  of  ^Morphia. — This  is  prepared,  according 
to  the  U.  S.  Pharmacopoeia,  in  the  same  manner  as  the  sulphate.  In 
Great  Britain  it  is  usually  prepared  directly  from  opium,  and  is  probably 
more  used  than  any  other  of  the  salts  of  morphia.  It  is  in  fine,  white- 
feathery,  acicular  crystals,  inodorous,  bitter,  and  soluble  in  water  and 
alcohol.  It  may  be  distinguished  from  the  sulphate  by  affording,  with 
nitrate  of  silver,  a  precipitate  insoluble  in  nitric  or  muriatic  acid,  but 
soluble  in  an  excess  of  ammonia.  The  dose  and  mode  of  administration 
are  the  same  as  those  of  the  sulphate. 

A  Solution  of  Hydrochlorate  of  Morphia  (Liquor  Morphias  Hijdro- 
chlora.ii!*,  Br.)  is  directed  in  the  British  Pharmacopoeia  to  be  prepared  by 
dissolving  four  grains  of  the  salt  in  six  fluidrachms  of  distilled  water,  to 
which  eight  minims  of  diluted  muriatic  acid  and  two  lluidrachms  of  rec- 
tified spirit  have  been  added.  The  use  of  the  acid  is  to  ensure  the 
complete  solution  of  the  salt ;  that  of  the  alcohol,  to  prevent  spontaneous 


CHAP.  I.]  CEREBRAL   STIMULANTS. — OPIUM.  765 

decomposition.  It  will  be  noticed  that  this  solution  is  four  times  as 
strong  as  our  officinal  solution  of  the  sulphate.  Great  care  will  be  neces- 
sary to  guard  against  the  mistake  of  considering  these  two  preparations, 
which  have  the  same  therapeutic  properties  and  uses,  as  of  the  same 
strength.  The  full  dose. of  the  British  solution  is  from  thirty  minims  to 
a  fluidraehm. 

CODEIA. 

This  is  the  only  other  opiate  alkaloid,  the  effects  of  which,  until  very 
recently,  have  been  investigated.  For  the  method  of  procuring  it, 'the 
reader  is  referred  to  the  Dispensatories.  It  is  white,  crystal lizable  in 
octohedra,  much  more  soluble  in  water  than  the  other  alkaloids  men- 
tioned, soluble  also  in  alcohol  and  ether,  but  insoluble  in  alkaline  so- 
lutions. It  is  distinguished  from  morphia  by  the  difference  of  its 
solubilities,  and  by  not  becoming  blood-red  with  nitric  acid,  or  blue  with 
sesquichloride  of  iron.  It  is  contained  in  small  proportion  in  opium, 
constituting  almost  always  less  than  1  per  cent.  Various  accounts  of 
its  effects  on  the  system  have  been  given,  among  the  most  reliable  of 
which  is  that  of  Dr.  Gregory,  of  Edinburgh.  From  three  grains  of  it 
he  obtained  no  obvious  effect:  but  when  the  dose  was  augmented  to  five 
or  six  grains,  he  found  it  to  increase  the  frequency  of  the  pnlse,  to  pro- 
duce a  feeling  of  warmth  in  the  head  and  face,  and  itching  in  the  skin, 
and  to  exhilarate  the  spirits.  This  condition,  after  lasting  for  several 
hours,  was  followed  by  unpleasant  depression,  with  nausea  and  some- 
times vomiting.  This  is  so  exactly  the  operation  of  morphia,  in  doses 
insufficient  to  produce  sleep,  as  to  suggest  the  inference  that  the  codeia 
employed  contained  a  small  proportion  of  the  stronger  alkaloid ;  and, 
from  the  statement  of  Pereira,  that  all  the  specimens  he  had  tried  of 
codeia  produced  an  orange-yellow  colour  with  nitric  acid  ( Mat.  Med.,  3d 
ed.,  p.  2099),  it  is  highly  probable  that  this  impurity  is  very  commonly 
present.  M.  Barbier,  of  Amiens,  found  codeia,  in  the  dose  of  a  grain  or 
two,  to  relieve  painful  affections  of  the  viscera  supplied  with  nervous  in- 
fluence from  the  sympathetic,  while  it  produced  no  effect  in  pains  of  the 
back  or  extremities.  Hence,  he  conceived  it  to  act  especially  on  the 
sympathetic  system  of  nerves.  It  did  not  disturb  the  circulation  or 
digestion,  or  produce  constipation ;  and,  when  taken  largely  enough  to 
cause  sleep,  occasioned  no  signs  of  cerebral  congestion.  Dr.  Miranda,  of 
Havana,  found  it  decidedly  beneficial  in  dyspepsia.  It  has  not,  how- 
ever, been  as  yet  proved  to  possess  powers  which  are  likely  to  render  it 
a  valuable  article  of  the  Materia  Medica.  Mauthner  recommends  it  in 
the  non-inflammatory  spasms  of  the  orbicular  muscle  of  the  eyelids 
occurring  in  infants.  He  applies  a  solution  of  one  part  in  four  of 
almond  oil,  by  means  of  a  hair  pencil,  three  times  daily  to  the  lids. 
More  recently,  Professor  Aran,  of  Paris,  has  made  extensive  use  of 


766  GENERAL   STIMULANTS.  [PART  II. 

codeia,  and  says  of  it  that  it  possesses  the  most  valuable  properties  of 
opium,  is  inferior  to  morphia  in  the  relief  of  pain  only  because  it  requires 
to  be  given  in  larger  doses,  and  is  superior  to  it  in  these  respects,  that  it 
does  not  cause  heavy  and  agitated  sleep,  does  not  induce  perspiration  or 
cutaneous  eruptions,  nor  trouble  digestion,  and  finally,  that  it  does  not 
cause  nausea,  vomiting,  or  obstinate  constipation.  It  is  specially  valua- 
ble in  procuring  calm,  relieving  obstinate  cough,  and  suppressing  the 
pains  of  rheumatism,  gout,  and  cancerous  affections.  (Am.  Journ.  of 
Med.  Sci.,  Jan.  1863,  p.  184.) 

The  French  Codex  prepares  a  syrup  of  codeia  by  dissolving  twenty 
centigrammes  of  the  powdered  alkaloid  in  thirty-four  grammes  of  distilled 
water,  and  adding  sixty-six  grammes  of  pure  sugar.  A  tablespoonful 
of  the  syrup  contains  only  four  centigrammes,  or  somewhat  more  than 
half  a  grain  of  codeia. 

In  relation  to  the  other  peculiar  principles  of  opium,  paramorpliia  or 
thebaina  was  found  by  Magendie  to  produce  tetanic  spasms  in  the  quan- 
tity of  a  grain,  when  thrown  into  the  jugular  vein  of  one  of  the  lower 
animals,  and  thus  to  resemble  strychnia  and  brucia  in  its  action ;  opi- 
ania,  according  to  Dr.  Hinterberger,  exercises  powerful  narcotic  effects 
on  the  lower  animals;  and  narcein  or  narceia  has  been  thrown  into 
the  jugular  vein  of  a  dog,  in  the  quantity  of  two  grains,  in  several 
instances,  without  any  observable  effect.  Not  much  is  known  of  the 
operation  of  meconin  or  meconic  acid ;  but  they  are  supposed  to  have 
little  effect.* 

*  Such  was  the  extent  of  our  knowledge  on  the  subject  of  the  active  principles  of 
opium,  at  ihe  period  of  publication  of  the  second  edition  of  this  work;  and  I  have 
allowed  the  statements  in  the  text  to  remain  with  little  alteration,  because,  though 
most  important  investigations  have  been  subsequently  made,  throwing  much  new 
light  on  the  subject,  yet  the  results  have  not  assumed  so  definite  a  form,  nor  been 
so  far  confirmed  by  trial  ou  the  human  subject,  as  to  justify  their  admission  among 
the  established  facts  of  our  science.  I  have,  therefore,  deemed  it  best  to  introduce 
a  notice  of  these  researches  in  the  form  of  a  note,  to  await  the  result  of  future 
inquiry. 

The  author  of  the  experiments  referred  to  was  M  Cl.  Bernard,  of  Paris.  They 
were  performed  on  several  diiferent  species  of  the  lower  animals,  and  great  care 
was  taken  to  avoid  sources  of  error;  so  that  the  conclusions  may  be  received  with 
great  confidence  ;  though  it  must  be  remembered  that  they  cannot  be  relied  on  im- 
plicitly in  relation  to  man.  They  relate  to  the  relative  powers  of  the  several  pe- 
culiar principles  which  have  been  extracted  from  opium  ;  and  these  powers  were 
tested  by  injecting  solutions  of  the  alkaloids  into  the  subcutaneous  areolar  tissue: 
the  effects  upon  the  same  animals  being  noted  and  compared,  and  the  comparison 
afterwards  extended  to  the  different  species,  in  all  of  which  the  results  obtained 
were  remarkably  uniform. 

M.  Bernard  tried  six  of  these  principles;  morphia,  narceia  (narcein),  codeia,  nar- 
colina,  papaverina,  and  thebaina  (thebain).  Of  these,  the  first  three  alone,  namely. 
morphia,  narceia,  and  codeia,  were  found  to  possess  soporific  properties  ;  and  these, 


CHAP.  I.]  CEREBRAL   STIMULANTS. — OPIUM.  767 

NARCOTINA. 

For  the  mode  of  obtaining  this  substance  from  opium,  the  reader  is 
referred  to  the  U.  S.  Dispensatory.  It  exists  uncombined  in  opium,  which 

while  agreeing  in  this  respect,  were  severally  distinguished  by  peculiar  properties 
of  their  own. 

Morphia  induced  profound  sleep,  with  sensibility  blunted  but  not  quite  lost;  as 
severe  pinching  caused  obvious  uneasiness,  and  sudden  sounds  occasioned  move- 
ments of  the  animal,  showing  that  they  were  heard.  But  there  was  a  striking  pecu- 
liarity in  the  mode  of  awaking.  The  animals  exhibited  an  aspect  as  if  startled  or 
alarmed,  and  their  hinder  limbs  were  depressed  as  if  partially  paralyzed,  so  as  to 
give  to  a  dog  the  carriage  of  the  hyena.  The  dog,  too,  under  these  circumstances, 
did  not  recognize  his  master,  and  sought  to  retire  into  some  place  where  he  could 
be  hidden.  Twelve  hours  elapsed  before  these  effects  had  entirely  disappeared. 

Godeia,  in  whatever  dose  exhibits  .1,  produced  a  less  profound  sleep.  The  animal 
could  be  easily  aroused,  and  sensibility  was  much  less  blunted.  On  awaking  from 
the  sleep  produced  by  it,  the  animal  exhibited  less  disorder  of  his  faculties,  and 
had  none  of  the  semi-paralyzed  condition  of  the  hinder  limbs,  mentioned  as  result- 
ing from  morphia. 

Narceia  caused  a  sleep  differing  from  that  of  either  of  the  other  alkaloids,  yet 
partaking  of  the  nature  of  both.  It  was  in  the  same  dose  more  soporific  than 
either:  the  sleep  produced  being  more  profound  than  that  of  codeia,  without  the 
leaden  torpor  caused  by  morphia;  and  the  sensibility,  though  blunted,  being  much 
le.^s  so  than  by  the  latter  alkaloid.  The  action  of  the  narceia  was  characterized  by 
calmness  and  want  of  excitability.  The  animal  was  not  disturbed  by  any  sudden 
noise,  and  on  awaking,  quickly  returned  to  its  normal  state,  with  much  less  of  the 
posterior  weakness  and  mental  confusion  that  marked  the  action  of  morphia. 
Narceia  is  peculiarly  suited  to  the  experimental  physiologist;  as  the  animal  is  per- 
fectly passive  under  his  hands,  and  makes  no  resistance  even  though  in  pain.  The 
same  effects  produced  by  narceia  on  the  lower  animals  were  found  by  Drs.  Debout 
and  Be"hier  to  be  caused  by  it  in  man. 

In  reference  to  the  poisonous  action  of  the  several  principles  ;  morphia  is  one  of 
the  least  poisonous,  thebaina  the  most  so.  Thus,  a  grain  and  a  half  of  the  muriate 
of  thebaina,  injected  into  the  veins  of  a  dog,  killed  the  animal  in  five  minutes: 
while  thirty  grains  of  the  muriate  of  morphia,  similarly  exhibited,  did  not  cause 
death.  Next  in  poisoning  power  to  thebaina  was  codeia.  Much  less  of  this  then 
of  morphia,  injected  into  the  veins,  was  required  to  cause  death. 

Another  point  of  comparison  between  the  alkaloids  was  in  regard  to  their  convul- 
sive effect.  M'liile  they  poison,  they  also  occasion  convulsions  of  a  tetanic  character, 
sometimes  violent.  The  only  exception  is  narceia,  which  occasions  no  convulsions 
even  in  a  fatal  dose ;  the  animal  dying  in  a  complete  state  of  relaxation. 

On  the  whole,  then,  the  conclusions  were  that  three  of  the  alkaloids  are  soporific; 
namely,  in  the  order  of  their  power,  1.  narceia,  2.  morphia,  and  3.  codeia;  the 
three  others,  not  soporific,  are  convulsive,  and  all  six  in  the  order  of  their  power 
in  this  respect  are  1.  thebaina,  2.  papaverina,  3.  narcotina,  4.  codeia,  5.  morphia, 
and  6.  narceia.  In  their  tonic  powers,  they  have  the  following  order;  1.  thebaina, 
"2.  codeia,  3.  papaverina,  4.  narceia,  5.  morphia,  and  6.  narcotina.  (Archives  Gen- 
f  rales,  Oe  sdr.,  iv.  455.) 

Therapeutic  effects  of  the  opiate  alkaloids.   This  subject  has  been  practically  inves- 
tigated by  Dr.  Ozanarie,  who  has  published  the  following  results  of  his  observations. 
I'xeudo- morphia  and  mec  :iin  are  destitute  of  action. 


768  GENERAL    STIMULANTS.  [PART  II. 

still  retains  it  in  considerable  quantities  after  maceration  in  water.  The 
portion  which  water  dissolves  is  probably  taken  up  through  the  agency 
of  the  free  acid  of  the  opium.  Xarcotina  is  in  white,  silky,  flexible, 
acicular  crystals,  without,  smell  or  taste,  insoluble  in  cold  water  and 
alkaline  solutions,  very  slightly  soluble  in  boiling  water,  slightly  so  in 
cold  and  much  more  freely  in  hot  alcohol,  and  readily  soluble  in  ether 
and  the  diluted  acids.  The  volatile  and  fixed  oils  also  dissolve  it. 
Though  capable  of  uniting  with  the  acids  to  form  definite  compounds, 
and  with  the  muriatic  and  sulphuric  acids  to  form  cry  stallizabte  salts, 
it  does  not  affect  the  colour  of  litmus,  and  must  be  considered  as  pos- 
sessing but  feeble  alkaline  powers.  It  is  distinguished  from  morphia  by 
its  solubility  in  ether,  by  assuming  a  yellowish  instead  of  red  colour 

Morphia  acts  on  the  whole  nervous  system,  first  on  the  brain,  then  on  the  spinal 
cord,  and  lastly  on  the  ganglionic  system,  as  evinced  by  the  expansion  of  the  capil- 
laries. 

Opiania  is  little  known  in  regard  to  its  effects,  but  is  thought  to  be  calmative  and 
stupefactive  like  morphia. 

Codeia  is  excitant,  calmative,  or  stupefactive,  according  to  the  dose.  Three  or 
four  grains  stupefy  like  morphia,  or  prove  anaesthetic  like  ether  or  chloroform. 
In  very  small  doses,  it  calms,  without  exciting  or  but  slightly.  In  moderate 
doses,  it  first  excites  and  then  calms.  Its  special  influence  appears  to  be  exerted 
on  the  cerebellum  and  medulla  oblongata.  A  disposition  to  retrogression  iu  the 
movements  has  been  observed  during  its  action,  and,  after  death  from  it.  the  parts 
mentioned  are  found  engorged  with  blood.  Hence  its  usefulness  in  coughs  and 
gastralgic  affections,  acting  through  the  pneumogaslric  nerve. 

Narcotina  is  always  excitant  in  its  influence  on  a  debilitated  system,  an  1.  even  in 
the  dying  state,  it  will  for  a  time  revivify  the  vital  actions.  The  dose  of  it  required 
for  this  effect  is  from  five  to  ten  centigrammes  (about  three-quarters  of  a  grain  to 
a  grain  and  a  half).  It  excites  the  pulse  and  increases  the  warmth  of  the  body, 
without  in  the  least  stupefying. 

Thebaina  is  more  violent  in  its  action  than  narcotic.  In  moderate  doses,  it  agi- 
tates and  even  tetanizes,  and  occasions  sleeplessness  rather  than  the  contrary.  Its 
influence  in  producing  tetanic  spasm  is  exerted  especially  on  the  upper  limbs,  sug- 
gesting that  it  may  perhaps  prove  useful  in  palsy  of  the  parts.  The  author  gave 
from  three  to  six  centigrammes  (about  half  a  grain  to  a  grain)  to  a  patient  with 
paraplegia,  but  found  the  medicine  to  produce  so  much  general  uneasiness,  and 
excitation,  especially  of  the  upper  extremities,  together  with  sleeplessness,  that  he 
was  compelled  to  suspend  it. 

Narceia  is  a  valuable  calmative.     In  the  dose  of  one  or  two  grains,  though  it 
may  not  produce  sleep,  it  gives  the  patient  a  feeling  of  calmness  and  perfect  com- 
fort; and  produces  these  effects  sometimes  when  morphia  will  not.     It  appear 
exercise  a  special  influence  on  the  lumbar  portion  of  the  spinal  cord.   (Kil.  M^L 
Journ.,  Nov.  1864,  p.  459;  from  Revue  de  Thfrap.  Medico-chirurg.,  Oct.  1  •".. 

Of  the  same  alkaloid  we  are  told  that,  of  all  the  alkaloids  of  opium,  it  produces 
physiological  sleep  in  the  smallest  dose.     In  a  child,  10  years  old,  with  phthisis, 
given  in  the  quantiiy  of  about  one-seventh  of  a  grain  through  the  day,  it  produced 
sleep  and  relieved  the  cough  beyond  all  other  means  employed.   (Ibid.,  April,  1" 
p.  947;  from  Gaz.  Med.  de  Paru,  March  11,  18*35.) — Note  to  the  third  edition. 


CHAP.  I.]  CEREBRAL    STIMULANTS. — OPIUM.  769 

with  nitric  acid,  and  by  the  want  of  the  other  properties  before  men- 
tioned as  characteristic  of  that  alkaloid.  If  it  be  mixed  with  sulphuric 
acid,  and  then  a  piece  of  nitre  be  added,  it  becomes  deep-red,  while  mor- 
phia, under  similar  circumstances,  becomes  brownish  or  olive-green.  In 
this  case,  it  is  a  mixture  of  the  nitric  and  sulphuric  acids  that  acts. 
Though  tasteless,  when  pure,  the  compounds  which  it  forms  with  the 
acids  are  very  bitter. 

Very  different  opinions  have  been  advanced  as  to  its  effects  on  the 
system.  While  some  have  found  it  very  powerful,  and  have  ascribed  to 
it  noxious  properties,  others  have  taken  or  given  it  largely,  without  any 
observable  effect,  whether  it  was  taken  in  the  solid  state  or  in  solution. 
Twenty,  thirty,  and,  as  asserted  by  M.  Baily,  even  sixty  grains  have 
been  given  with  entire  impunity.  The  probability,  therefore,  is  that, 
when  pure,  it  has  little  narcotic  influence  upon  the  system,  and  that  the 
effects  at  first  ascribed  to  it  have  resulted  from  the  use  of  an  impure  pre- 
paration, containing  morphia,  or  some  other  active  principle  of  opium. 
Dr.  Roots,  of  England,  was  induced  by  the  bitterness  of  its  salts  to  em- 
ploy it  in  intermittent  fever;  and  Dr.  O'Shaughnessy,  of  Calcutta,  gave 
it  with  the  happiest  results  in  a  great  number  of  cases,  considering  it 
superior  even  to  quinia  in  antiperiodic  powers.  He  gave  it  in  the  dose 
of  three  grains  three  times  a  day,  and  never  found  it  to  produce  narcotic 
effects,  headache,  nausea,  or  constipation,  but  to  act  powerfully  as  a  dia- 
phoretic. It  is  contained  in  opium  in  very  varying  proportions,  from 
two  to  nine  or  ten  per  cent.,  and  is  generally  most  abundant  when  mor- 
phia is  least  so. 

Denarcotized  Opium. — Denarcotized  Extract  of  Opium.  —  Denar- 
cotized Laudanum.  Under  the  impression  that  opium  owed  its  unpleas- 
ant effects  to  narcotina,  preparations  were  introduced  into  notice  and 
extensive  use,  in  which  the  medicine  was  deprived  of  this  principle, 
retaining  its  other  principles  unchanged.  Thus,  opium  or  its  extract 
was  deprived  of  narcotina  by  ether,  and  a  tincture  was  prepared  from 
the  denarcotized  extract  by  treating  it  with  diluted  alcohol,  so  as  to 
have  about  the  strength  of  the  ordinary  tincture,  and  this  has  been 
called  denarcotized  laudanum.  But,  as  before  mentioned,  it  is  ex- 
tremely doubtful  whether  pure  narcotina  exercises  any  obvious  influence 
on  the  system ;  and,  if  the  preparations  referred  to  have  any  advantage 
over  the  ordinary  extract  and  tincture,  the  fact  must  be  ascribed  to  some 
other  modification  of  opium  than  the  mere  absence  of  this  principle.  The 
officinal  deodorized  tincture  of  opium  (see  page  757)  renders  unneces- 
sary all  other  preparations  in  which  the  object  is  to  get  rid  of  narcotina. 


VOL.  i. — 49 


770  GENERAL   STIMULANTS.  [PART  II. 

POPPY-HEADS.  —  PAPAVER.  U.S.,  Br. 

These  arc  tlio  dried  ripe  capsules  of  the  poppy.  They  owe  all  their 
medicinal  virtues  to  the  narcotic  principles  of  opium  they"  contain, 
among  which  is  morphia  in  variable,  but  always  small  proportion. 
Their  seeds,  which  are  white  in  the  white  variety  of  Papaver  somnif- 
erum,  and  dark  in  the  black  variety,  are  perfectly  free  from  narcotic 
properties,  but  yield  by  expression  a  bland  fluid  oil,  much  used  on  the 
continent  of  Europe,  and  for  which  the  poppy  is  largely  cultivated  in 
France  and  Germany.  The  capsules  are  used  for  obtaining  the  slighter 
effects  of  opium,  particularly  in  children.  The  preparations  are  the 
decoction,  extract,  and  syrup. 

The  Decoction  (DECOCTUM  PAPAVERIS,  Br.)  is  made  by  boiling  four 
ounces  of  the  capsules,  deprived  of  their  seeds,  in  three  Imperial  pints  of 
water,  for  ten  minutes.  It  is  used  as  a  fomentation,  or  mixed  with 
emollient  cataplasms,  in  painful  tumours  and  superficial  inflammations. 

The  Syrup  (SYRUPUS  PAPAVERIS,  Br.)  is  made  by  adding  sugar  to  a 
concentrated  decoction,  and  a  little  spirit  to  enable  it  to  keep  better.  It 
is  considerably  used  in  England  to  allay  cough,  quiet  restlessness, 
relieve  pain,  and  produce  sleep,  in  infantile  cases.  But  a  syrup  made 
with  one  of  the  salts  of  morphia  is  much  to  be  preferred,  as  of  a  more 
definite  strength.  The  dose  is  from  half  a  fluidrachm  to  a  fiuidrachm 
for  an  infant,  and  from  half  a  fluidounce  to  a  fluidounce  for  an  adult. 
The  preparation  is  very  little  used  in  the  U.  States,  but  is  often  referred 
to  by  British  writers  on  medicine. 


VI.    HEMP   OF   INDIA. 
CAXNABIS  INDICA.  Br. 

I  prefer  the  designation  above  given  to  that  of  Indian  Hemp,  ordina. 
rily  applied  to  the  medicine,  because  the  latter  name  is  habitually  used 
in  this  country  for  the  Apocynum  cannabinum,  which  is  totally  differ- 
ent, both  in  its  botanical  relations  and  medicinal  properties,  from  the  sub- 
stance now  under  consideration. 

Hemp  of  India,  considered  as  a  medicine,  consists  of  the  dried  flower- 
ing tops  of  Gannabis  saliva,  which  is  a  native  of  the  interior  of  Asia, 
but  cultivated  in  many  parts  of  the  world,  and  to  a  considerable  extent 
in  our  own  Western  States.  It  is  only,  however,  the  product  of  the  plant 
grown  in  the  East  Indies  that  is  used  medicinally.  Its  virtues  reside 
mainly  in  a  resinous  exudation,  which  is  thrown  out  in  hot  weather,  upon 
the  surface  of  the  plant,  rendering  it  clammy  and  adhesive  to  the 
fingers.  This  is  produced  much  more  largely  in  the  Indian  than  in  the 


CHAP.  I.]    CEREBRAL  STIMULANTS. — HEMP  OF  INDIA.         771 

European  plant,  probably  owing  simply  to  the  difference  of  climate. 
The  hemp  of  this  country,  if  we  are  to  judge  from  the  odour  it  exhales 
when  growing  as  a  crop  in  the  fields,  and  its  viscidity  to  the  touch, 
ought  to  be  efficacious ;  and  it  would  be  an  object  worthy  of  attention 
to  investigate  this  point  experimentally. 

In  Hindostan  the  tops  are  cut  after  flowering,  and  when  dried  are  tied 
together  in  bundles,  two  feet  in  length,  each  containing  about  twcuiy- 
four  plants.  These  bundles  are  called  ganjah  or  gunjah  by  the  natives; 
and  are  essentially  the  same  as  the  hashish  of  the  Arabs.  Bang  is  a 
name  given  to  a  mixture  of  the  leaves  and  capsules,  without  the  stem. 
The  resinous  exudation  is  collected  in  various  methods  from  the  grow- 
ing plants  in  the  flowering  period,  and  formed  into  small  masses  which 
are  called  char  r  us.  It  is  an  alcoholic  extract  from  the  dried  tops,  or 
gunjah,  that  is  recognized  in  the  U.  S.  Pharmacopoeia,  under  the  name 
of  Extract  of  Hemp  or  EXTRACTUM  CANNABIS.  In  the  British  Phar- 
macopeia the  preparation  is  recognized  by  the  name  of  EXTRACTUM 
CANNABIS  INDICT. 

Properties.  The  tops  of  hemp,  when  fresh,  have  a  characteristic  odour, 
which,  in  the  growing  plant,  is  said  sometimes  to  produce  narcotic  effects ; 
and,  in  passing  by  fields  of  hemp,  I  have  myself  either  felt,  or  imagined 
that  I  have  felt,  something  of  the  kind.  This  odour  is  diminished  in 
drying,  and  in  the  tops,  as  imported,  is  relatively  very  faint.  Their 
taste  is  feeble  and  bitterish.  The  churrus,  as  described  by  Dr.  Royle,  is 
of  a  blackish-gray,  blackish-green,  or  dirty  olive  colour,  a  fragrant  and 
narcotic  odour,  and  a  slightly  warm,  bitter,  and  acrid  taste.  The 
best  extract,  as  sold  in  our  shops,  is  soft,  of  a  blackish-green  colour,  a 
feeble  narcotic  odour,  and  a  taste  which  is  very  slight  at  first,  but 
becomes  bitterish  and  herbaceous,  and  leaves  a  slight  sense  of  acrimony 
for  some  time  in  the  mouth. 

Active  Principles.  So  far  as  is  known,  the  active  principles  of  hemp 
are  a  volatile  oil  and  a  peculiar  resin  called  cannabin.  That  the  for- 
mer has  narcotic  properties  is  to  be  inferred  from  the  effects  of  the  odour 
of  the  plant.  The  latter  is  a  neuter  substance,  having  a  somewhat 
fragrant  odour,  especially  when  heated,  and  a  warm,  bitterish,  subacrid, 
and  balsamic  taste.  It  is  insoluble  in  water,  but  soluble  in  alcohol  and 
ether,  and  from  its  alcoholic  solution  is  precipitated  white  by  water.  M. 
Jacques  Personne  has  made  an  experimental  investigation  into  the  chem- 
ical composition  of  hemp,  from  which  it  may  be  inferred  that  this  nar- 
cotic owes  its  powers  of  affecting  the  system  wholly  to  its  volatile  oil, 
and  that  the  resin,  when  entirely  freed  from  the  oil,  is  inert.  M.  Per- 
sonne found  the  oil  to  be  complex,  consisting  of  two  carburetted-  hydro- 
gens, one  of  which  he  proposes  to  name  cannabene,  the  other  hydrate 
of  cannabene.  (Journ.  de  Pharm.  et  de  Chim.,  3e  ser.,  xxxi.  50.) 

Effects  upon  the  System.    The  effects  of  hemp  have  a  certain  analogy 


772  GENERAL   STIMULANTS.  [PART  II. 

with  those  of  opium,  and,  so  far  as  regards  the  brain,  with  those  of 
alcohol ;  showing  that  all  three  belong  to  the  same  class  of  agents.  But 
there  are  also  decided  peculiarities  in  the  operation  of  hem  p.  which  dis- 
tinguish it  in  a  marked  degree,  from  all  other  cerebral  stimulants.  It  is 
feeble  in  its  local  influence,  and  but  moderately  stimulant  to  the  circu- 
lation ;  producing  a  slight  increase  in  the  force  of  the  pulse,  with  little 
or  none  in  its  frequency.  Upon  the  brain,  however,  it  acts  with  great 
energy.  Like  all  stimulants  to  the  cerebral  centres,  it  first  exalts,  then 
deranges,  and  finally  diminishes  their  functions.  Hence,  as  a  first  effect, 
there  is  generally  a  remarkable  exhilaration  of  the  spirits,  with  a  con- 
dition of  mental  reverie,  in  which  a  new  state  of  existence  seems  to 
open,  the  most  pleasing  fancies  present  themselves,  and 'the  thoughts 
rush  along  in  rapid  succession,  with  little  guidance  or  government  from 
the  will.  In  this  state,  there  is  often  a  disposition  to  laugh,  sing,  shout. 
or  dance,  or  to  do  some  other  extravagant  act ;  but,  in  other  instances,  the 
excitement  betrays  itself  in  a  quarrelsome  temper  or  deeds  of  violence ; 
and  in  others,  again,  there  is  a  quiet  internal  enjoyment  which  does  not 
seek  any  outward  expression.  The  sense  of  hearing  is  said,  in  some  in- 
stances, to  be  greatly  exalted.  A  not  unfrequent  peculiarity  of  this 
mental  state  is  that  objects  seem  further  off  than  they  really  are,  and 
sounds  seem  to  come  from  a  distance.  The  individual  affected  often 
speaks,  after  recovery,  as  having  felt  himself  buoyed  up,  and  rising 
above  the  surface  of  the  earth.  There  is,  too,  a  feeling  of  spiritual  or 
intellectual  exaltation,  and  of  superiority  to  ordinary  men.  Sometimes 
there  are  impressions  of  duality,  as  if  the  patient  were  at  the  same  time 
himself  and  another.  Occasionally  a  species  of  intoxication  is  induced. 
with  hallucinations  or  complete  delirium.  These  effects  come  on  within 
an  hour  or  two,  and  are  attended  with  a  sense  of  giddiness,  and,  as 
writers  generally  assert,  with  aphrodisiac  excitement.  They  gradually 
subside  into  a  pleasing  calm,  a  feeling  of  luxurious  repose  and  indolence, 
during  which  the  senses,  particularly  that  of  touch,  become  more  or  less 
obtuse,  and  general  sensibility  is  so  much  impaired,  that  pinching,  or 
other  act  ordinarily  attended  with  pain  is  scarcely  felt,  and  causes  no 
uneasiness.  Drowsiness  soon  follows,  and,  in  three  or  four  hours  from 
the  taking  of  the  medicine,  the  person  falls  into  a  sleep  or  stupor,  which 
continues  about  six  or  eight  hours.  During  this  condition,  the  pupils  are 
generally  dilated,  and  a  state  of  the  muscles  is  sometimes  induced  analo- 
gous to  catalepsy,  in  which  the  limbs  are  perfectly  flexible,  and  may  be 
moved  in  every  direction,  but  have  a  tendency  to  retain  any  position  in 
which  they  may  be  placed.  This  latter  affection,  however,  has  not  been 
noticed  by  those  who  have  used  the  medicine  in  this  country  and  Europe. 
Dr.  O'Shaugl messy  observed  it  in  several  instances  among  the  Hindoos. 
Upon  awaking,  it  is  said  that,  instead  of  the  nausea  which  is  apt  to 
follow  the  influence  of  opium,  there  is  often  a  strong  desire  for  food  ; 


CHAP.  I.]          CEREBRAL    STIMULANTS. HEMP    OF    INDIA.  773 

and  the  medicine  is  believed  to  have  the  property  of  exciting  the  ap- 
petite. 

Though  thus  analogous  in  its  course  of  action,  and  in  many  of  its 
effects  to  opium,  it  yet  differs  from  that  narcotic  remarkably,  in  one 
respect,  in  its  operation  on  the  brain.  While  opium  elevates  and  for  a 
time  appears  to  invigorate  the  intellectual  faculties,  hemp,  on  the  con- 
trary, tends  to  confuse  the  mind,  and  induces  a  purposeless  succession  of 
ideas,  which,  though  generally  pleasing  and  even  exciting,  have  no  es- 
sential connection,  and  lead  to  no  special  result.  It  does  not  aid  the 
student  in  acquiring  or  the  writer  or  speaker  in  dispensing  knowledge. 
It  is  the  imagination  and  feelings  which  appear  to  be  most  highly  stimu- 
lated, and  altogether  without  the  control  of  reason.  The  wildest  vaga- 
ries, the  most  fantastic  images,  and  the  most  gorgeous  scenes,  rapturous 
to  every  sense,  and  often  voluptuous  under  the  aphrodisiac  influence  of 
the  drug,  rush  in  throngs  through  the  fancy,  and  seem  to  carry  the  soul 
along  with  them  through  long -periods  of  passive,  but  diversified  and 
thrilling  adventure. 

In  its  operation  on  the  organic  functions,  also,  hemp  differs  greatly 
from  opium  in  several  important  points.  Though,  like  it,  sometimes 
diaphoretic,  it  is  so  in  a  much  less  degree  ;  and  has  none  of  that  tend- 
ency to  produce  constipation  of  the  bowels  and  dryness  of  the  mouth, 
or  to  check  the  mucous  or  biliary  secretion  which  so  often  interferes  with 
the  beneficial  influence  of  opium,  and  so  much  limits  its  use.  It  is,  more- 
over, much  less  apt  to  induce  nausea,  and  to  leave  headache  or  other 
disorder  behind  it. 

From  alcohol  hemp  differs  in  being  much  less  excitant  to  the  vascular 
system,  less  brutifying  in  its  effects  on  the  mind  and  temper,  and  indis- 
posed to  produce  that  thickness  of  speech,  and  staggering  movement,  so 
characteristic  of  the  former  stimulant. 

There  can  be  little  doubt  that,  in  over-doses,  it  is  capable,  like  the 
other  cerebral  stimulants,  of  proving  poisonous ;  but  its  effects  in  this 
respect  have  not  been  fully  investigated.  A  case  is  reported  by  Prof. 
Schroff  in  which  ten  grains  of  an  Indian  preparation,  after  giving  rise, 
in  an  exaggerated  degree,  to  the  characteristic  effects  of  the  medicine, 
produced  an  alarming  prostration  of  the  circulation  ;  but  the  case  ended 
in  recovery.  (Dublin  Quarterly  Journ.,  xxvi.  231.)  Alcohol  is  said  to 
be  the  most  efficient  antagonist.  (Ann.  de  Therap.,  1865,  p.  81.)  Among 
those  who  use  it  habitually,  it  is  said  ultimately  to  impair  the  mental 
faculties.  The  remedies,  both  in  its  acute  and  chronic  poisoning,  would 
lie  the  same  as  those  required  by  opium. 

Hemp  probably  operates,  like  opium  and  alcohol,  through  absorption. 
Drs.  Ballard  and  Garrocl,  in  their  Elements  of  Materia  Medico,  state 
that  it  imparts  an  odour  to  the  urine,  like  that  produced  by  mixing  the 
tincture  with  water,  and  somewhat  resembling  that  of  the  Tonquin 
bean. 


774  GENERAL   STIMULANTS.  [PART  II. 

Therapeutic  Application.  Hemp  was  known  to  the  ancient  Greeks 
and  Romans,  who  seem  to  have  had  some  confused  notion  of  its  narcotic 
powers,  though  there  is  no  reason  to  suppose  that  they  ever  employed 
it  as  a  medicine.  From  time  immemorial  it  has  been  used  in  India  and 
Persia  as  a  luxury,  both  internally  and  by  smoking,  in  the  same  manner 
as  opium.  Its  intoxicating  and  stupefying  powers  are  spoken  of  by 
Linnaeus,  Murray  in  his  Apparatus  Medicaminum,  and  other  early 
modern  writers  on  Materia  Medica ;  but  it  was  not  employed  as  a  rem- 
edy, to  any  extent  at  least,  in  Europe  or  America,  until  introduced  to  the 
notice  of  the  profession,  not  many  years  since,  by  Dr.  O'Shaughnessy,  of 
Calcutta,  in  the  treatment  of  rheumatism,  tetanus,  cholera,  etc. 

The  indications  for  the  use  of  hemp,  founded  upon  a  knowledge  of  its 
physiological  effects,  are,  1.  to  allay  pain,  2.  to  relieve  spasm  and  various 
other  nervous  disorders,  and  3.  to  promote  sleep.  In  producing  these 
effects,  it  probably  operates  in  the  same  manner  as  opium ;  and  it  may 
be  substituted  for  that  medicine,  for  any  of  the  purposes  above  men- 
tioned, when  opium  has  failed  to  act  as  desired,  or  is  contraindicated  by 
some  idiosyncrasy  of  the  patient,  or  when  it  is  specially  desirable  to 
avoid  its  occasional  nauseating  influence  on  the  stomach,  its  constipating 
effect  on  the  bowels,  and  its  tendency  to  restrain  the  secretions. 

Another  indication,  derived  from  a  supposed  property  of  hemp  not 
yet  particularly  noticed,  is  to  produce  uterine  contraction.  Attention,  I 
believe,  was  first  called  to  this  property  by  Dr.  Alexander  Christison,  of 
Edinburgh,  who  observed  that,  in  several  cases  in  which  he  had  employed 
it  during  labor,  it  very  much  increased  the  intensity  of  the  contrac- 
tions.* The  effect  usually  occurred,  if  at  all,  in  two  or  three  minutes 
after  its  administration,  ceased  after  a  few  pains,  and  was  not  followed 
by  any  of  the  ordinary  physiological  results  of  its  exhibition,  as  mental 
excitement,  intoxication,  or  sleep  ;  nor  does  the  sense  of  pain  appear  to 
have  been  blunted.  Indeed,  the  action  took  place  much  sooner  than 
is  required  for  its  usual  effects,  and  its  powers  seem  to  have  been  ex- 
hausted in  the  effort.  Dr.  Christison  thinks  the  action  of  hemp  more 
energetic,  and  perhaps  more  certain,  than  that  of  ergot.  (See  Am.  Journ. 
of  Med.  Sci.,  N.  S.,  xxiii.  200.)  Notwithstanding  this  supposed  action  of 
hemp,  it  has  been  found,  in  large  doses,  very  promptly  to  suppress  ute- 
rine pains  in  delivery.  (Ed.  Med.  Journ.,  ii.  6G7.) 

With  a  view  to  the  first  indication,  that,  namely,  of  allaying  pain, 
hemp  has  been  used  in  different  forms  of  neuralgia,  in  acute  and  sub- 
acute  rheumatism,  and  in  gout,-  and  may  be  employed  in  these  affections 
under  the  same  circumstances  as  opium. 

*  Sir  J.  Y.  Simpson  informed  me.  when  in  Edinburgh,  Unit  the  idea  of  using 
hemp  of  India  for  its  cfl'eots  in  causing  uterine  contraction:-;  oi-^inuted  wiiii  himself. 
(Mile  to  the  third  edition.) 


CHAP.  I.]          CEREBRAL   STIMULANTS. — HEMP   OF   INDIA.  775 

To  relieve  pain  and  relax  spasm  jointly,  it  has  been  considerably  used 
in  tetanus,  and  with  variable  results.  Dr.  O'Shaughnessy  found  it  effect- 
ual on  several  occasions  ;  a  few  successful  cases  have  been  reported  by 
others ;  and,  in  some  instances,  where  it  has  failed  to  cure,  it  has  afforded 
relief.  But  the  general  result  has  not,  I  think,  been  favourable.  As  in 
the  use  of  opium  in  this  disease,  it  is  necessary  to  increase  the  ordinary 
dose  six  or  tenfold,  or  more,  and  to  repeat  the  dose  frequently.  The 
medicine  has  been  tried  also  in  hydrophobia,  but  has  proved  quite  pow- 
erless. In  epidemic  cholera  it  is  said  to  have  been  found  useful ;  but 
the  property  of  checking  alvine  discharges,  which  renders  opium  so  ben- 
eficial in  that  disease,  is  wanting  in  hemp,  and  it  can  act  only  by  relieving 
pain  and  resolving  spasm. 

Hemp  has  also  been  used  in  various  painless  spasmodic  affections,  and 
nervous  disorders,  usually  treated  with  the  nervous  Stimulants  and  narco- 
tics. In  convulsions  not  connected  with  cerebral  congestion,  in  chorea,  hys- 
teria, languid  or  depressed  spirits,  and  insanity,  it  has  been  found  more 
or  less  beneficial.  For  allaying  cough,  whether  spasmodic,  as  in  per- 
tussis and  hysteria,  or  dependent  on  bronchial  irritation,  as  in  different 
pulmonary  affections,  it  may  be  resorted  to  as  a  substitute  for  opium, 
when  this  is  contraindicated  by  its  property  of  checking  mucous  se- 
cretion. 

To  promote  sleep,  it  may  be  employed  in  any  case  of  wakefulness, 
not  associated  with  vascular  irritation  of  the  cerebral  centres,  and  is  said 
to  have  been  used  with  special  advantage  in  relieving  the  sleeplessness 
of  drunkards. 

In  reference  to  "its  supposed  property  of  promoting  uterine  contraction, 
it  may  be  employed  in  protracted  cases  of  delivery,  in  which  it  is  pref- 
erable to  ergot,  if  it  be  true,  as  may  be  inferred  from  the  observations  of 
Dr.  Alexander  Christison,  that  its  operation  is  soon  over,  and  not  pro- 
tracted like  that  of  the  medicine  alluded  to.  It  is  thus  free  from  the 
greatest  objection  to  ergot,  that,  namely,  of  endangering  the  life  of  the 
foetus  by  the  steady  and  prolonged  contraction  of  the  uterus.  The  same 
property  of  hemp  would  render  it  useful  in  expelling  the  retained  pla- 
centa, and  in  checking  uterine  hemorrhage,  when  sustained  by  a  relaxed 
condition  of  the  organ. 

But,  if  preferable  to  opium  under  the  circumstances  above  mentioned, 
in  which  that  medicine,  though  indicated  by  certain  symptoms,  is  con- 
traindicated  by  others,  hemp  cannot  be  brought  into  competition  with  it 
in  any  of  the  cases  to  which  they  are  both  applicable.  It  is  not  only  less 
efficient  than  opium,  but  is  much  more  uncertain  on  account  of  the  ine- 
quality of  strength  in  the  preparations  used,  and  probably  also  in  conse- 
quence of  the  inequality  of  its  operation  upon  different  individuals,  even 
when  it  may  be  of  the  due  strength 

Dr.  Fronniuller,  who  speaks  of  the  practical  use  of  hemp,  with  an  au- 


776  GENERAL   STIMULANTS.  [PART  II. 

thority  based  on  the  experience  of  a  thousand  cases,  says  that  it  pro- 
duces sleep  more  like  the  natural  than  any  other  narcotic,  causes  consid- 
erable vascular  excitement,  does  not  disturb  the  secretory  functions,  and 
leaves  behind  no  unpleasant  sequelae,  and,  finally,  that  it  may  be  em- 
ployed as  a  substitute  for  opium  in  all  the  phlegmasias,  and  all  the 
typhous  affections,  without  apprehension  of  evil  result.  It  is,  however, 
at  the  same  time,  less  energetic  and  less  certain  than  opium.  (Arch. 
Gen.,  5e  ser.,  xv.  745.) 

Preparations.  The  forms  in  which  hemp  is  ordinarily  used  in  Europe 
and  this  country  are  the  extract  and  tincture. 

Extract  of  Hemp  (EXTRACTUM  CANNABIS),  as  recognized  in  the  IT.  S. 
Pharmacopeia,  is  prepared  by  treating  the  dried  tops  with  alcohol,  and 
evaporating  the  tincture  thus  obtained.  But  it  may  also  be  procured  by 
purifying  the  crude  cfrurrus  of  the  Hindoos,  by  dissolving  what  is  solu- 
ble of  it  in  alcohol,  allowing  the  undissolved  impurities  to  subside,  and 
then  decanting  and  evaporating.  In  this  way  is  prepared  the  Purified 
Extract  of  Hemp  (EXTRACTUM  CANNABIS  PURIFICATTJM)  of  the  U.  S. 
Pharmacopoeia.  A  still  purer  form  of  it  is  prepared  by  a  somewhat 
complicated  process,  for  an  account  of  which  the  Dispensatories  may  be 
consulted.  One  of  the  best  tests  of  its  strength,  independently  of  actual 
trial,  is  its  possession,  in  the  highest  degree,  of  the  characteristic  prop- 
erties of  smell  and  taste.  Prof.  Procter,  who  has  specially  investigated 
the  subject,  gives  as  its  characteristic  properties,  its  peculiar  smell  when 
slightly  heated,  its  indifference  to  the  alkalies,  and  its  solubility  in  alco- 
hol, ether,  chloroform,  benzole,  and  oil  of  turpentine ;  but  the  best  test, 
he  thinks,  is  nitric  acid,  which  acts  on  it  slowly  when' cold,  but  rapidly 
with  heat,  giving  out  red  fumes,  and  converting  the  resin  into  an  orange- 
red  substance,  which,  when  washed  and  dried,  closely  resembles  gam- 
boge in  colour.  (U.  S.  Dispensatory,  12th  ed.) 

The  dose  of  the  extract  varies  extremely,  in  consequence  of  the  vari- 
able strength  of  the  preparation.  When  of  the  best  quality,  half  a  grain 
of  it  will  produce  obvious  effects,  while  ten  or  twelve  grains  are  oTtcn 
required,  and  sometimes  the  drug  is  quite  inert.  It  is  best,  as  a  general 
rule,  to  begin  with  one  grain  or  less,  which  may  be  repeated  every  two, 
three,  or  four  hours,  until  its  effects  are  produced;  and,  if  none  can  be 
obtained  from  this  dose,  gradually  to  increase  it,  until  the  amount  is 
ascertained  in  which  the  parcel  employed  will  act.  In  tetanus,  ten  grains 
may  be  given  every  half  hour  till  it  operates,  and  the  quantity  increased. 
if  necessary.  It  may  be  administered  in  pill  or  emulsion.  The  latter  is 
the  preferable  form,  where  speedy  effect  is  required.  It  may  be  made 
by  rubbing  the  extract  up  with  a  little  olive  oil,  and  then  suspending  it 
in  water,  or  one  of  the  aromatic  waters,  by  means  of  gum  arabic  and 
sugar. 

Tincture  of  Hemp  (TINCTURA  CANNABIS,  U.  S.;  TINCTURA  CANNA- 


CHAP.  I.]  CEREBRAL   STIMULANTS. — HENBANE.  777 

BIS  INDICT,  Br.)  is  made  by  dissolving  six  drachms  of  the  extract  in  a 
pint  of  officinal  alcohol  (sp.  gr.  0.835).  The  dose,  equivalent  to  one 
grain  of  the  extract,  is  about  20  minims  or  40  drops.  Dr.  O'Shaugh- 
nessy  gave  10  drops  of  the  tincture  every  half  hour  in  cholera,  and  a 
fluidrachm  as  often  in  tetanus,  until  the  desired  effects  were  produced,  or 
the  medicine  showed  decided  signs  of  acting  on  the  brain.  This  is  among 
the  substances  which  have  been  used  in  the  form  of  spray,  as  made  by 
the  atomizer ;  from  five  to  ten  minims  being  mixed  for  the  purpose  with 
a  fluidounce  of  water.  It  has  been  inhaled  for  the  relief  of  nervous  or 
spasmodic  cough,  and  that  attendant  on  phthisis.  It  has  also  been  used 
hypodermically  for  the  general  effects  of  the  medicine,  in  the  dose  of  from 
ten  to  twenty  drops. 


VII.  HENBANE. 
HYOSCYAMUS.  Br. 

This  is  the  Hyoscyamvs  nigerof  botanists,  an  annual  or  biennial  herba- 
ceous plant,  indigenous  in  Europe,  where  it  is  also  cultivated  for  medical 
usr.  It  has  been  introduced  into  this  country,  and  grows  wild  in  some 
of  our  Northern  States,  especially  in  Michigan,  where  it  abounds  in  the 
neighbourhood  of  Detroit,  The  whole  plant  is  possessed  of  medicinal 
virtue.  The  IT.  S.  Pharmacopoeia  recognizes  the  leaves  and  seeds. 

HENBANE  LEAF.  —  Hyoscyami  Folium.  U.S. —  Hyoscyamus.  Br. 

The  leaves  of  henbane,  in  their  recent  state,  are  somewhat  hairy,  viscid 
to  the  touch,  of  a  sea-green  colour,  of  a  strong,  disagreeable,  narcotic 
odour  when  bruised,  and  of  a  mucilaginous,  somewhat  acrid  taste.  By 
drying  they  become  nearly  or  quite  inodorous  and  tasteless.  They  im- 
part their  virtues  to  alcohol  and  water.  By  destructive  distillation, 
th%  yield  a  very  poisonous  empyreunmtic  oil. 

HENBANE  SEED. — Hyoscyami  Semen.  U.  S. 

The  seeds  are  very  small,  roundish,  compressed,  of  a  grayish  or  yel- 
lowish-gray colour,  in  odour  like  that  of  the  plant,  and  a  bitter,  oily 
taste.  They  are  stronger  than  the  leaves,  but  less  used. 

Active  Principle.  There  is  little  or  no  doubt  that  the  virtues  of  hen- 
bane reside  in  a  peculiar  alkaloid,  denominated  hyotciamia,  which,  how- 
ever, though  it  has  been  isolated  and  accurately  described,  and  its  effects 
upon  the  system  investigated,  has  scarcely  been  introduced  into  use  as  a 
medicine.  It  exists  most  largely  in  the  seeds,  but  in  small  proportion 
even  in  these.  Experiment  has  proved  that  both  it  and  its  salts  are  very 
poisonous.  M.  Gustave  Lemattre,  who  has  carefully  investigated  the 
physiological  action  of  this  and  other  alkaloids  of  the  solanacese.,  with 


778  GENERAL    STIMULANTS.  [PART  II. 

the  view  of  determining  their  relations  to  one  another,  was  unable  to 
discover  any  appreciable  difference,  in  this  respect,  between  hyoscyamia 
and  the  two  better  known  alkaloids,  atropia  and  daturia.  (Archives 
Generates,  Aoiit,  1865,  p.  186.)  Dr.  A.  B.  Garrod,  of  London,  has  sat- 
isfactorily determined  that  the  caustic  alkalies,  potassa  and  soda,  entirely 
destroy  the  activity  of  hyoscyamia,  and  render  hyoscyamus  inert,  in 
reference  both  to  its  local  and  general  effects.  It  is  not,  however,  inju- 
riously affected  by  the  carbonates  of  the  same  alkalies.  (Med.  Times  and 
Gaz.,  Dec.  1857,  p.  589.) 

Effects  on  (he  System.  In  doses  scarcely  sufficient  to  make  themselves 
felt  in  health,  hyoscyarnus  appears  to  act  as  a  nervous  stimulant  in  dis- 
ease, calming  restlessness,  and  other  forms  of  slight  nervous  disorder, 
and,  in  cases  of  morbid  wakefulness,  producing  sleep  indirectly  by  re- 
moving the  cause  which  prevents  it.  In  full  medicinal  doses,  it  often 
produces,  along  with  some  increase  in  the  frequency  of  pulse  and  general 
warmth,  or  with  no  observable  effect  of  the  kind,  an  agreeable  and  diffu- 
sive feeling  of  comfort,  followed  perhaps  by  slight  vertigo,  or  other  un- 
easy sensations  in  the  head,  and  after  a  time  by  an  easy  natural  sleep. 
Sometimes,  however,  it  occasions  headache,  and,  instead  of  sound  sleep, 
gives  rise  to  uneasy  dreams,  spectral  illusions,  or  delirium.  In  not  a 
few  instances,  nothing  like  sleep  can  be  obtained  from  any  ordinary 
dose  ;  and,  in  such  cases,  some  degree  of  seasonal  or  mental  aberration 
is  apt  to  occur,  if  the  medicine  is  pushed.  Dr.  Pereira  says  that  it  is 
least  apt  to  produce  sleep  in  persons  accustomed  to  the  use  of  opium. 
A  characteristic  effect  of  it,  as  of  other  solanacese,  especially  belladonna 
and  stramonium,  when  the  system  is  fully  under  their  influence,  is  dila- 
tation of  the  pupil.  Besides  these  effects,  it  often  occasions  heat  or  irri- 
tation in  the  fauces,  sometimes  increases  the  perspiration  or  urine,  and, 
in  rare  instances,  has  caused  a  pustular  eruption  upon  the  surface.  In- 
stead of  constipating  like  opium,  it  either  produces  no  effect  on  the 
bowels,  or  acts  as  a  laxative ;  the  latter  result  being  not  uncommon. 
In  some  persons,  or  in  certain  states  of  the  system,  it  occasions  general 
febrile  heat  and  irritation.  After  the  subsidence  of  its  full  direct  effects, 
a  state  of  greater  or  less  depression  occurs,  which,  when  the  quantity 
taken  has  been  very  large,  may  amount  even  to  prostration. 

Hyoscyamus  has  not  unfrequently  been  swallowed  in  poisonous  quan- 
tities. This  has  happened  most  frequently  with  the  root,  which  has  been 
taken  by  mistake  for  that  of  some  other  plant,  as  parsnep  or  chiccory. 
The  effects  are  usually  giddiness,  more  or  less  stupor,  extreme  dilatation 
of  the  pupils,  disordered  vision,  spectral  illusions,  diminution  or  loss  of 
the  power  of  speech,  accelerated  pulse,  delirium,  sometimes  violent  and 
maniacal,  sometimes  low  and  muttering,  often  attended  with  laughter, 
tonic  spasms,  convulsions,  coma,  paralysis,  and  at  length  irivat  prostra- 
tion, with  small  and  irregular  pulse,  difficult  breathing,  and  cohlne.-s.  of 


CHAP.  I.]  CEREBRAL    STIMULANTS. — HENBANE.  779 

the  extremities.  From  this  extreme  condition,  however,  reaction  gener- 
ally takes  place,  and  comparatively  few  cases  terminate  fatally.  Yet 
death  has  occurred  in  several  recorded  instances.  Sometimes,  with  these 
narcotic  effects,  symptoms  of  severe  gastro-intestinal  irritation  are  exhib- 
ited, as  nausea,  vomiting;,  abdominal  pains,  and  purging.  The  adminis- 
tration of  the  medicine  by  enema,  and  its  external  application  over  the 
abdomen,  have  been  known  to  produce  severe  symptoms,  though  never. 
I  believe,  fatal. 

The  operation  of  the  poison  usually  continues  for  about  twelve  hours 
before  abating  spontaneously.  The  remedies  are  the  same  as  those  for 
opium  ;  full  vomiting  being  the  most  important.  From  the  experiments 
of  Dr.  Garrod,  it  appears  that  animal  charcoal  is  an  efficient  antidote  to 
hyoscyamia,  completely  destroying  its  powers,  even  in  small  quantities. 
This,  therefore,  should  be  used,  along  with  the  other  means  employed, 
in  the  treatment  of  its  poisonous  effects.  Of  course  it  can  exert  no  in- 
fluence on  the  poison  after  absorption.  (Hed.  Times  and  Gaz.,  Dec.  1857, 
p.  590.) 

The  lower  animals  are  affected  very  differently  by  the  herb.  Some, 
as  horses,  cows,  sheep,  goats,  and  hogs,  eat  it  with  impunity;  while 
birds  and  dogs  are  affected  like  man.  It  is  not  impossible  that  injury 
may  have  accrued,  particularly  to  children,  from  the  use  of  the  milk  of 
cows  and  goats  which  have  been  feeding  on  henbane. 

The  effects  of  hyoscyamia  have  been  carefully  investigated  by  Prof. 
Schroff,  of  A'ienna.  In  a  moderate  dose  it  produced  dryness  of  the  mouth 
and  throat,  dilatation  of  the  pupils,  diminution  followed  by  increased 
frequency  of  pulse,  vertigo,  hebetude  of  mind,  general  feelings  of  languor, 
and  finally  quiet  sleep.  By  larger  doses  these  effects  were  produced  in 
a  greater  degree.  The  dryness  of  throat  was  very  great,  there  was  diffi- 
culty of  deglutition,  the  sense  of  taste  and  smell  were  impaired,  head- 
ache came  on,  and  a  deep  and  quiet  sleep  closed  the  series.  A  solution 
of  it  dropped  into  the  eye  caused  a  dilatation  of  the  pupil  more  rapidly, 
intensely,  and  for  a  longer  time  than  any  other  agent.  Given  to  rabbits 
in  poisonous  doses  it  produced  deep  sleep,  followed  by  death,  without 
any  convulsive  movements,  or  apparent  delirium.  It  appeared  to  occa- 
sion inflammation  of  the  lungs.  This  result  is  somewhat  singular ;  as 
the  same  animals  can  eat  the  herb  freely  with  impunity.  (Wochenblatt 
der  Gesellschafl  der  Aertze  zu  Wien,  June  16, 1855.)*  Reisinger  states 


*  A  solution  of  this  difficulty  will  be  found  under  belladonna,  the  peculiar  alka- 
loid of  which  so  closely  resembles  hyoscyamia,  as  to  have  led  to  the  supposition 
that  the  two  might  be  identical.  It  appears  that  the  reason  why  certain  animals 
can  feed  with  impunity  on  the  leaves  of  the  solanaceae  is  that,  in  consequence  of  the 
mass  of  matter  in  their  stomachs  undergoing  digestion,  the  proportion  of  the  poison- 
ous principle  absorbed,  within  a  given  time,  is  insufficient  to  cause  a  poisoned  state 


780  GENERAL   STIMULANTS.  [PART  II. 

that  a  single  drop  of  an  aqueous  solution  containing  one  part  of  it  to 
ten  of  water,  introduced  into  the  eye  caused  dilatation  of  the  pupil  with- 
out irritation  of  the  conjunctiva. 

Mode  of  Action.  Though  it  would  be  difficult  to  prove  that  hyoscya- 
mus  operates  upon  the  system  through  absorption,  analogy  leads  almost 
necessarily  to  this  conclusion.  Its  local  action  is  that  of  a  very  moderate 
irritant,  as  shown  by  its  occasional  effects  on  the  stomach,  and  its  not 
unfrequent  action  upon  the  bowels.  As  a  direct" circulatory  stimulant  it 
is  very  feeble,  being,  in  this  respect,  greatly  inferior  to  opium ;  and,  in 
many  instances,  the  pulse  is  not  affected,  at  least  in  frequency.  The  de- 
pression of  the  circulation  which  attends  its  full  narcotic  action  is  a 
secondary  result,  depending  probably  on  the  condition  of  the  nervous 
centres.  Its  influence  upon  the  cerebral  centres  is,  I  have  no  doubt, 
essentially  stimulant;  sleep  resulting  from  a  mild  congestive  action  upon 
them,  while,  in  a  higher  degree  of  the  same  operation,  delirious  excite- 
ment is  produced,  and,  when  the  centres  are  quite  overwhelmed,  coma. 
The  effect  upon  the  pupil  may  be  considered  as  a  kind  of  sleep  of  the 
nervous  centre,  which  causes  contraction  of  the  iris;  or  it  may  result 
from  an  excitant  influence  upon  the  sympathetic  centres,  producing  a 
strong  contraction  of  the  dilating  fibres. 

Therapeutic  Application.  Henbane  was  known  as  a  medicine  to  the 
ancients,  but  received  little  notice,  until  attention  was  attracted  to  it  by 
Baron  Storck,  of  Vienna,  so  famous  for  his  experiments  with  this  and 
other  narcotics,  and  for  the  enthusiastic  estimate  he  placed  upon  their 
therapeutic  powers.  Though  this  medicine  has  not  realized  all  that  was 
hoped  from  it,  in  consequence  of  his  representations,  it  is,  however,  of  no 
little  value,  and  assuredly  does  not  deserve  the  sentence  of  banishment 
from  the  Materia  Medica  pronounced  upon  it  by  M.  Fouquier.  (Arch. 
Gen.,  \.  297  and  312.) 

The  indications  which  hyoscyamus  is  calculated  to  fulfil  are  to  allay 
pain,  produce  sleep,  relax  spasm,  and  quiet  nervous  disturbance  gen- 
erally. These  are,  among  others,  the  therapeutic  effects  of  opium, 
which  hyoscyamus  probably  as  nearly  resembles,  in  its  soporific  influ- 
ence, as  any  other  medicine.  It  is,  however,  in  these  respects,  much  in- 
ferior to  opium,  and  incomparably  less  to  be  relied  on ;  but  there  arc 
certain  circumstances  under  which,  in  consequence  of  its  want  of  prop- 
erties which  sometimes  interfere  with  the  beneficial  operation  of  that  medi- 
cine, it  may  be  used  when  opium  cannot,  arid  is  admirably  calculated  to 
supply  its  place.  In  the  first  place,  it  is  much  less  stimulant  to  the  cir- 


of  the  blood,  which  throws  out  the  noxious  matter  before  time  hns  been  allow>  1  for 
it  to  accumulate  HO  as  to  be  destructive.  But  if  one  of  the  solanaceou.s  alkaloids 
be  injected  into  the  veins,  or  even  into  the  subcutaneous  tissue,  it  acts  on  these  ani- 
mals poisonously,  just  as  it  acts  on  man.  (Note  to  the  third  edition.) 


CHAP.  I.]  CEREBRAL    STIMULANTS. HENBANE.  781 

dilation  than  opium,  and  though,  from  this  deficiency,  it  is  of  little  use 
in  supporting  the  system  in  certain  conditions  of  debility  where  opium 
is  highly  valuable,  it  is  more  safely  used  in  others,  in  which  the  anodyne 
and  soporific  properties  of  opium  are  wanted,  but  its  stimulant  prop- 
erty contraindicates  it.  Again,  it  does  not  constipate  like  opium,  but  is 
rather  laxative,  and  cannot,  therefore,  be  substituted  for  it  in  diarrhoea; 
but  thei'e  are  frequent  occasions  in  which  this  dissimilarity  gives  it  great 
advantages.  Thirdly,  it  has  no  such  effect  in  restraining  the  secretion 
of  mucus,  bile,  and  urine  as  opium  has ;  and  may  on  this  account  be 
sometimes  preferably  employed,  where  it  is  desirable  rather  to  promote 
than  to  impede  those  secretions,  as  sometimes  in  the  early  stages  of  in- 
flammation of  the  bronchial  tubes,  liver,  and  kidneys.  Lastly,  from  in- 
dividual idiosyncrasy,  or  peculiarity  in  disease,  opium  not  unfrequently 
occasions  so  much  nausea,  headache,  delirium,  or  other  disagreeable 
effect,  that  it  cannot  be  given,  however  strongly  called  for  as  an  anodyne 
or  soporific.  In  such  cases,  hyoscyamus  may  sometimes  be  substituted 
with  great  advantage. 

In  fevers,  hyoscyamus  may  often  be  usefully  employed  to  quiet 
nervous  disturbance  and  produce  sleep,  where  the  excitement  may  be 
too  high  for  opium,  or  that  medicine  may  be  objectionable  upon  some 
one  or  more  of  the  grounds  just  mentioned.  This  remark  is  especially 
applicable  to  the  febrile  affections  of  infants,  in  which  a  little  hyoscya- 
mus may  often  be  advantageously  conjoined  with  the  refrigerant  or 
laxative  medicines,  when  there  is  considerable  nervous  disturbance,  in- 
quietude, and  wakef ulness;  while  opium  might  do  more  harm  than  good. 

In  the  different  phlegmasise,  also,  the  medicine  may  be  used  to  fulfil 
its  proper  indications,  with  no  little  benefit.  This  is  particularly  the 
case  in  bronchial  inflammation,  whether  original,  or  connected  with 
other  diseases,  as  measles,  pneumonia,  etc.,  in  the  earlier  stages,  before 
secretion  has  taken  place,  and  in  any  stage,  whether  acute  or  chronic, 
if  the  prominent  indication  is  to  promote  secretion,  and  to  allay  cough. 
Opium  might  fulfil  the  latter  indication  at  the  expense  of  the  former. 
Hyoscyamus,  if  it  do  not  fulfil  both,  has  certainly  no  effect  in  restrain- 
ing the  secretion.  It  should  be  combined  with  the  expectorants  em- 
ployed. The  same  may  be  said  of  its  use  in  hepatitis,  especially  when 
the  substance  of  the  gland  is  affected.  In  the  peritoneal  form  of  hepa- 
titis, opium  would  be  incomparably  superior.  In  nephritis,  when  there 
is  a  great  deficiency  of  secretion,  hyoscyamus  may  sometimes  be  pref- 
able  ;  and  for  the  same  reason,  applying,  however,  in  this  instance  to 
the  mucous  and  not  the  urinary  secretion,  there  may  be  instances  in 
which  this  narcotic  would  be  more  appropriate  than  opium  in  inflamma- 
tion of  the  bladder  and  urinary  passages. 

To  the  relief  of  the  more  violent  forms  of  neuralgia,  or  indeed  of  ex- 
cessive pain  from  any  cause,  the  anodyne  powers  of  hyoscyamus  are 


782  GENERAL   STIMULANTS.  [PART  II. 

generally  inadequate;  though  it  may  be  tried  in  any  case  of  the  kind 
where  opium  cannot  be  given.  There  is,  however,  one  condition  of 
things  in  which  it  is  peculiarly  indicated;  I  refer  to  attacks  of  excessive 
sensitiveness  of  the  retina.  A  case  of  this  kind  occurred  to  me,  many 
years  since,  which  will  illustrate  my  meaning.  A  gentleman  of  highly 
nervous  temperament,  in  the  state  of  general  depression  following  an 
acute  disease,  and  after  considerable  depletion,  was  seized  with  an  ex- 
quisite irritability  and  sensitiveness  of  the  eye,  which  occasioned  the 
most  severe  suffering.  Light  was  torture  to  him;  and  it  was  neeessary 
to  close  the  outer  shutters  of  the  apartment,  and  to  draw  the  curtains 
closely  around  his  bed.  so  as  to  prevent  the  least  particle  from  reaching 
him.  Notwithstanding,  however,  this  precaution,  he  complained  of  the 
intolerable  brightness,  the  intense  and  insufferable  glow,  as  of  incandes- 
cent metal  held  immediately  before  his  face,  or  of  a  concentration  of  the 
whole  blazing  light  of  the  sun  directed  upon  his  vision  ;  and  language, 
in  one  who  knew  its  resources  well,  and  knew  how  to  wield  them  pow- 
erfully under  the  impulse  of  a  brilliant  imagination,  was  exhausted  to 
find  expressions  strong  enough  to  convey  an  idea  of  his  sufferings. 
Under  the  impression  that  he  was  affected  with  inflammation  of  the  < 
he  refused  opiates  altogether,  though  urged  upon  him.  At  last  I  pre- 
vailed on  him  to  take  a  single  grain  of  extract  of  hyoscyamus  every 
hour.  He  had  not  taken  more  than  three  or  four  doses,  when  he  expe- 
rienced a  sensible  amelioration  of  his  sufferings,  along  with  the  first 
narcotic  impression  of  the  medicine ;  and  they  continued  to  abate  so 
long  as  the  hyoscyamus  was  used.  Convinced  now  of  the  nature  of  tin 
affection,  he  consented  to  take  an  opiate  enema,  which  immediately 
put  an  end  to  the  symptoms.  I  have  no  doubt  that  a  full  dose  of  the 
hyoscyamus  would  have  had  the  same  effect.  It  is  especially  imlir; 
in  neuralgic  affections  of  the  eyeball,  through  its  influence  over  the  nerv- 
ous centre  of  vision. 

In  carcinomatous  and  other  painful  organic  affections,  hyoscyamus 
may  lie  alternated  with  opium,  in  the  hope  of  protracting  longer  the 
period  of  susceptibility  to  the  anodyne  effect  of  the  latter  remedy. 

Spasmodic  and  convulsive  diseases,  and  other  forms  of  nervous  irri- 
tation, afford  frequent  occasion  for  the  use  of  this  narcotic.  It  can  do 
little  good  in  the  more  violent  cases  of  painful  spasm,  such  as  spasm  of 
the  stomach,  severe  colic,  the  cramps  of  cholera,  tetanus,  etc.:  yet  in  the 
milder  conditions  of  the  affection  it  may  often  be  usefully  combined  with 
other  medicines,  as  in  slight  colicky  pains  with  cathartics,  in  the  milder 
forms  or  stages  of  colica  piclonum  with  alum,  in  similar  conditions  of 
the  biliary  and  urinary  passages  with  calomel  in  the  former  case,  and 
bicarbonate  of  soda  in  the  latter.  In  asthmatic  affections.  pi>rtu.~ 
and  the  convulsive  attacks  of  infants  dependent  on  teething  or  intes- 
tinal irritation,  it  may  sometimes  be  advisable.  Though  inadequate  to 


CHAP.  I.]  CEREBRAL    STIMULANTS. — HENBANE.  783 

the  cure  of  epilepsy  or  chorea,  it  may  be  usefully  combined,  in  some  in- 
stances, with  the  metallic  tonics  and  nervous  stimulants  used  in  those 
complaints.  In  the  multiplied  nervous  disorders  of  hysteria,  hyoscy- 
amus  may  now  and  then  be  had  recourse  to,  with  great  benefit,  for  reliev- 
ing distressing  sensations,  soothing  inquietudes,  and  procuring  sleep. 

It  is  a  favourite  practice  with  many  to  combine  hyoscyamus  with  the 
more  irritating  purgatives,  under  the  impression  that  it  tends  to  pre- 
vent their  griping,  without  diminishing  their  purgative  effects.  For 
this  purpose  it  is  frequently  used  with  the  compound  extract  of  colo- 
cynth,  or  with  scammony,  colocynth,  and  aloes  severally. 

Contraindications  to  the  use  of  hyoscyamus  are  active  congestion  or 
inflammation  of  the  brain,  a  very  high  degree  of  febrile  or  inflammatory 
excitement  generally,  and  inflammation  of  the  stomach  or  bowels. 

Topical  Use.  Fresh  henbane  is  sometimes  used  in  the  form  of  a  cata- 
plasm, or  infused  in  hot  water  as  a  lotion  or  fomentation,  to  relieve  pain 
and  irritation,  as  in  hemorrhoidal  or  carcinomatous  tumours,  painful 
glandular  swellings,  gouty  or  rheumatic  affections,  scrofulous  and 
cancerous  ulcers,  nervous  headache,  etc.  The  extract  is  also  employed 
for  the  same  purposes.  The  remedy  is  sometimes  used  in  the  way  of 
enema,  to  relieve  irritation  of  the  rectum,  bladder,  urinary  passages, 
or  genital  organs.  Oculists  sometimes  use  it  to  dilate  the  pupil  before 
the  operation  for  cataract ;  a  solution  of  the  extract,  or  an  infusion  of  the 
leaves  being  drppped  into  the  eye,  or  the  extract  with  lard,  rubbed  upon 
the  lids  and  around  them.  The  effect  is  usually  produced  within  four 
hours,  and  continues  twelve.  The  same  application  has  been  recom- 
mended after  the  operation  for  cataract,  when  there  is  danger  of  iritis, 
to  prevent  the  pupil  from  closing.  Used  in  this  way,  it  does  not  affect 
the  vision. 

Administration.  Neither  generally  nor  locally  should  henbane  be 
administered  with  one  of  the  fixed  caustic  alkalies;  and,  when  it  is  de- 
sirable to  combine  an  alkaline  action  with  that  of  the  medicine,  the  car- 
bonates should  be  used.  The  medicine  may  be  given  in  substance, 
extract,  or  tincture.  The  dried  leaves  are  so  uncertain  that  they  are  very 
seldom  used.  The  dose  to  begin  with  is  from  five  to  ten  grains.  The 
seeds  should  not  be  employed  at  first  in  more  than  half  the  smaller  dose 
mentioned.  The  extract  is  much  more  frequently  used. 

Two  extracts  of  henbane  are  directed  by  our  national  Pharmacopoeia, 
one  made  by  inspissating  the  expressed  juice  of  the  fresh  leaves,  the  other 
by  evaporating  an  alcoholic  tincture  of  the  dried  leaves  The  former  is 
called  simply  Extract  of  Henbane  (EXTRACTUM  HYOSCYAMI,  U.  S.),  the 
latter  Alcoholic  Extract  of  Henbane  (EXTRACTUM  HYOSCYAMI  ALCO- 
HOLICUM,  U.  S.).  As,  in  many  parts  of  our  country,  the  fresh  leaves 
cannot  be  obtained,  it  is  necessary  either  to  use  the  imported  extract,  or 
to  prepare  the  alcoholic.  Unhappily,  in  either  case,  the  preparation  is  of 


784  GENERAL   STIMULANTS.  [PART  II. 

very  uncertain  strength,  and  often  extremely  feeble.  The  proper  method 
of  proceeding,  in  this  uncertainty,  is  to  give  from  one  to  three  grains  of 
the  extract,  and  gradually  increase  the  dose  until  it  produces  the  desired 
effect,  or  at  least  evinces  some  narcotic  power;  and,  having  thus  ascer- 
tained the  strength  of  the  parcel,  to  be  guided  afterwards  accordingly. 
The  dose  will  often  be  raised  to  ten  grains  before  acting,  sometimes  even 
to  twenty  or  thirty  grains,  or  indeed  much  higher;  for  occasionally  the 
extract  is  quite  inert. 

A  Fluid  Extract  (EXTRACTUM  HYOSCYAMI  FLUIDUM,  U.  S.)  was  in- 
troduced into  the  U.  S.  Pharmacopoeia  at  the  late  revision.  It  is  a  con- 
centrated tincture,  and  may  be  given  in  the  commencing  dose  of  from 
five  to  ten  minims. 

The  Tincture  of  Henbane  (TINCTURA  HYOSCYAMI,  U.  S.,  Br.)  is  also 
officinal.  It  is  prepared  from  the  leaves  by  percolation  with  diluted 
alcohol,  and  is  of  such  a  strength  that  a  fluidrachm  represents  rather 
less  than  eight  grains.  The  same  ru^e  holds  as  to  the  commencing  dose 
in  this  as  in  the  extract;  for  the  preparation  is  almost  equally  uncer- 
tain. From  thirty  minims  to  a  fluidrachrn  and  a  half  may  be  given  at 
first. 

Should  hyoscyamia  be  used,  not  more  than  one-sixteenth  of  a  grain 
should  be  given  at  once.  As  water  dissolves  it  in  small  proportion,  its 
aqueous  solution  may  be  used  for  dilating  the  pupil,  being  for  that  pur- 
pose dropped  into  the  eye. 


VIII.  BELLADONNA. 

BELLADONNA  LEAF.  — BELLADONNA  FOLIUM.  U.S.—  BELLA- 
DONNA. Br. 
BELLADONNA  ROOT.— BELLADONNA  RADIX.  U.  S.,  Br. 

Origin.  Under  the  name  of  Belladonna,  the  British  Pharmacopoeia 
recognizes  the  leaves  of  Alropa  Belladonna,  or  deadly  nightshade,  which 
in  our  own  are  designated  as  Belladonnae  Folium  ;  while  in  both,  the  root 
of  the  plant  is  officinal,  with  the  title  of  Belladonna  Radix.  The  plant 
is  herbaceous,  but  perennial,  indigenous  in  Europe,  and  cultivated  in  this 
country,  but  to  no  great  extent,  for  medicinal  purposes.  Though  all 
parts  of  the  plant  are  active,  the  leaves  only  were  officinally  recognized 
until  the  recent  revision  of  the  Pharmacopoeias,  when  the  root,  which  is 
said  to  be  much  more  active  than  the  leaves,  was  adopted.*  The 

*  Hirtz  states  that  the  roots  are  stronger  than  the  leaves  in  the  proportion  of  five 
to  one.  (Ann.  de  Thfrap.,  1862,  p.  22.) 


CHAP.  I.]      CEREBRAL  STIMULANTS. — BELLADONNA.          785 

fruit,  though  not  specially  used  in  medicine,  merits  a  particular  notice, 
as  it  is  highly  poisonous,  and  has  frequently  been  eaten  with  fatal  effect. 

Properties.  The  root  is  a  foot  or  more  in  length,  round,  an  inch  or 
more  in  thickness,  branched,  grayish  or  brownish-white  when  fresh,  be- 
coming reddish-brown  by  drying,  internally  whitish  and  fleshy,  of  a  faint 
peculiar  odour,  and  sweetish,  slightly  bitter,  mawkish  taste.  The  leaves, 
which  are  often  in  unequal  pairs,  upon  short  footstalks,  are  from  four  to 
six  inches  long,  ovate,  pointed,  entire  upon  their  edges,  of  a  deep-green 
colour  above  and  paler  below  when  fresh,  of  a  dusky  or  brownish-green 
when  dried,  and,  in  the  latter  state,  almost  destitute  of  odour,  and  of  a 
feeble  subacrid  taste.  The  fruit  is  a  berry,  at  first  green,  then  red,  and, 
when  ripe,  of  a  fine  glossy  blackish-purple  colour,  about  as  large  as  a 
cherry,  with  a  longitudinal  furrow  on  each  side,  having  the  adhering 
calyx  at  the  base,  and  containing  numerous  seeds  in  a  juicy  pulp.  Its 
taste  is  sweetish,  but  mawkish,  and  not  agreeable.  All  parts  of  the  plant 
impart  their  medicinal  properties  to  water  and  alcohol. 

Active  Principle.  The  ingredient  to  which  belladonna  chiefly  if  not 
exclusively  owes  its  virtues  is  a  peculiar  alkaloid,  denominated  alropia, 
which  will  be  specially  treated  of  at  the  close  of  this  article.  Brandes 
obtained  also  a  peculiar  substance  called  pseudotoxin,  and  Lubekind 
supposed  that  he  had  detected  another  alkaloid  which  he  named  bella- 
donnin;  but  little  is  known  of  their  properties;  and  the  ordinary  exist- 
ence of  the  latter  may  be  looked  on  as  doubtful.  In  relation  to  the  in- 
compatibility between  atropia  and  caustic  potassa  and  soda,  even  in  very 
weak  solution,  the  same  remarks  are  applicable  as  were  made  upon 
hyoscyamia.  (See  page  777.) 

1.  Effects  on  the  System. 

Belladonna  produces  its  characteristic  effects  upon  the  system,  to  what- 
ever part  it  may  be  applied,  whether  to  the  stomach,  the  skin,  the  rectum, 
the  cellular  tissue,  or  the  blood.  When  it  is  given  in  small  doses,  re- 
peated two  or  three  times  daily,  so  as  to  bring  the  system  gradually 
under  its  influence,  the  first  effect  usually  noticed  is  a  feeling  of  dryness 
and  stricture  in  the  fauces,  soon  followed,  if  the  medicine  be  continued 
or  increased,  with  slight  uneasiness  or  pain  in  the  forehead,  vertiginous 
sensations,  some  dimness  of  vision,  and  occasionally  dilatation  of  the 
pupil.  The  system  maybe  kept  long  under  its  influence,  with  little  other 
observable  effect,  by  a  careful  management  of  the  dose.  In  some  very 
susceptible  persons,  however,  the  quantity  usually  given  will  act  more 
powerfully ;  in  one,  producing  blindness  with  large  dilatation  of  the  pupil ; 
in  another,  decided  pain  in  the  head,  flushed  face,  perhaps  slight  delirium, 
and  an  excited  pulse. 

From  larger  quantities,  the  effects  are  more  quickly  induced  and  more 
VOL.  i. — 50 


786  GENERAL   STIMULANTS.  [PART  II. 

severe.  A  dose  sufficient  to  bring  the  system  at  once  decidedly  under 
its  influence,  generally  begins  to  show  its  effects  in  about  half  an  hour. 
Pryness  of  the  mouth  and  fauces,  a  feeling  of  stricture  of  the  throat, 
difficult  deglutition,  thirst,  dimness  of  vision  sometimes  amounting  to 
blindness,  dilated  pupil,  vertigo  or  headache,  flushed  face,  suffused  eyes, 
morbid  sounds,  irregular  muscular  contractions,  and  hallucination  or  de- 
lirium, sometimes  followed  by  a  disposition  to  sleep,  sometimes  attended 
throughout  with  wakefulness,  are  symptoms  which  most  frequently  ap- 
pear, though  not  all  generally  in  the  same  case,  and  which,  having  con- 
tinued for  twelve  hours  or  more,  gradually  subside,  without  leaving  any 
ill  consequences  behind.  Along  with  more  or  less  of  the  effects  men- 
tioned, there  is  generally  some  frequency  of  pulse  and  febrile  excitement : 
but  sometimes  the  circulation  is  at  first  little  affected  ;  and,  when  the  cer- 
ebral phenomena  are  at  their  height,  it  is  in  a  greater  or  less  degree 
depressed.  According  to  Lemattre.  even  when  most  excited,  the  pulse 
is  diminished  in  tension  or  force.  Not  unfrequently  there  is  an  increase 
either  of  perspiration  or  urine,  sometimes  an  eruption  of  scarlet  rash  on 
the  surface,  or  irritation  of  the  urinary  passages.  Occasionally,  also, 
there  is  some  nausea  or  griping  pain  with  diarrhoea,  intimating  an  irri- 
tating influence  on  the  alimentary  mucous  membrane. 

A  curious  fact  in  relation  to  the  tolerance  of  belladonna  by  children 
has  been  made  known  by  Dr.  H.  W.  Fuller,  of  London.  Having  pre- 
scribed the  extract  in  a  case  of  chorea,  and  observing  no  effect  to  follow, 
he  gradually  increased  the  dose,  and  was  surprised  to  find  that  very 
large  quantities  were  borne  without  effect.  He  tried  the  medicine  in 
other  cases  of  chorea  with  the  same  result.  In  one  girl  of  ten  years, 
seventy  grains  were  given  daily  with  little  effect.  It  was  satisfactorily 
ascertained  that  the  extract  used  was  active  ;  and,  in  one  instance,  atro- 
pia  escaped  copiously  with  the  urine.  He  then  tried  the  medicine  in 
healthy  children  from  five  to  twelve  years  old,  and  found  the  same  tol- 
erance evinced ;  and  hence  came  to  the  conclusion  that  this  singular  phe- 
nomenon was  ascribable  to  peculiarity  in'the  systems  of  children.  The 
quantity  which  was  quite  harmless  in  a  child  could  net  be  borne  by  an 
adult.  (Med.  Times  and  Gaz.,  July,  1859,  p.  95.)  Nevertheless,  this  ex- 
perience of  Pr.  Fuller  should  not  be  hastily  acted  on ;  as  peculiar  un- 
known circumstances  may  possibly  have  influenced  the  result,  and  a 
similar  tolerance  might  not  be  found  in  other  instances. 

Poisonous  Effects.  When  poisonous  quantities  are  taken,  the  effects 
described  are  experienced  in  a  still  greater  degree.  The  circulation  is 
accelerated  and  the  heat  of  skin  increased.  The  lips,  tongue,  and  fauces 
are  very  dry,  with  a  burning  sensation  in  the  throat  and  stomach,  a  sense 
of  severe  constriction  of  the  throat,  great  difficulty  of  swallowing,  and 
intense  thirst.  Not  unfrequently  there  is  nausea  with  ineffectual  retch- 
ings ;  and  sometimes  strangury  and  bloody  urine.  The  dimness  of  vision 


CHAP.  I.]      CEREBRAL  STIMULANTS. — BELLADONNA.          787 

is  extreme,  and  total  blindness  not  uncommon,  with  the  pupil  greatly 
dilated,  immovable  and  quite  insensible  to  the  brightest  light.  The  hear- 
ing is  also  defective,  and  not  unfrequently  there  is  great  difficulty  of 
speaking,  amounting  sometimes  to  aphonia.  General  sensibility,  which 
is  at  first  somewhat  exaggerated,  after  a  time  becomes  blunted,  and  at 
last  disappears.  (Lemaltre.)  The  face  is  red  and  swollen,  and  the  eyes 
suffused  with  blood,  sometimes  as  it  were  projecting,  sometimes  with  a 
fixed  meaningless  stare,  sometimes  haggard,  or  wild  and  fierce.  Vertigo 
soon  comes  on  with  .visual  deceptions,  and  the  patient  fancies  that  he 
sees  objects  in  his  vicinity  which  have  no  real  existence,  and  makes  mo- 
tions accordingly.  There  are  occasionally  illusions  of  hearing,  but  they 
are  much  rarer  than  those  of  sight.  In  one  case,  complete  somnambul- 
ism was  observed ;  the  patient  imagining  that  he  was  a  tailor,  and  for 
twenty-four  hours  making  gestures  as  if  working  at  his  trade.  The  de- 
lirium is  generally  cheerful  or  gay  ;  agreeable  or  ludicrous  ideas  present 
themselves;  and  the  patient  smiles  or  bursts  out  into  laughter,  or  makes 
whimsical  gesticulations.  Sometimes,  however,  he  is  wild  or  even  fu- 
rious. The  intoxication  is  not  unlike  that  of  alcohol.  Stupor  or  coma 
at  length  supervenes,  sometimes  alternating  or  mingling  with  delirium, 
and  even  in  sleep  the  dreams  are  occasionally  ludicrous,  producing  bursts 
of  laughter.  Partial  spasmodic  contractions  take  place ;  the  jaws  being 
closed,  the  muscles  of  the  face  working,  and  those  of  the  hands  moving 
irregularly ;  but  convulsions,  though  they  sometimes  occur,  are  very 
rare.  On  attempting  to  rise,  the  patient  is  unable  to  maintain  the  erect 
position,  staggers,  or  moves  with  his  body  bent  forward.  Sometimes 
dysury  has  been  noticed ;  but  no  increase  of  urine  unless  when  the  pa- 
tient has  indulged  his  great  thirst.  The  pulse  is  now  very  feeble,  the  ex- 
tremities cold,  a  disposition  to  syncope  evinced ;  and,  if  the  case  is  to 
terminate  fatally,  death  is  preceded  by  great  prostration,  subsultus  ten- 
dinum,  and  profound  coma.  If,  on  the  contrary,  recovery  takes  place, 
which  happens  in  the  great  majority  of  cases,  even  without  medical  in- 
terference, the  symptoms  gradually  disappear,  and,  in  two  or  three  days, 
the  patient  is  restored,  usually  remembering  nothing  of  what  had 
passed.  * 

The  poisonous  effects  have  been  experienced  from  belladonna  injected 
into  the  rectum,  applied  to  blistered  surfaces,  and  even  employed  in 


*  The  symptoms  above  given,  as  characteristic  of  poisoning  by  belladonna,  must 
not  be  considered  as  all  occurring  in  every  case,  nor  at  the  same  time  in  the  same 
case ;  but  the  affection  of  the  pupil  and  of  vision  is  probably  uniform.  Many  of  the 
symptoms  have  been  drawn  from  an  account,  by  M.  Gamier  de  Claubry,  of  one 
hundred  and  fifty  French  soldiers,  who,  in  one  of  the  campaigns  in  Germany,  ate 
the  berries  of  the  belladonna  plant  by  mistake,  and  all  suffered  in  greater  or  less 
degree.  Many  of  them  perished.  (Journ.  Gfnfral  de  Mid.,  xlviii.  335.) 


788  GENERAL   STIMULANTS.  [PART  II. 

the  form  of  a  large   cataplasm   over  the   abdomen,  with   the   cuticle 
unbroken. 

Its  influence  extends  to  the  contents  of  the  womb  in  pregnancy ;  and 
it  is  said  that  the  aqueous  humor,  taken  from  the  foetus  of  one  of  the 
lower  animals  poisoned  with  it,  will  expand  the  pupils  in  another  animal, 
if  dropped  into  the  eye. 

The  quantity  necessary  to  destroy  life  varies  so  much,  according  to 
the  constitution  of  the  patient,  and  the  strength  of  the  preparation,  that 
it  is  impossible  to  fix  the  poisonous  dose,  with  an  approach  to  precision 
Two  grains  of  the  extract  have  produced  alarming  symptoms  ;  six  grains 
administered  by  enema  have  had  a  similar  effect;  while  it  is  asserted 
that  a  pound  of  the  berries  were  eaten  by  a  man  on  one  occasion,  who 
nevertheless  recovered  under  treatment.  (Christison  on  Poisons.) 

Accurate  accounts  are  wanted  of  the  appearances  left  behind  by  the 
poisoning  of  belladonna.  In  general  the  stomach  exhibits  signs  of  some 
irritant  action,  and,  in  a  case  recorded  by  Gmelin,  the  vessels  of  the  head 
were  found  engorged,  and  the  blood  was  fluid.  According  to  Lemattre, 
no  lesions  are  found  in  the  larynx  or  pharynx,  or  in  the  proper  nervous 
tissues ;  and  the  only  ascertained  signs  of  disorder  are  offered  in  conges- 
tion. Hyperasmia  of  the  pulmonary  tissue  is  generally  presented,  but 
always  in  small  foci,  which  sometimes  unite,  and  are  more  frequent  on 
the  surface  than  in  the  depths  of  the  lungs.  There  is  also  congestion 
of  the  meninges,  especially  at  the  base  of  the  brain,  and  in  the  choroid 
plexus  of  the  lateral  ventricles.  The  pia  mater  is  strongly  congested ; 
and  the  same  is  the  case  with  the  retina  in  chronic  poisoning.  The  con- 
gestion, however,  is  not  inflammatory,  but  rather  hemorrhagic.  No 
signs  of  exudation  are  discoverable.  (Arch.  Gen.,  Aout,  1865,  p.  173.) 

The  treatment  of  this  poisoning  is  exactly  the  same  as  that  for  opium, 
to  which  the  reader  is  referred.  As  the  insensibility  of  the  stomach  and 
bowels  is  often  great,  though  not  equal  to  that  from  opium,  the  same 
measures  must  be  had  recourse  to,  in  order  to  favour  the  operation  of 
emetics,  including  the  loss  of  blood  if  the  symptoms  of  cerebral  conges- 
tion should  be  very  prominent.  The  stomach-pump  should  never  be 
trusted  to,  when  the  berries  have  been  taken.  In  the  state  of  coma,  the 
electro- magnetic  machine  may  be  employed.  In  addition  to  the  other 
measures,  it  may  be  advisable  to  use  animal  charcoal  as  an  antidote, 
as  in  poisoning  by  hyoscyamus.  (See  page  779.) 

Much  has  been  said  of  an  antagonistic  relation  between  opium  and 
belladonna,  in  their  effects  on  the  system,  which  is  supposed  to  render 
them,  to  a  certain  extent,  mutually  antidotal  in  cases  of  poisoning  from 
either;  opium  being  considered  as  an  antidote  in  poisoning  by  bella- 
donna, and  belladonna  in  poisoning  by  opium.  The  idea  seems  to  have 
originated  in  the  marked  difference  in  their  action  on  the  pupil,  which  is 


CHAP.  I.]     CEREBRAL  STIMULANTS. — BELLADONNA.          789 

dilated  by  belladonna,  while  it  is  often  contracted  by  opium  in  large 
doses.  It  was  supposed  that  there  might  be  a  similar  opposition  in 
other  respects.  Indeed,  opium  had  been  long  previously  employed,  and 
advantageously,  in  the  treatment  of  belladonna  poisoning.  But  the  ap- 
plication of  belladonna  to  opium  poisoning  seems  to  have  originated 
with  Dr.  Thomas  Anderson,  who,  in  a  paper  offered  to  the  Physio- 
logical Society  of  Edinburgh,  in  1854,  gave  the  details  of  two  success- 
ful cases  in  which  he  had  used  belladonna.  Afterwards,  Mr.  Benjamin 
Bell,  of  Edinburgh,  derived  advantage,  in  a  case  of  excessive  action  of 
atropia,  from  injecting  a  solution  of  morphia  into  the  subcutaneous  areo- 
lar  tissue.  (Ed.  Month.  Journ.,  July,  1858,  p.  6.)  A  few  other  cases 
of  similar  significance  had  been  published  in  the  journals  of  Europe  and 
this  country  ;  but  it  was  not  till  1862,  that  the  attention  of  the  profes- 
sion was  generally  aroused  to  the  subject,  by  a  paper  of  Dr.  Wm.  F.  Norris, 
of  Philadelphia,  published  in  the  American  Journal  of  the  Medical 
Sciences  (Oct.  1862,  p  395),  describing  two  cases  of  opium  poisoning, 
in  which  belladonna  was  employed  with  other  measures,  and  giving  a 
brief  account  of  what  was  known  on  the  subject  up  to  the  time  at  which 
he  wrote.  Since  then,  numerous  cases  have  been  published  in  which 
these  medicines  have  been  employed  with  apparent  success  as  antidotes, 
the  one  of  the  poisonous  effects  of  the  other ;  and  the  general  sentiment 
of  the  profession  is  probably  favourably  inclined  to  the  idea  of  their  mutual 
corrective  powers.  I  have  examined  many  of  these  reported  cases,  and 
have  come  to  the  conclusion,  that  we  should  not  be  justified,  by  anything 
which  has  yet  been  published,  in  relying  practically  upon  the  entire 
adequacy  of  either  of  these  narcotics  to  the  prevention  of  the  poisonous 
effects  of  the  other,  and  especially  upon  that  of  belladonna  to  obviate  the 
danger  from  excessive  doses  of  opium.  In  the  first  place,  very  many 
of  the  cases  of  poisoning  from  these  narcotics,  even  from  large  quantities, 
end  favourably,  without  any  aid  from  the  physician,  sometimes  in  con- 
sequence of  the  spontaneous  occurrence  of  vomiting,  sometimes  from  a 
remarkable  insusceptibility  of  the  patient,  but  still  more  frequently  from 
the  dose  taken  having  been  sufficient  to  produce  very  alarming  symptoms, 
and  yet  not  large  enough  to  destroy  life  ;  and  it  is  very  obvious,  from  a 
perusal  of  the  published  cases,  that  many  of  them  belonged  to  this  cate- 
gory. Secondly,  in  a  large  proportion  of  the  cases  recorded,  measures 
had  been  successfully  used  for  the  evacuation  of  the  poison,  even  at  an 
early  period ;  and  this  measure  alone,  if  complete,  is  often  sufficient  to 
save  life  Thirdly,  in  almost  all  instances,  other  remedies  were  em- 
ployed in  connection  with  belladonna,  in  opium  poisoning,  such  as  had 
often  before  proved  efficient ;  so  that  it  would  be  impossible  to  deter- 
mine to  which  one,  or  to  what  combination  of  them,  the  favourable 
result  was  really  ascribable.  Besides,  cases  of  failure  have  been  re- 


790  GENERAL   STIMULANTS.  [PART  II. 

corded  as  well  as  successes  ;*  and  experiments  have  been  performed, 
which,  if  confirmed,  must,  as  appears  to  me,  be  decisive  against  the 
opinion  of  a  mutual  antidotal  power.  Dr.  Bois  has  published,  in  the 
Gazette  des  Hopitaux,  an  account  of  experiments,  in  which  large  doses  of 
morphia  and  atropia  were  injected  successively  into  animals,  with  conse- 
quences which  induced  him  to  conclude  that,  so  far  from  neutralizing 
each  other,  they  produced  conjointly  more  powerful  poisonous  effects 
than  could  proceed  from  either  acting  separately.  (Arch.  Gen.,  Aout, 
1865,  p.  203.)  Nor  is  this  otherwise  than  might  be  reasonably  ex- 
pected a  priori.  Both  poisons  operate  with  a  powerfully  congestive 
influence  on  the  brain  ;  and  both  destroy  life  in  the  same  way  ;  that  is, 
either  by  suspending  respiration,  or  by  the  vast  secondary  prostration 
consequent  on  their  primary  excitant  action.  It  is  true  that  in  some 
points  they  actually  are  antagonistic.  Thus  one  contracts,  the  other  ex- 
pands the  pupils ;  one  agitates  and  greatly  disturbs  the  cerebral  functions, 
the  other  has  a  composing  influence  on  these  functions.  This  probably 
happens  in  consequence  of  a  special  direction  of  each  poison  to  separate 
nervous  centres  ;  while,  in  regard  to  their  fatal  effects,  they  operate  upon 
the  same.  Therefore,  though  belladonna  may  expand  a  pupil  contracted 
by  opium,  and  partially  rouse  a  patient  from  the  torpor  produced  by  the 
latter;  yet,  in  their  fatal  action  on  the  respiratory  centres,  and  in  the  sec- 
ondary prostration,  they  coincide,  and  augment  each  other's  effects ;  and 
at  least  in  one  of  the  fatal  cases  on  record,  it  seems  to  me  highly  probable 
that  death,  which  was  caused  by  great  debility,  was  really  the  result  of 
the  conjoint  prostration  from  excessive  doses  of  the  two  narc6tics.  To 
produce  a  decided  impression  in  opium  poisoning,  large  doses  of  bella- 
donna are  considered  needful,  and  the  quantity  sometimes  exhibited  has 
been  such  as  under  other  circumstances  might  endanger  life.  This  fact 
has  been  advanced  in  support  of  the  idea  of  antagonism ;  but  the  fact  is 
that,  when  the  nerve  centres  are  under  any  powerful  impression,  much 
larger  doses  of  one  of  the  narcotics  is  required  to  produce  a  given  effect 
than  under  ordinary  circumstances.  The  enormous  doses  of  opium  tol- 
erated and  required  in  tetanus,  delirium  tremens,  and  some  cases  of 
neuralgia  are  familiar  to  every  one.  So,  when  the  system  is  under  a 

*  A  case  is  recorded  in  the  Bost.  Med.  and  Surg.  Journ.  (Ix.  468),  in  which  over- 
doses of  sulphite  of  morphia  and  extract  of  belladonna  were  by  accident  taken  simul- 
taneously, and  in  which,  instead  of  any  material  counteraction,  there  was  an  exag- 
geration of  effect,  which  could  scarcely  have  arisen  from  any  other  cause  than  the 
conjoint  influence  of  both.  In  the  Med.  Times  and  Gaz.  (Nov.  18!>6,  p.  473),  there  is 
an  account  of  a  casein  which  the  two  poisons  were  taken  in  connection;  a  liniment 
intended  for  external  use,  containing  extract  of  belladonna  and  laudanum,  having 
been  swallowed  by  mistake.  The  symptoms  of  the  two  narcotics  were. jointly  pro- 
duced; and,  though  there  was  scarcely  enough  of  either  or  both  together  to  cai!-*o 
death,  yet  the  symptoms  were  alarming.  (Note  to  the  third  edition.) 


CHAP.  I.]     CEREBKAL  STIMULANTS. — BELLADONNA.          791 

strong  influence  from  opium,  much  more  belladonna  is  required  for  the 
production  of  its  own  peculiar  phenomena  than  in  ordinary  health. 
From  all  this  it  results,  that  it  would  be  very  hazardous  to  trust  a  case 
of  poisoning  from  belladonna  or  opium  exclusively  to  the  supposed  anti- 
dotal powers  of  either.  Still,  both  of  these  narcotics  may  be.  advan- 
tageously used,  with  due  attention  to  their  special  influences.  Thus,  the 
excessive  agitation  of  belladonna  poisoning,  and  the  prostration  of  its 
advanced  stage,  may  be  relieved  by  the  composing  and  stimulant  influ- 
ence of  opium ;  while  the  stupor  and  depression  which  mark  the  later 
stage  of  the  effects  of  opium,  may  be  counteracted  by  the  agitating  and 
supporting  action  of  belladonna  ;  but  care  should  be  taken  that  the 
two  should  not  coincide  in  their  poisonous  effects;  that  is,  that  neither 
the  early  nor  the  advanced  stages  of  their  action  should  come  together. 
As  has  been  before  mentioned,  one  of  the  great  dangers  of  opium  poison- 
ing is  the  secondary  prostration.  Here  belladonna  may  be  used  as  a 
stimulant,  in  like  manner  as  brandy,  carbonate  of  ammonia,  etc.  In  the 
similar  stage  of  belladonna,  when  the  great  danger  is  debility,  opium 
may  sometimes  perhaps  save  life  by  its  stimulant  action,  in  the  same 
manner  as  the  alcoholic  stimulants. 

On  the  lower  animals  the  effects  of  belladonna  vary  greatly.  The 
herbivorous  eat  the  plant  with  apparent  impunity,  while  the  carnivorous 
are  affected  like  man.  Instances  are  mentioned  in  which  the  horse,  the 
ass,  and  rabbits  have  eaten  of  it  freely,  with  no  observable  symptoms, 
while  dogs  are  poisoned.  A  rabbit  was  fed  on  it  for  eight  days,  and  was 
not  observed  to  suffer.  (Journ.  de  Pharm.,  x.  85.)* 

2.  Mode  of  Operation. 

Belladonna  is  a  feeble  local  irritant,  has  upon  the  circulation  either  a 
moderately  excitant  effect,  or  no  direct  effect  whatever,  and  powerfully 
stimulates  the  brain.  It  undoubtedly  operates  on  the  system  through 
absorption.  The  proofs  of  this  fact  are  that  it  produces  the  same  effect 
to  whatever  surface  it  may  be  applied,  even  when  introduced  into  the 

*  The  generally  admitted  fact,  that  plants  poisonous  to  man  are  taken  with  im- 
punity by  certain  of  the  lower  animals,  does  not,  according  to  M.  Lemattre,  imply 
that  the  active  principles  are  not  poisonous  to  these  animals,  if  absorbed  into  the 
circulation.  M.  Lemattre  found  that  all  animals,  upon  whioh  the  trial  was  made, 
were  susceptible  of  the  poisonous  action  of  atropia,  and  the  other  solanaceous  alka- 
loids. The  impunity,  therefore,  with  which  rabbits,  goats,  etc.,  may  eat  the  leaves 
of  the  belladonna  and  stramonium  plants  must  be  attributed  to  the  non-absorption 
of  the  alkaloids  from  the  stomach,  or  so  slow  an  absorption  that  sufficient  does  not 
enter  the  circulation  at  one  time  to  produce  deleterious  effects.  This  may  be  ex- 
plained in  part  by  the  fulness  of  the  stomach  with  various  fresh  vegetable  matters, 
which  interfere  with  the  rapid  digestion  of  the  poison.  (Archives  Gen.,  Juillet,  1865, 
p.  89;  also  Lancet,  Sept.  2,  1865,  p.  269.) — Note  to  the  third  edition. 


792  GENERAL    STIMULANTS.  [PART  II. 

blood,  and  that  its  active  principle  has  been  detected  in  the  urine.  It  is 
asserted  that  the  urine  of  a  rabbit  which  had  been  fed  upon  it,  caused 
dilatation  in  the  pupil  of  a  cat  to  which  it  was  applied.  According  to 
M.  Runge,  of  Berlin,  belladonna,  stramonium,  and  henbane,  are  the  only 
substances  which  have  this  effect  on  cats.  (Orfila,  Toxicologie.)  The 
circumstance  that  this  plant,  as  well  as  others  of  the  same  natural  family 
of  Solanaceae,  is  eaten  by  some  animals  with  impunity,  while  it  kills 
others,  proves  that  the  medicine  acts  on  the  susceptibility  of  the  tissues, 
and  not  by  a  chemical  reagency  upon  their  organization.  From  the  suc- 
cession of  phenomena  produced,  it  may  be  inferred  that  belladonna  acts 
with  a  powerful  irritant  influence,  primarily  on  the  centres  of  conscious 
perception  in  the  brain  and  annular  protuberance,  and  subsequently  on 
the  spinal  marrow ;  as  sensibility  to  pain  is  lost,  while  yet  reflex  action 
continues,  showing  a  persistent  sensitiveness  of  the  gray  matter  of  the 
cord.  The  congestion  of  the  cerebral  membranes  and  those  of  the  upper 
part  of  the  spinal  cord,  observed  after  death,  confirms  this  view  of  the 
operation  of  the  poison.  (Lemaltre.) 

One  of  the  most  curious  effects  of  this  medicine,  and  of  other  Solana- 
ceae, is  that  which  they  exert  on  vision  and  the  pupil.  The  dilatation  of 
the  puj.il  i.s  probably  owing  to  an  irritant  influence  upon  the  centres  of 
the  sympathetic  nerve,  a  branch  from  which  governs  the  action  of  the 
dilating  fibres  of  the  iris.  Its  influence  on  vision  may  be  ascribed,  when 
complete  amaurosis  exists,  to  a  constriction  of  the  blood-vessels  of  the 
retina,  depriving  it  for  a  time  of  blood,  and,  of  course,  of  sensibility. 
but  a  less  degree  of  visual  disturbance,  such  as  presbyopia,  or  an  ina- 
bility to  see  near  objects,  while  the  distant  are  visible,  is  probably  refer- 
able to  the  action  of  the  sympathetic  on  the  ciliary  muscles,  thereby 
disturbing  the  accommodating  powers  of  the  eye.  When  belladonna  is 
locally  applied  to  the  eye,  the  effect  is  much  more  prompt  than  from  its 
internal  use,  and  quite  as  great  if  not  more  so.  But,  under  these  circum- 
stances, the  vision  is  not  affected,  and  the  nervous  centres  of  the  retina, 
therefore,  not  acted  on.  Generally  only  the  eye  to  which  the  application 
is  made  is  affected ;  but  it  is  asserted  that  the  other  eye  sometimes  par- 
ticipates ;  in  which  case  it  is  possible  that  the  medicine  may  have  been 
absorbed,  and  reached  the  cerebral  centres.  The  dilatation  of  the  pupil 
and  dimness  of  vision  appear  to  be  direct,  without  any  preceding  excita- 
tion of  the  organ. 

3.   Therapeutic  Application. 

It  is  uncertain  whether  belladonna  was  used  by  the  ancients  as  a 
medicine.  The  earliest  account  we  have  of  its  employment  in  modern 
times  was  about  the  close  of  the  seventeenth  century,  when  it  appear- 
to  have  passed  from  empirical  use  into  the  hands  of  the  regular  profes- 


CHAP.  I.]      CEREBRAL  STIMULANTS. — BELLADONNA.          793 

sion.  At  first  it  was  chiefly  valued  as  a  remedy  in  cancerous  tumours 
and  ulcers,  of  which  it  was  supposed  sometimes  to  effect  cures;  and  cases 
were  recorded  which  would  go  far  to  confirm  this  opinion  of  its  powers, 
did  we  not  know  how  frequently  erroneous  diagnosis  has  led  to  false 
estimates  of  the  efficacy  of  medicines  in  these  affections.  At  present 
there  are  very  few  who  would  maintain  that  belladonna  could  do  more 
than  palliate  in  true  cancer.  But,  though  now  little  employed  in  those 
complaints  for  the  cure  of  which  it  was  first  brought  into  notice,  it  has 
been  found,  by  abundant  experience,  to  possess  powers  which  render  it 
highly  useful  for  various  other  purposes. 

Indications.  The  chief  indications  which  belladonna  is  calculated  to 
fulfil  are,  1.  to  subdue  pain,  2.  to  relax  muscular  spasm  and  rigidity,  - 
3.  to  stimulate  the  nervous  centres,  and  4.  in  reference  specially  to  the 
eye,  to  lessen  the  sensibility  of  the  retina,  and  dilate  the  pupil.     As  a 
soporific,  it  cannot  be  relied  on,  and  is,  I  believe,  never  employed. 

One  mode  in  which  it  operates,  in  answering  these  purposes,  is  by 
rendering  the  nervous  centres  insusceptible  of  irritative  impressions,  and 
incapable  of  transmitting  irritative  action  ;  but  there  can  be  no  doubt 
that  it  is  capable  also  of  operating  directly  on  the  peripheral  sensibility 
of  the  nerves,  and  of  producing  the  same  insusceptibility  at  their  extrem- 
ities as  at  their  centres.  Whether  it  acts  in  this  way  by  an  immediate  or 
by  an  indirect  sedative  agency  it  would  not  be  easy  to  determine;  but, 
as  the  evidence  is  irresistible  that  it  occasionally  does  stimulate  the 
nervous  centres,  it  is  safest  to  admit  that  in  this  respect  its  action  is  uni- 
form, and  that  the  depression  evinced  is  an  indirect  result  of  an  active 
congestion  in  all  instances.  What  tends  to  confirm  this  view  is,  that 
tht-  medicine  has  not  been  found  applicable  to  cases,  in  which  the  nerv- 
ous centres  were  already  in  a  state  of  active  congestion  or  inflammation; 
the  very  condition  in  which  it  would  seem  to  be  specially  indicated, 
were  it  directly  sedative. 

In  the  relief  of  painful  and  spasmodic  affections,  belladonna  seems  to 
be  capable  of  something  more  than  a  mere  temporary  influence.  Not 
only  does  it  give  ease ;  but,  by  a  perseverance  in  its  use,  we  not  unfre- 
quently  obtain  positive  cures  from  it,  which  opium  itself,  though  more 
powerful  as  a  mere  anodyne,  is  unable  to  effect.  It  would  appear,  there- 
fore, to  produce  some  permanent  modification  in  the  nervous  tissue,  in- 
compatible with  that  which  existed  in  its  morbid  condition,  in  other 
words,  1<>  art  as  an  alterative  as  well  as  an  anodyne.  Another  advantage 
which  it  possesses  over  opium,  in  the  treatment  of  chronic  or  frequently 
repeated  painful  affections,  is  its  entire  exemption  from  the  liability  of 
abuse  as  an  exhilarating  agent,  which  constitutes  one  of  the  greatest 
objections  to  the  use  of  that  most  fascinating  drug. 

Contraindications.  The  contraindications  to  the  use  of  belladonna 
are,  as  in  this  class  of  medicines  generally,  active  congestion  or  inflam- 


794  GENERAL   STIMULANTS.  [PART  II. 

mation  of  the  brain,  inflammation  of  the  stomach,  high  inflammatory  or 
febrile  excitement,  and  a  plethoric  state  of  system ;  in  all  which  condi- 
tions, should  any  special  symptom  call  for  this  remedy,  its  use  should  be 
preceded  by  depleting  measures. 

I  shall  treat  of  the  special  complaints  in  which  belladonna  is  used, 
under  the  several  indications  above  mentioned. 

1.  For  the  Relief  of  Pain. 

a  Neuralgic  Affections.  In  these  belladonna  displays  its  most  useful 
powers ;  and  I  know  few  remedies  more  effectual  in  their  cure.  No 
matter  where  the  pain  is  seated,  provided  it  be  purely  functional,  that 
'  is,  connected  with  no  inflammatory  or  other  organic  disease  affecting  the 
nerve  or  its  centre,  the  medicine  may  be  employed.  It  may  be  used 
both  internally  and  locally ;  and,  when  the  pain  is  near  the  surface,  or 
in  any  position  to  which  near  access  can  be  obtained,  it  is  generally 
advisable  either  to  depend  on  the  topical  use  of  the  remedy,  or  to  em- 
ploy it  in  the  two  methods  jointly.  The  general  rule  is  to  administer  it 
in  quantities  sufficient  to  produce  obvious  effects,  without  going  so  far  as 
to  cause  delirium,  stupor,  or  dimness  of  vision  approaching  blindness. 
Though  these  latter  phenomena  have  seldom  if  ever  proved  really 
dangerous,  when  proceeding  from  medicinal  doses,  yet  they  are  not 
necessary  to  the  anodyne  effect,  and  are,  therefore,  better  avoided.  I 
am  in  the  habit,  in  neuralgic  cases,  of  giving  half  a  grain  of  the  extract 
three  times  a  day,  and,  if  no  effect  is  experienced  from  this  dose,  of 
gradually  increasing  it,  until  dryness  of  the  throat,  dimness  of  vision, 
dilatation  of  the  pupil,  slight  frontal  uneasiness,  or  feelings  of  fulness  or 
giddiness  in  the  head  are  produced ;  and  of  afterwards  so  managing  the 
dose  that  these  effects  should  not  be  exceeded.  Sometimes  the  first  dose 
will  act  with  unexpected  energy;  in  which  case  it  should  be  reduced  to 
one-third  or  one-quarter  of  a  grain,  and  afterwards  increased  again  if 
necessary.  More  frequent  repetition  than  three  times  a  day  is  unneces- 
sary to  maintain  a  continued  operation  of  the  medicine,  and  might  lead 
to  cumulative  effects. 

Both  in  the  neuralgic  and  spasmodic  diseases  belladonna  may  often 
be  very  advantageously  associated  with  those  tonics  which  have  the 
effect  of  strengthening  the  nervous  centres,  as  quinia,  the  chalybeates, 
and  the  preparations  of  silver,  copper,  and  zinc;  the  narcotic  and  tonic 
being  administered  conjointly  in  the  same  pill,  or  separately,  as  may  be 
most  convenient. 

Modes  of  Application  in  Neuralgia.  Some  remarks  in  relation  to 'the 
method  of  using  the  remedy  locally  in  these  cases  m:iy  l>r  advisable 
here.  A  decoction  of  the  leaves  maybe  employed,  or  tin-  extract ;  and 
one  or  the  other  of  these  may  be  used  in  the  form  of  lotion,  cataplasm, 
liniment,  ointment,  or  plaster.  Of  the  use  of  atropia  1  shall  treat  under 


* 

CHAP.  I.]      CEREBRAL  STIMULANTS. — BELLADONNA.          795 

a  separate  head.  The  extract  may  be  brought  into  the  state  of  liniment 
by  simply  rubbing  it  with  a  little  water;  and  of  an  ointment  by  incor- 
porating it  with  lard.  The  plaster  is  officinal.  Usually  it  will  be  suffi- 
cient to  make  the  application  upon  the  unbroken  skin ;  but  the  effect  is 
more  speedy  and  much  more  powerful  when  the  remedy  is  used  ender- 
mically,  the  cuticle  having  been  removed  by  a  blister.  In  this  case, 
the  extract  should  be  used  mixed  with  water  or  lard,  and  never  at  first  in 
quantities  exceeding  two  or  three  grains,  which  may  be  increased  if  neces- 
sary. As  it  occasions  some  pain  if  brought  into  direct  contact  with  the 
denuded  surface,  it  may  be  applied,  as  recommended  by  MM.  Trousseau 
and  Pidoux,  spread  on  a  piece  of  linen  with  the  uncovered  surface  next 
the  skin,  and  protected  by  means  of  adhesive  plaster.  The  effect  is  thus 
gradually  produced,  and  without  pain.  To  the  writers  just  named  I  am 
also  indebted  for  some  of  the  following  observations  in  relation  to  the 
local  use  of  the  medicine  in  special  cases. 

In  neuralgia  of  the  scalp,  a  decoction  of  the  leaves  made  in  the  pro- 
portion of  half  an  ounce  to  the  pint  of  water  may  be  used  locally. 
With  this  the  hair  may  be  saturated ;  and  a  thick  linen  compress  thor- 
oughly moistened  with  it,  having  been  applied  over  the  head,  the  whole 
should  be  covered  with  a  cap  of  oiled  or  waxed  linen,  or  silk.  A  solu- 
tion of  the  extract  in  the  proportion  of  a  drachm  to  the  pint,  or  the 
officinal  tincture  diluted  with  four  parts  of  water,  may  be  similarly  em- 
ployed. 

In  supra-orbital  neuralgia,  or  that  of  the  eyeball,  from  five  to  ten 
grains  of  the  extract,  mixed  with  a  little  water,  may  be  rubbed  upon  the 
lids  and  around  the  eye,  with  gentle  friction,  for  ten  or  fifteen  minutes; 
and  the  process  may  be  repeated  every  two  or  three  hours,  the  part 
being  in  the  mean  time  covered  with  a  light  compress,  until  the  pain  is 
relieved.  Or  a  cataplasm  made  with  a  solution  of  the  extract  and  flax- 
seed  meal  may  be  applied  over  the  whole  eye.  The  same  method  may 
be  employed  in  other  forms  of  facial  neuralgia;  but  in  the  infra- 
orbital  and  submaxillary  forms,  the  authors  above  mentioned  prefer 
the  friction  to  be  made  upon  the  gums  or  inside  of  the  cheeks.  Of 
course,  care  must  be  taken  that  the  patient  do  not  swallow  the  medi- 
cine. In  painful  affections  of  the  ear,  a  solution  of  the  extract  may  be 
injected  into  the  meatus,  and  cotton  afterwards  introduced  impregnated 
with  the  same.  In  toothache,  the  extract  itself  may  be  introduced  into 
the  carious  cavity. 

In  neuralgia  of  the  limbs  or  trunk,  the  application  should  be  made  as 
near  to  the  seat  of  pain  as  possible;  and  in  these,  the  endermic  method 
will  often  be  advisable.  In  sciatica,  which  is  one  of  the  most  obstinate 
forms  of  the  affection,  the  blistered  surface  should  be  made  in  the  course 
of  the  nerve  as  it  passes  out  of  the  pelvis.  MM.  Trousseau  and  Pidoux 
have  met  with  great  success,  in  very  obstinate  cases  of  this  affection,  by 


796  GENERAL    STIMULANTS.  [PART  II. 

making  an  incision  through  the  skin,  between  the  great  trochantor  and 
ischium,  and  inserting  a  ball  in  the  form  of  a  pea,  containing  from  one 
to  five  grains  of  the  extract  with  a  little  opium ;  thus  gaining  the  effects 
of  an  i>suc>  with  those  of  the  narcotic. 

In  angina  pectoris  the  medicine  has  been  used  locally  with  advant- 
age. Dr.  Davies  relates  a  case  in  which  a  plaster  of  belladonna  was 
applied  to  the  chest  after  tartar  emetic,  and  before  the  ulcers  from  this 
had  healed.  Alarming  symptoms  were  induced;  but,  on  their  subsi- 
dence, it  was  found  that  the  angina  had  ceased.  (Led.  on  Dis.  of  Lungs 
and  Heart,  p.  496.) 

In  the  internal  neuralgic  affections  of  the  abdomen,  as  gastralgia, 
enteralgia,  nephralgia,  etc.,  the  external  use  of  the  medicine  should  be 
resorted  to  when  the  complaint  is  complicated  with  vomiting  or  purging, 
while  opium  is  used  internally.  But,  in  the  contrary  condition  of  con- 
stipation, it  would  be  better  to  try  the  effects  of  extract  of  belladonna 
internally. 

Lead  colic  and  nervous  colic,  which  are  really  forms  of  intestinal 
neuralgia,  may  be  advantageously  treated  in  their  milder  and  more 
chronic  conditions,  with  belladonna  combined  with  alum  or  iodide  of 
potassium  internally,  and  frictions  with  an  ointment  of  the  extract  ex- 
ternally over  the  surface  of  the  abdomen. 

b.  Rheumatic  and  Gouty  Disease.  Among  the  painful  affections  which, 
in  like  manner  with  neuralgia,  may  be  treated  with  the  internal  and  ex- 
ternal use  of  belladonna,  are  rheumatism  and  gout.     The  medicine  has 
been  employed  even  in  acute  rheumatism,  and  is  asserted  to  have  proved 
very  successful.    After  a  proper  use  of  the  lancet,  and  in  connection  with 
purgatives  and  arterial  sedatives,  I  have  no  doubt  that  it  would  prove 
serviceable,  given  so  as  to  maintain  a  constant  and  decided  impression ; 
and,  in  cases  where  some 'idiosyncrasy  may  forbid  the  use  of  opium, 
might  be  had  recourse  to  with  great  propriety.    But  it  is  in  the  nervous 
or  neuralgic  forms  of  these  diseases  that  belladonna  is  especially  indj- 
cated ;  and  here  it  is  among  the  most  efficacious  remedies.     It  is  also 
frequently  serviceable  in  the  shifting  forms  of  subacule  rheumatism 
without  fever;    and,  in  the  chronic  forms  of  the  same  disease,  is  a 
standard  remedy,  given  in  connection  with  one  or  more  of  the  various 
alteratives  used.     In  this  form  of  the  disease  it  may  also  be  advanta- 
geously employed  locally,  in   the  shape  of  poultice   or  plaster;    the 
former  being  most  conveniently  applied  to  the  joints,  the  latter  over 
muscular  parts,  as  to  the  small  of  the  back  in  lumbago,  and  to  the  side 
in  pleurodynia. 

c.  Other  Painful  Affections.  There  is  a  number  of  painful  affections, 
local  in  their  character,  in  which  the  topical  use  of  belladonna  has  been 
resorted  to  with  more  or  less  benefit.    In  dijsmenorrhcea  it  has  been  in- 

'  troduced  into  the  vagina,  either  by  injecting  a  decoction  of  the  leaves  or 


CHAP.  I.]      CEREBRAL  STIMULANTS. — BELLADONNA.          797 

solution  of  the  extract,  or  in  the  form  of  a  pill  containing  half  a  grain  or 
a  "Train  of  the  latter  preparation.  Fissures  of  the  anus,  painful  piles, 
and  excessive  sensitiveness  of  the  rectum,  may  often  be  usefully  treated 
with  an  ointment  made  by  mixing  the  extract  with  lard ;  not  more  than 
from  half  a  grain  to  a  grain  and  a  half  of  the  former  being  used  at  the 
first  application,  especially  if  introduced  within  the  sphincter.  Phymosis 
and  paraph ymosis,  sivelled  testicle,  inflamed  urethra,  and  various  pain- 
ful tumours  and  ulcers,  cancerous,  scrofulous,  or  simply  phlegmonous, 
are  additional  affections  in  which  the  extract  has  been  recommended,  in 
the  shape  of  cataplasm  or  ointment,  with  the  view  of  relieving  pain. 

2.  For  the  Relief  of  Spasm  or  Muscular  Rigidity. 

Singular  as  it  may  seem,  the  painful  spasmodic  affections  are  less 
benefited  in  general  by  belladonna  than  either  pure  neuralgic  pain,  or 
spasmodic  affections  without  pain.  Thus,  spasms  of  the  stomach,  bowels, 
ureters,  hepatic  ducts,  etc.,  and  those  of  tetanus,  do  not  yield  readily  to 
belladonna,  perhaps  because  the  centres  of  irritation  in  these  cases  are  in 
the  spinal  marrow,  upon  which  that  narcotic  may  exercise  less  power 
than  on  the  cerebral  centres.  Still,  the  medicine  has  been  used  in 
tetanus,  and  in  certain  colicky  affections,  and  not  without  favourable 
results.  Cases  are  on  record  of  its  successful  employment  in  spasmodic 
constriction  of  the  bowels,  with  obstinate  constipation,  and  even  in  ileus. 
As  a  remedy  iu  colica  pictonum,  it  has  already  been  spoken  of;  bat 
this  is  rather  a  neuralgic  affection  of  the  bowels,  than  simply  spas- 
modic, and,  moreover,  probably  depends  more  on  the  local  influence 
of  the  lead  upon  the  nervous  tissue  of  the  bowel  itself,  than  upon  the 
nervous  centres.  In  cholera  it  is  said  to  have  been  advantageously 
employed  in  large  doses;  and,  independently  of  its  use  in  relieving  the 
spasms  of  that  disease,  it  may  possibly  act  favourably,  by  its  stimu- 
lant influence  over  the  sympathetic  centres,  causing  a  contraction 
everywhere  of  the  relaxed  capillaries,  and  thus  restraining  the  excessive 
discharges. 

In  painless  spasms,  the  medicine  is  often  highly  beneficial.  In  these 
affections,  it  not  only  yields  relief,  but  serves,  as  in  neuralgia,  to  make  a 
permanent  impression  on  the  nervous  centres,  which  sometimes  proves 
curative;  and,  in  like  manner,  may  be  usefully  combined  with  the  anti- 
spasmodic  tonics,  as  quinia  and  various  metallic  salts.  It  will  very  seldom 
cure  epilesy;  but,  in  some  purely  functional  cases,  it  is  said  to  have  had 
this  effect,  and  it  will  often  ameliorate  the  symptoms.  The  patient 
should  be  kept  under  its  very  moderate  influence  for  a  long  time,  with  oc- 
casional intermissions ;  and,  about  the  period  of  the  expected  paroxysms, 
it  should  be  given  more  freely. 

In  the  non-epileptic  convulsions  of  puerperal  women  and  children 
it  has  been  highly  recommended  ;  but  should  not  be  given  when  in  these 


798  GENERAL   STIMULANTS.  [PART  II. 

• 

cases  there  is  active  cerebral  congestion,  or  any  suspicion  of  inflamma- 
tion. In  infantile  cases,  it  should  be  confined  to  the  convulsions  which 
depend  on  some  extra-cranial  irritation,  such  as  teething  or  spasm  of  the 
bowels.  In  both  instances,  it  is  best  adapted  to  those  attacks  in  which 
there  is  a  frequent  recurrence  of  the  paroxysms,  and  should  be  given  in 
the  interval,  in  order  to  prevent  the  convulsions,  and  not  during  their 
continuance. 

On  the  continent  of  Europe,  belladonna  was  long  since  used  in 
hooping-cough,  but  was  neglected  until  the  practice  was  at  a  recent 
period  revived  by  Bretonneau.  In  this  country,  it  has  been  employed 
and  highly  recommended  by  Dr.  Samuel  Jackson,  late  of  Northumber- 
land, who  gave  to  children  two  years  old  from  the  twelfth  to  the  sixth  of 
a  grain  of  the  extract,  twice  or  three  times  a  day,  increasing  the  dose 
until  the  pupil  became  dilated.  Dr.  Hiram  Corson,  of  Montgomery 
County,  Pennsylvania,  also  used  it  with  great  success.  My  own  ex- 
perience with  it  is  confined  to  a  single  case.  This  occurred  in  an  infant, 
to  the  chest  of  which  I  applied  a  belladonna  plaster.  The  child  was 
soon  afterwards  attacked  with  convulsions,  which  were  frequently  re- 
peated, and  very  alarming.  It  recovered,  however ;  and  the  hooping- 
cough  ceased  with  the  convulsions.  It  is  possible  that  the  medicine 
may  have  cured  the  disease,  and  may  not  have  caused  the  convulsions, 
which  are  not  uncommon  in  hooping-cough  ;  and  I  am  disposed  to  think 
that  this  was  really  the  case ;  for  belladonna  very  rarely  produces 
this  effect,  even  in  poisonous  doses.  The  occurrence,  however,  deterred 
me  from  afterwards  having  recourse  to  the  remedy  in  that  disease.  It  is 
thought  by  some  to  be  more  efficacious  in  hooping-cough,  when  associ- 
ated with  sulphate  of  zinc. 

In  asthma  it  has  been  strongly  commended.  It  has  been  used  in- 
ternally in  this  complaint,  being  given  during  the  intervals  of  the  par- 
oxysms, so  as  to  sustain  a  steady  impression ;  but  the  most  efficient 
method  of  employing  it  is  by  the  inhalation  of  its  fumes.  For  this  pur- 
pose, the  dried  leaves  may  be  smoked  in  a  pipe,  or  in  the  form  of  cigars, 
made  like  those  of  tobacco.  Great  care,  however,  must  be  taken  that 
too  great  a  narcotic  effect  is  not  produced.  This  use  of  the  remedy  no 
doubt  originated  in  a  similar  employment  of  stramonium,  which  very 
closely  resembles  belladonna  in  its  medical  properties.  Another  mode 
of  using  the  remedy,  in  the  same  complaint,  is  by  inhaling  the  vapour 
from  a  decoction  either  of  the  leaves  or  extract ;  two  drachms  of  the 
former,  or  fifteen  grains  of  the  latter,  being  boiled  with  a  pint  of  water. 
The  smoking  of  the  leaves,  steeped  when  fresh  in  a  strong  infusion  of 
opium  and  then  dried,  is  said  to  have  afforded  relief  in  phthisis.  As  the 
breathing  of  the  fumes  arising  from  the  combustion  of  paper,  impreg- 
nated with  nitre,  often  affords  great  relief  in  the  asthmatic  paroxysm,  the 
idea  occurred  to  M.  Dauncey,  an  apothecary  of  Bordeaux,  that  advantage 


CHAP.  I.]      CEREBRAL  STIMULANTS. — BELLADONNA.          799 

might  accrue  from  a  similar  impregnation  of  the  leaves  of  belladonna 
before  being  smoked.  Accordingly  he  prepared  cigars  from  leaves  thus 
treated,  and  found  them  to  answer  the  purpose  intended.  A  solution  of 
nitre  containing  three  ounces  is  sprinkled  on  three  avoirdupois  pounds  of 
the  leaves,  spread  out  after  drying.  The  nitre  thus  penetrates  the 
tissues  of  the  leaves,  and  is  left  after  the  dissipation  of  the  moisture. 
Another  advantage  of  the  preparation  is  that  the  carbonaceous  matter 
of  the  smoke  is  consumed  in  the  combustion.  (Am.  Journ.  of  Pharni., 
xxx.  404.) 

In  muscular  rigidity,  the  local  application  of  belladonna  has  been 
found  very  useful  in  a  number  of  different  affections.  In  constriction  of 
the  sphincters  of  the  anus  and  neck  of  the  bladder,  and  in  spasm  of  the 
urethra,  it  has  been  employed  in  poultice,  or  in  the  way  of  friction  to 
the  perineum,  with  the  extract  mixed  with  lard ;  and,  in  the  urethral 
affection,  it  has  been  introduced  into  the  passage  by  means  of  a  bougie 
smeared  with  the  ointment.  Rigidity  of  the  os  uteri  in  delivery  is  said 
sometimes  to  yield  to  the  local  application  of  the  extract.  It  has  been 
employed  externally  in  strangulated  hernia,  to  produce  relaxation  of  the 
abdominal  muscles.  M.  Chrestien,  of  Montpellier,  in  France,  speaks 
very  strongly  of  the  favourable  influence  of  the  extract  of  belladonna, 
rubbed  over  the  surface  of  the  tumour,  in  reducing  the  strangulated 
bowel.  (Arch.  Gen.,  Dec.  1865,  p.  743.) 

Under  the  impression  that  vomiting  in  pregnancy  is  sometimes  caused 
by  irritation  from  a  spasmodic  contraction  of  the  uterine  fibres,  resisting 
the  expanding  growth  of  the  foetus,  Bretonneau  was  induced  to  employ 
friction  with  the  extract  over  the  hypogastric  region,  and  met  with  great 
success.  It  is  unnecessary  to  admit  his  theory  of  the  influence  of  the 
medicine,  which  may  relieve  other  disorders  of  the  uterus  besides  con- 
striction of  its  fibres,  and  thus  obviate  sympathetic  irritation  elsewhere ; 
but  the  fact  is  important.  Its  accuracy  is  confirmed  by  the  experience 
of  MM.  Trousseau  and  Pidoux ;  and  the  late  Dr.  R.  L.  Scruggs,  of 
Louisiana,  employed  the  remedy  repeatedly,  with  uniform  success.  He 
also  succeeded,  by  the  same  method,  in  relieving  an  obstinate  and  dis- 
iiv-sing  cough,  apparently  dependent  on  irritation  from  the  impregnated 
uterus.  (South.  Journ.  of  Med.  and  Phys.  Sci.,  i.  318.) 

3.   To  Stimulate  the  Nervous  Centres. 

In  reference  to  this  indication,  belladonna  has  been  used  in  certain 
conditions  of  paralysis  with  asserted  success,  particularly  in  paraplegic 
cases.  It  is  quite  obvious  that  it  should  never  be  employed  in  cases  de- 
pendent on  congestion,  inflammation,  or  organic  lesion  of  the  nervous 
centres,  until  this  condition  shall  have  ceased  entirely,  and  nothing  is 
left  but  mere  inertness.  In  paralysis  combined  with  neuralgic  pains,  as 
in  lead  palsy,  we  may  readily  conceive  that  the  medicine  may  act  fa- 


800  GENERAL    STIMULANTS.  [PART  IT. 

vourably.  In  amaurosis,  moreover,  it  is  said  to  have  proved  useful ;  but 
here  also  the  affection  should  be  purely  functional  to  justify  its  employ- 
ment. 

Belladonna  has  been  used  in  insanity,  particularly  in  its  melancholy 
forms ;  and  it  is  probably  useful  in  cases  similar  to  those  in  which  opium 
proves  advantageous,  but  it  is  so  much  inferior  to  that  narcotic,  that 
unless  some  special  objection  to  opium  may  exist,  it  would  scarcely  be 
worth  while  to  employ  it.  When  complicated,  however,  with  neuralgic 
pains,  the  disease  would  present  a  much  stronger  indication. 

In  delirium  tremens  it  has  been  used  like  most  other  narcotics ;  but, 
as  it  has  little  tendency  to  produce  sleep,  which  is  the  great  object  aimed 
at  here,  it  would  not  seem  to  be  specially  called  for.  In  this  complaint  the 
pupils  are  often  very  much  contracted ;  and  belladonna  has  been  suggested 
as  an  appropriate  remedy,  because  one  of  its  most  constant  effects  is  to 
dilate  the  pupil.  Dr.  James  Grieve,  of  Dumfries,  Scotland,  has  used  it 
locally  to  expand  the  pupil,  and  thus  to  obviate  spectral  illusions  which 
he  supposed  might  be  connected  with  this  condition  of  the  iris.  I 
tried  it  in  one  instance,  with  no  satisfactory  result.  Besides,  one  of  the 
characteristic  effects  of  belladonna,  when  given  largely,  is  to  produce 
illusions. 

Under  this  head  we  may  introduce  a  notice  of  the  use  of  belladonna 
in  the  nocturnal  incontinence  of  urine  of  children.  There  can  be 
no  doubt  of  its  frequent  usefulness  in  this  affection.  It  should  be  given 
at  bedtime,  and  continued  for  a  week  or  two  before  being  relinquished  if 
unsuccessful.  If  it  prove  efficacious,  it  should  be  persevered  with  for 
some  time  after  apparent  cure,  in  order  to  break  up  the  habit.  It  prob- 
ably acts  either  by  giving  greater  energy  to  the  sphincter  through  the 
nervous  centre  which  regulates  its  action,  or  by  rendering  it,  through  a 
congestive  influence  on  the  centre,  insensible  to  irritant  impressions.  A 
similar  efficacy  has  been  claimed  for  the  remedy  in  fecal  incontinence 
occurring  in  children.  (Bulletin  Gen.  de  Therap  ,  Aout  15,  1855.) 

Upon  the  same  principle  of  its  action  on  the  nervous  centres,  must  be 
explained  its  asserted  influence  in  preventing  the  very  serious  reflex  in- 
juries following  extensive  burns. 

4.  In  Reference  to  its  Influence  upon  the  Eye. 

Belladonna  is  employed  in  affections  of  the  eye  with  two  objects ;  one 
to  diminish  the  sensibility  of  the  retina  or  optic  nervous  tvntre,  and  the 
other  to  dilate  the  pupil.  With  the  first  object,  it  may  be  employed  in 
that  not  uncommon  condition  of  the  eye,  in  which,  altogether  independ- 
ently of  inflammation,  light  in  extremely  painful  to  it,  and,  though  the 
vision  is  in  no  degree  impaired,  the  use  of  the  organ  for  any  length  of 
time  is  impossible,  in  consequence  of  the  pain  induced.  It  has  also  been 
advised  in  the  similar  sensitiveness  which  attends  ophthalmia;  though 
its  appropriateness,  in  the  latter  condition,  is  more  equivocal. 


CHAP.  I.]      CEREBRAL  STIMULANTS. — BELLADONNA.          801 

For  the  dilatation  of  the  pupil  belladonna  is  much  used  by  the  sur- 
geons. It  is  the  local  application  of  it  that  is  resorted  to  for  this  pur- 
pose. The  infusion  of  the  leaves,  or  solution  of  the  extract  may  be 
dropped  into  the  eye,  or  the  extract  itself,  mixed  with  a  little  water  or 
lard,  may  be  rubbed  upon  the  eyelids  and  around  them.  By  many 
atropia  is  preferred  for  the  purpose  on  account  of  cleanliness.  The  dila- 
tation usually  begins  in  about  half  an  hour,  is  at  its  height  in  three  or 
four  hours,  and  may  continue  one  or  two  days  or  longer. 

The  objects  in  producing  dilatation  with  it  are  manifold.  Before  the 
operation  for  cataract,  it  is  useful  by  removing  the  iris  out  of  the  way : 
and,  after  the  operation,  has  been  recommended,  in  order  to  prevent  the 
adhesion  of  the  iris  and  obliteration  of  the  pupil,  which  might  result 
from  inflammation  of  that  membrane.  In  operations  which  involve  a 
wound  of  the  iris,  it  is  supposed  to  be  indicated  upon  the  same  score. 
It  is  said  that  even  in  partial  or  complete  obliteration  of  the  pupil  al- 
ready produced,  if  recent,  the  remedy  will  obviate  the  evil  by  causing  a 
separation  of  the  adhesions  while  still  soft.  In  iritis,  either  exclusive, 
or  attendant  upon  conjunctivitis,  it  has  been  recommended  with  the  same 
view  of  obviating  obliteration  of  the  pupil.  In  cases  of  commencing 
cataract,  it  is  sometimes  temporarily  serviceable  by  bringing  within 
reach  of  the  light  the  yet  unaffected  portions  of  the  lens  nearest  the  cir- 
cumference. In  opacity  of  the  cornea.,  moreover,  in  which  vision  is  ob- 
structed by  the  position  of  the  opacity  immediately  before  the  pupil,  it 
occasionally  restores  sight  for  a  time  by  dilating  that  orifice,  so  that  the 
light  passing  the  transparent  parts  of  the  cornea  may  enter  it. 


Belladonna  has  been  used  for  other  purposes  besides  those  mentioned. 
It  has  been  recommended  in  scarlet  fever,  both  as  a  remedy  and  pro- 
phylactic. I  have  no  confidence  in  its  efficiency  in  either  capacity.  Its 
use  was  suggested  by  the  originator  of  the  homoeopathic  delusion,  upon 
the  basis  of  one  of  his  dogmas,  that  diseases  are  cured  by  remedies  the 
effects  of  which  resemble  the  disease  itself.  Belladonna  causes  dryness 
and  irritation  of  the  fauces,  and  sometimes  a  rash  like  that  of  scarlet 
fever;  therefore  it  is  the  appropriate  remedy  for  that  complaint.  If  it  be 
capable  of  acting  rernedially,  it  is  probably  capable  also  of  preventing 
the  disease.  Such  is  the  rationale  of  its  use.  Though  I  would  accept 
a  useful  fact  from  the  homceopathists,  or  any  other  class  of  men  what- 
ever, or  from  any  source  whatever,  I  should  be  disposed  to  subject  it  to 
a  close  scrutiny  before  admitting  its  claims  to  be  a  fact.  I  think  that 
many  in  our  profession  have  been  somewhat  too  hasty  in  adopting  this 
scion  of  a  false  hypothesis.  It  is  true  that,  in  many  instances,  numlx-rs 
of  children  to  whom  belladonna  has  been  administered,  have  escaped 
scarlatina  though  exposed  to  the  cause ;  but  nothing  is  more  common 
VOL.  i. — 51 


802  GENERAL    STIMULANTS.  [PART  II. 

than  a  similar  result  where  belladonna  has  not  been  given.  Every  one 
knows,  who  has  seen  much  of  this  disease,  that  it  is  extremely  capricious 
in  its  choice  of  subjects,  sometimes  attacking  all  the  children  of  a  family, 
and  not  unfrequently  seizing  upon  one  only  of  a  large  number  equally 
exposed  to  the  cause ;  so  that  the  exemption,  under  the  circumstances 
referred  to,  might  well  have  taken  place,  though  no  preventive  had  been 
used.  Besides,  numerous  trials  have  been  made  by  persons  quite  as  de- 
serving of  credit,  in  which  the  use  of  belladonna  has  entirely  failed  in 
securing  the  desired  exemption,  which  could  not  have  happened  were  it 
possessed  of  the  power  ascribed  to  it.  The  mistake  might  be  a  very 
fatal  one,  if,  in  reliance  upon  the  prophylactic  virtues  of  belladonna, 
other  means  of  securing  exemption,  such  as  common  sense  would  sug- 
gest, should  be  neglected. 

The  medicine  is  asserted  to  possess  antaphrodisiac  properties,  and  to 
be  useful  in  priapism,  chordee,  and  other  irritated  conditions  of  the  sexual 
organs.  It  probably  operates  here,  like  other  narcotics  in  the  secondary 
stage  of  their  action,  by  diminishing  the  sensibility  of  the  nervous  centres. 

Another  application  made  of  belladonna  is  to  arrest  the  secretion  of 
milk,  when  the  infant  is  from  any  cause  withdrawn  from  the  breast. 
For  this  purpose  a  solution  of  the  extract,  or  an  ointment  made  by  rub- 
bing it  with  lard,  may  be  applied  to  the  areola  and  around  it.  The  dis- 
tended and  painful  breast  is  said  to  be  thus  greatly  relieved,  and  the 
practice  has  been  extensively  adopted  But  the  remedy  is  by  no  means 
uniformly  efficient  (Bost.  Med.  and  Surg.  Journ.,  Iviii.  487,  and  lix.  80); 
and  a  case  has  been  recorded  in  which  serious  poisoning  was  produced 
by  the  application  made  to  an  abraded  breast  (Lancet,  Nov.  11,  1865, 
p  536).  Care,  therefore,  must  be  taken  that  the  extract  should  be  used 
in  this  way  only  when  the  cuticle  is  unbroken. 

The  local  application  of  belladonna  in  the  form  of  tincture,  or  of  lini- 
ment made  with  the  extract  and  lard,  has  been  recommended  by  Mr. 
Cooke,  of  Scarborough,  England,  as  affording  great  relief  in  erysipelas, 
inflamed  chilblains,  boils,  and  carbuncles.  (Med.  Times  and  Gaz., 
July,  1858,  p.  126.) 

Another  local  application  of  belladonna  which  has  been  recommended 
is  for  the  relief  of  the  tenesmus  of  dysentery.  For  this  purpose  the  ex- 
tract or  atropia  may  be  used,  in  the  form  of  a  suppository  made  by  incor- 
porating it  with  cacao  butter. 

4.  Administration. 

After  what  has  been  stated  above,  little  remains  to  be  said  on  this 
point.  Belladonna  may  be  given  in  substance,  infusion,  extract,  or  tinc- 
ture; and  there  are  two  officinal  preparations  intended  exclusively  for 
external  use,  namely,  the  plaster  and  ointment.  Atropia  is  also  among 
the  officinal  preparations. 


CHAP.  I.]  CEREBRAL   STIMULANTS. — BELLADONNA.  803 

The  commencing  dose  of  the  powdered  leaves  is  one  or  two  grains, 
to  be  repeated  two  or  three  times  daily,  and  to  be  gradually  increased 
until  the  effects  of  the  medicine  are  produced.  When  the  leaves  have 
not  been  injured  by  time,  ten  or  twelve  grains  daily  can  rarely  be  ex- 
ceeded without  inconvenient  effects. 

The  Infusion  may  be  prepared  by  macerating  a  scruple  of  the  dried 
leaves  in  ten  fluidounces  of  boiling  water.  The  dose  at  first  is  one  or 
two  fluidounces  two  or  three  times  daily,  to  be  increased  as  in  the  case 
of  the  powder. 

The  medicine,  however,  in  this  county,  is  much  more  used  in  the 
form  of  extract  than  in  any  other  way.  The  U.  S.  Pharmacopoeia  directs 
two  extracts,  one  of  which  is  the  inspissated  juice,  and  the  other  is  pre- 
pared by  means  of  diluted  alcohol. 

EXTRACT  OP  BELLADONNA.  —  EXTRACTUM  BELLADONNA. 
U.  S.,  Br. 

This  is  prepared  by  bruising  the  fresh  leaves,  expressing  the  juice, 
heating  this  to  the  boiling  point  so  as  to  coagulate  the  albumen,  then 
straining,  and  evaporating  the  clear  liquor  to  the  proper  consistence.  It 
has  a  dark-brown  colour,  a  narcotic  not  disagreeable  odour,  a  bitterish 
taste,  and  a  soft  consistence.  As  used  in  this  country  it  is  generally 
imported,  and  is  of  unequal  strength,  sometimes  very  powerful,  some- 
times feeble,  and  therefore  requiring  to  be  administered  with  much  cau- 
tion. Special  care  must  be  taken  that,  in  increasing  the  dose,  the  same 
parcel  should  be  employed ;  and  if  a  new  one  is  to  be  used,  the  dose 
should  be  reduced  so  as  to  test  its  strength.  This  is  the  preparation 
most  employed  in  the  United  States.  The  commencing  dose  is  from 
one-quarter  to  one-half  a  grain,  twice  or  three  times  a  day,  gradually  in- 
creased, if  necessary,  until  some  sign  of  its  action  is  produced,  as  dry- 
ness  of  the  throat,  dimness  of  vision  with  dilatation  of  the  pupil,  or 
uneasy  sensation  in  the  head.  I  have  often  known  half  a  grain  to  act 
decidedly. 

In  the  way  of  enema  not  more  than  three  times  as  much  should  be 
given  as  by  the  mouth.  For  endermic  use,  three  or  four  grains  may  be 
employed,  but  its  effects  should  be  watched.  If  no  effect  is  produced, 
the  quantity  may  be  increased.  For  friction  on  the  sound  skin,  from  ton 
to  thirty  grains  or  more  may  be  used,  with  sufficient  water  to  bring  it 
to  the  consistence  of  thick  cream,  or  with  twice  its  weight  of  lard. 

ALCOHOLIC    EXTRACT    OP  BELLADONNA.  —  EXTRACTUM 

BELLADONNA  AI.COHOLICUM.  U.  S. 

The  alcoholic  extract  is  prepared  by  evaporating  a  tincture  of  the  leaves 
made  with  diluted  alcohol.  The  dose  is  half  a  grain  to  begin  with. 

TINCTURE  OP  BELLADONNA.  —  TINCTURA  BELLADONNA. 
U.  S.,  Br. 

This  is  made  in  the  proportion  of  four  ounces  of  the  dried  leaves  to 


80  i  GENERAL    STIMULANTS.  [PART  II. 

two  pints  of  diluted  alcohol.  It  is  an  efficient  preparation,  if  made 
from  recently  dried  leaves.  The  dose  is  fifteen  or  thirty  drops,  or  half 
the  number  of  minims,  to  be  increased  as  the  other  preparations. 

Not  more  than  one- sixth  or  one-eighth  of  the  doses  above  mentioned 
should  be  given  at  first  to  a  child  two  years  old. 

PLASTER  OP  BELLADONNA. — EMPLASTRUM  BELLADONNA. 
U.  S.,  Br. 

This  is  prepared  by  incorporating  the  extract  (alcoholic  extract,  U.  S.) 
with  melted  resin  plaster.  It  is  used,  spread  upon  coarse  linen  or 
leather,  in  rheumatic  pains,  neuralgia,  dysmenorrhoea,  etc.  I  have 
known  the  system  to  be  affected  by  it;  and  a  case  is  on  record  in  which 
even  alarming  symptoms  resulted  from  the  application  of  this  plaster  to 
a  surface  covered  with  an  eruption,  and  partially  ulcerated. 

OINTMENT  OP  BELLADONNA.  —  UNGUEXTUM  BELLADONNA. 
U.  S.,  Br. 

This  consists  of  one  part  of  the  extract  and  eight  of  lard  mixed.  It  is 
used  for  friction  upon  the  skin,  or  as  a  dressing  to  blistered  surfaces. 
For  the  latter  purpose,  not  more  than  half  a  drachm  or  two  scruples 
should  be  applied  at  first. 

LINIMENT  OP  BELLADONNA. — LINIMENTUM  BELLADONNA.  Br. 

This  is  a  very  concentrated  tincture  of  the  root  of  belladonna,  intended 
exclusively  for  external  use.  It  may  be  applied  by  means  of  a  camel's- 
hair  pencil,  or  may  be  diluted  with  two  or  more  measures  of  soap  lini- 
ment, and  rubbed  upon  the  part.  It  is  peculiar  to  the  British  Pharma- 
copoeia. 

ATROPIA.  U.  S.,  Br. 

This  is  thought  to  exist  in  belladonna,  combined  with  malic  acid  in 
excess.  For  an  account  of  the  different  somewhat  complex  processes  by 
which  it  is  extracted,  the  reader  is  referred  to  the  U.  S.  Dispensatory. 
Mr.  W.  T.  Luxton,  of  London,  proposes  the  following  simple  method. 
To  a  decoction  of  the  leaves  he  adds  a  little  concentrated  sulphuric  acid, 
which  precipitates  the  albumen  and  forms  sulphate  of  atropia;  then, 
having  drawn  off  the  clear  liquor,  he  precipitates  the  atropia  either  by 
solution  of  ammonia,  or  tin-  Beaquicarbonste  of  that  alkali.  After  a  day 
or  two  the  clear  liquid  is  drawn  off,  and  the  crystals  which  have  formed, 
having  been  thrown  on  a  filter  to  dry,  are  washed  with  a  little  spirit  of 
ammonia,  which  deprives  them  of  most  of  their  colouring  matter,  leaving 
them  "  moderately"  white.  He  has  thus  generally  obtained  about  5.5 
parts  from  1000  of  the  leaves,  while  the  process  usually  employed  yields 
only  3  parts  for  1000.  (See  Am.  Journ.  of  Pharm.,  xxvii.  156.) 

Atropia  is  in  white,  translucent,  silky,  acicular  crystals,  inodorous,  of 
a  bitter  acrid  taste,  sliirlitly  soluble  in  cold  water,  considerably  more  so 
in  ether,  very  soluble  in  alcohol,  and  dissolved  by  all  these  liquids  in 


CHAP.  I.]      CEREBRAL  STIMULANTS. — BELLADONNA.          805 

larger  proportion  when  hot  than  cold.  It  melts  with  heat,  and  at  a 
higher  temperature  is  dissipated;  part  being  volatilized  without  change, 
and  the  remainder  decomposed.  It  has  an  alkaline  reaction  with  litmus- 
paper,  and  neutralizes  the  acids,  forming  crystallizable  salts  with  the  sul- 
phuric, muriatic,  and  acetic.  Nitric  acid  dissolves  it,  forming  a  yellow 
solution  ;  sulphuric  acid  dissolves  it  without  change  of  colour  if  cold, 
but  when  hot  reddens  it.  Like  the  other  organic  bases,  it  is  precipitated 
by  the  alkalies  from  its  saline  solutions,  unless  very  feeble ;  and  from  the 
same  solutions  tannic  acid  throws  down  the  tannate  of  atropia.  Like 
most  of  these,  too,  it  consists  of  carbon,  hydrogen,  oxygen,  and  nitrogen. 

The  effects  produced  upon  the  system  by  atropia  are  exactly  those  of 
belladonna,  only  that  they  occur  more  promptly,  and  are  relatively  much 
more  powerful.  Thus,  the  alkaloid  gives  evidence  of  its  operation  in 
twenty  minutes,  while  the  powdered  leaves  or  extract  usually  require 
half  an  hour.  Its  action  continues  from  twelve  to  twenty-four  hours  or 
longer.  One-sixth  of  a  grain,  taken  into  the  stomach,  generally  pro- 
duces symptoms  of  a  somewhat  violent  character,  as  accelerated  pulse, 
dryness  and  stricture  of  the  throat,  dimness  of  vision  with  dilated  pupil, 
giddiness,  abnormal  sounds,  phantasms,  delirium,  and  sometimes  numb- 
ness and  tingling  of  the  extremities,  and  strangury,  with  depression  of 
the  circulation  and  temperature  of  the  surface.  Two-thirds  of  a  grain 
have  occasioned  the  most  alarming  symptoms,  from  which,  however, 
recovery  took  place. 

For  internal  use  it  has  little  advantage  over  the  other  preparations, 
while,  from  its  small  bulk,  it  might  be  more  liable  to  be  taken  in  poison- 
ous quantities.  Nevertheless,  if  pure,  it  may  be  more  certainly  depended 
on  in  a  given  dose,  and  danger  may  be  avoided  with  care.  It  is  appli- 
cable to  the  same  diseases  precisely  as  belladonna  itself.  The  dose  at 
first  should  never  exceed  the  twelfth  of  a  grain ;  and  it  would  be  best  to 
commence  with  the  twenty-fourth  or  thirtieth,  which  may  be  repeated 
two  or  three  times  daily,  and  increased  if  requisite. 

Externally,  especially  for  application  to  the  eye,  it  is  preferred  by 
some  to  the  extract,  in  consequence  of  the  less  quantity  required,  and  its 
greater  cleanliness.  It  may  also  be  used  with  great  effect  endermically. 
It  is  chiefly  employed  to  dilate  the  pupil,  which  it  does  very  promptly, 
in  exceedingly  minute  quantity.  One  drop  of  a  solution,  containing 
only  a  grain  in  a  fluidounce  of  the  menstruum,  will  produce  the  effect. 
M.  Steafield  recommends  for  this  purpose  the  use  of  atropia  paper, 
which  may  be  made  by  saturating  paper  with  the  solution  just  men- 
tioned, in  such  a  way,  that  a  little  piece,  about  one-fifth  of  an  inch 
square,  shall  be  wet  with  exactly  one  drop  of  the  solution.  The  paper 
is  then  dried,  and,  when  wanted,  may  be  applied  by  drawing  down  the 
lower  lid,  and  placing  the  piece  of  paper  upon  the  ball  beneath  the 
cornea.  (Ann.  de  Therap.,  1864,  p.  33.) 


806  GENERAL    STIMULANTS.  [PART  II. 

Atropia  has  also  been  used  hypodermicaUy  for  the  relief  of  neuralgic 
affections.  Its  use  in  this  way  has  greatly  extended  of  late ;  and  it  has  been 
employed  in  most  other  complaints  in  which  belladonna  has  been  thought 
to  be  useful.  It  seems  to  have  been  peculiarly  efficacious  in  severe  rheu- 
matic pains  of  a  subacute  character,  but  of  considerable  duration,  espe- 
cially sciatica.  One-twenty-fourth  or  one-sixteenth  of  a  grain,  dissolved 
in  from  fifteen  to  thirty  minims  of  water,  may  be  injected  into  the  sub- 
cutaneous areolar  tissue  at  one  operation;  but  some  cases  of  unexpected 
violence  from  its  use  in  this  way  have  led  to  peculiar  caution  in  regard  to 
the  hypodermic  dose ;  and  it  is  now  recommended  not  to  administer  by  in- 
jection, at  the  first  operation,  more  than  one- half  the  quantity  administered 
by  the  mouth.  It  is  not  improbable  that,  in  the  cases  where  alarming 
effects  have  been  suddenly  produced,  the  solution  may  have  been  injected 
directly  into  a  punctured  vein.  To  avoid  such  a  result,  the  point  of  the 
instrument  may  be  very  slightly  drawn  back  before  the  liquid  is  injected. 
A  case  is  on  record  in  which  the  -,-^-g-  of  a  graiu  produced  apparently 
serious  effects. 

The  British  Pharmacopoeia  directs  a  Solution  of  Atropia  (LIQUOR 
ATROPI/I:,  Br.\  made  by  dissolving  four  grains  of  the  alkaloid  in  a  fluid- 
ounce  of  a  menstruum  consisting  of  seven  fluidrachms  of  distilled  water 
and  one  of  rectified  spirit.  Four  minims,  equivalent  to  one-thirtieth  of 
a  grain  of  atropia,  may  be  given  as  a  commencing  dose,  and  increased 
if  necessary  to  ten  or  twelve  minims.  Half  the  quantity  may  be  used 
for  subcutaneous  injection.  Diluted  with  four  measures  of  distilled 
water,  it  may  be  used  for  dilating  the  pupil. 

An  Ointment  of  Atropia  (UNGUENTUM  ATROPIA,  Br.)  is  also  officinal 
in  the  British  Pharmacopoeia,  made  by  first  dissolving  eight  grains  of 
atropia  in  half  a  fluidrachm  of  rectified  spirit,  and  afterwards  mixing  the 
solution  with  one  ounce  (avoirdupois)  of  prepared  lard.  In  the  appli- 
cation of  this  ointment,  care  must  be  taken  that  it  do  not  come  in  con- 
tact with  wounded,  abraded,  or  ulcerated  surfaces. 

The  U.  S.  Pharmacopoeia  directs  the  Sulphate  of  Atropia  (ATROPIJE 
SULPHAS,  U.  S.) ;  but  it  has  little  advantage  over  the  pure  alkaloid, 
which  may  be  dissolved  in  water  with  the  utmost  facility  by  means  of  a 
little  acetic  acid.  Valerianate  of  atropia  has  also  been  recommended 
as  peculiarly  efficacious  in  asthma;  but  the  dose  of  valerianic  acid  is  so 
controlled  by  that  of  atropia  that  it  can  scarcely  exercise  any  observable 
influence.  The  following  preparations  may  be  made  for  use.  Dissolve 
one  grain  of  atropia  in  a  fluidrachm  of  alcohol,  and  add  seven  fluidrachms 
of  distilled  water  to  the  solution;  or  mix  a  grain  with  a  fluidounce  of 
pure  water,  and  drop  in  diluted  acetic  acid  till  the  solution  is  effected. 
Of  either  of  these  preparations,  fifteen  minims  may  be  given  for  a  com- 
mencing dose,  and  a  drop  or  two  may  be  introduced  into  the  eye  in  order 
to  dilate  the  pupil.  An  ointment  may  be  made  by  rubbing  up  five 


CHAP.  I.]     CEREBRAL  STIMULANTS. — BELLADONNA.          807 

grains  thoroughly  with  three  drachms  of  lard;  of  which  a  portion 
about  as  large  as  a  pea  may  be  used  in  friction  to  the  eyelids  and  face, 
to  dilate  the  pupil,  or  relieve  neuralgia.  Another  method  is  to  paint  the 
eyelid  with  a  solution  of  atropia  in  a  chloroformic  solution  of  gutta 
percha.  When  atropia  is  applied  to  a  blistered  surface,  or  that  of  an 
ulcer,,  not  more  than  the  dose  given  by  the  mouth  should  be  used  at  first, 
in  consequence  of  its  very  rapid  absorption.  It  causes  when  thus  em- 
ployed a  slight  pain,  which  soon  ceases.  A  case  of  fatal  poisoning  is 
said  to  have  occurred  from  the  application  to  a  blister  on  the  neck  of  an 
ointment  composed  of  15.5  parts  of  sulphate  of  atropia  and  700  parts 
of  lard.  (Pharm.  Journ.  and  Trans.,  June,  1865,  p.  664.)* 

*  Atropia  and  Morphia.  Some  interesting  results  have  been  recently  obtained  in 
regard  to  the  physiological  action  of  atropia,  and  of  its  relation  with  the  alkaloid 
of  opium.  A  series  of  observations  on  these  points  were  undertaken,  under  favour- 
able circumstances,  jointly  by  Drs.  S.  Weir  Mitchell.  Win.  W.  Keen,  and  Geo.  R. 
Morehouse,  of  Philadelphia,  which  eventuated  in  the  following  conclusions:  and 
these  correspond  very  closely  with  the  results  of  similar  inquiries  made  about  the 
same  time  by  Dr.  Da  Costa,  of  this  city,  and  subsequently  by  Dr.  Erlenmeyer,  of 
Bendorf,  in  Germany.  In  the  experiments  of  Dr.  Mitchell  and  his  coadjutors,  the 
alkaloids  in  solution  were  injected  into  the  subcutaneous  areolar  tissue ;  the  mor- 
phia, in  the  form  of  sulphate,  in  doses  varying  from  one-third  to  one-fourth  of  a 
grain;  the  atropia,  from  one-fifteenth  to  one-thirtieth. 

1.  Circulation  and  Respiration.   On  the  circulation,  the  first  effect  of  atropia  was  for 
a  few  minutes  either  nothing,  or  a  slight  diminution  in  the  frequency  of  the  pulse; 
but  uniformly  tlii.«  short  period  of  quiescence  or  diminution  (from  4  to  10  minutes) 
was  followed  by  excitement;  the  pulse  rising  from  15  to  40  beats  in  a  minute,  con- 
tinuing thus  about  an  hour,  then  gradually  subsiding  till,  after  about  4  hours,  it 
fell  considerably  below  the  natural  standard.     The  greatest  depression  was  in  the 
tenth  or  eleventh  hour,  after  which  it  rose  again,  and  became  normal  in  24  hours. 
The  respiration  did  not  increase  in  frequency  with  the  pulse,  but  either  remained 
unaltered,  or  was  slightly  depressed. 

After  the  injection  of  morphia,  the  pulse  was  not  strikingly  affected.  In  a  few  cases 
it  rose  slightly,  in  a  larger  number  it  was  unchanged,  and  in  a  still  larger  number 
fell  an  average  of  8  beats  only ;  but  the  fulness  was  increased  with  the  general 
influence  of  the  morphia.  The  respiration  was  little  affected.  The  general  conclu- 
sion was  that  morphia  subcutaneously  administered,  in  ordinary  remedial  doses, 
has  no  conspicuous  influence  on  the  heart  and  lungs. 

When  the  two  alkaloids  were  administered  conjointly,  the  result  was  precisely 
the  same  on  the  pulse  and  respiration  as  when  the  atropia  was  given  alone;  that 
is,  its  action  was  in  no  degree  modified  by  the  morphia. 

The  inference  is  that,  in  relation  to  the  functions  of  circulation  and  respiration, 
there  is  no  antagonism  between  atropia  and  morphia. 

2.  Action  on  the  Eye.  In  their  action  on  the  eye,  the  alkaloids  appeared,  to  a  cer- 
tain extent  at  least,  to  neutralize  each  other.  When  the  pupil  was  dilated  with  atro- 
pia, the  injection  of  morphia  caused  it,  within  half  an  hour,  either  to  return  to  the 
normal  standard,  or  to  contract  still  further.     So  also  with  the  power  of  accommo- 
dation, which,  however,  oftener  remained  paralyzed  for  an  hour  or  more  after  the 
pupils  began  to  show  the  influence  of  morphia;  so  that  in  this  respect  the  opiate 


808  GENERAL    STIMULANTS.  [PART  II. 


IX.  STRAMONIUM. 

Datura  Stramonium,  thornapple,  or  Jamestown  weed,  is  an  annual 
plant  from  two  to  six  feet  high,  growing  in  all  quarters  of  the  world, 
and  flourishing  especially  in  rank  soil,  as  on  dung-heaps,  and  on  the 
road-sides  and  commons  near  towns  and  villages,  whore  refuse  matter  is 
apt  to  be  collected.  Its  original  native  country  is  uncertain.  It  is  often 
clustered  in  patches,  and  scents  the  air  of  the  neighbourhood  with  its 
disagreeable  odour.  All  parts  of  it  are  active.  The  U.  S.  Pharmacopoeia 
recognizes  the  leaves,  seeds,  and  root. 

1.  STRAMONIUM  LEAF.  —  Stramonii  Folium.  U.  S.  —  Stramonii  Folia. 
Br.  —  These  have  short  footstalks,  are  five  or  six  inches  long,  unequal  at 
the  base,  irregularly  sinuated  and  notched    at  the  border,  dark  green 
above,  and  pale  beneath.     When  fresh  and  bruised,  they  have  a  fetid, 
narcotic  odour,  which  they  lose  by  drying;  retaining,  however,  a  bitter 
and  nauseous  taste. 

2.  STRAMONIUM  SEED.  —  Stramonii  Semen.  U.  S.  —  Stramonii  Semi- 
na.  Br.  —  These  are  small,  kidney-shaped,  flattened  on  the  sides,  of  a 
blackish-brown  colour,  without  smell,  and  of  a  bitter,  nauseous,  some- 
alkaloid  seemed  to  be  less  powerfully  antagonistic  than  in  reference  to  the  pupil. 
The  general  conclusion,   however,  was  that  the  two  alkaloids   neutralized  each 
other  in  their  action  both  on  the  retina  and  the  ciliary  muscle. 

8.  Cerebral  functions.  Here  there  was  found  to  be  a  decided  antagonism  in  some 
points.  Thus  the  headache,  phantasms,  visual  disorder,  and  deafness  caused  by 
atropia  were  lessened  or  disappeared  under  the  influence  of  morphia;  while  the 
drowsiness  and  stupor  of  the  latter  alkaloid  were  controlled  by  the  former.  The 
pallor  of  morphia  and  the  flush  of  atropia  were  also  mutually  modified. 

4.  Other  actions.  The  nausea  often  caused  by  morphia  was  not  diminished  by 
iitropia. 

The  effects  of  the  two  alkaloids  on  the  mucous  membrane  coincided ;  but  the 
property  of  inducing  dryness  in  the  throat  was  greater  in  atropia. 

In  producing  dysury,  they  appeared  to  concur. 

The  influence  of  morphia  in  the  relief  of  pain  was  not  disturbed  by  atropia. 

According  to  the  same  experimenters,  neither  atropia,  daturia,  nor  conia,  has  any 
power  of  lessening  pain  when  administered  hypodermically.  In  this  respect,  how- 
ever, the  conclusion  of  the  authors  does  not  coincide  with  that  of  many  others,  who 
have  found  great  relief  to  painful  affections  from  the  subcutaneous  injection  of 
atropia.  Dr.  Erlenmeyer  states  that  the  atropia  and  morphia  given  jointly,  will,  in 
many  cases  of  neuralgia,  succeed  perfectly,  after  entire  failure  with  both  adminis- 
tered separately.  (Arch.  Gen.,  Mars,  1866,  p.  362.) 

From  all  these  results  it  may  be  inferred  that,  while  a  certain  degree  of  antago- 
nism exists  between  atropia  and  morphia  on  some  points,  in  others  they  coincide 
or  are  indifferent  ;  and  therefore  that  it  would  be  unsafe  to  rely  upon  either  exclu- 
sively in  poisoning  by  the  other;  though  they  may  be  employed  to  meet  certain 
indications.  (See  Am.  Journ.  of  Metl.  .S'ci.,  July.  1865,  p.  67.) — A'ote  to  the  third 
flit  ion. 


CHAP.  I.]  CEREBRAL   STIMULANTS*—  STRAMONIUM.  809 

what  acrid  taste.  They  are  stronger  in  medicinal  qualities  than  any 
other  part  of  the  plant. 

3.  STRAMONIUM  ROOT.  —  Stratnonii  Radix.  U.S.  1850.  —  This  is 
large,  whitish,  branched,  with  numerous  fibres,  fleshy  when  fresh,  light 
and  spongy  when  dry,  and  of  very  little  smell  or  taste,  though  it  leaves 
a  slightly  acrid  impression  in  the  mouth  when  chewed. 

All  these  parts  yield  their  virtues  to  water  and  alcohol. 

Active  Principle  The  odour  of  the  plant  would  suggest  that  the  vol- 
atile principle  might  possess  narcotic  properties ;  but  it  is  asserted  that 
water  distilled  from  the  fresh  leaves,  though  it  has  their  odour  in  some 
degree,  is  without  effect  on  the  system ;  and  the  seeds,  which  are  inodor- 
ous, are  stronger  than  the  leaves.  It  is  probable  that  the  virtues  of  the 
plant  reside  exclusively  in  an  organic  alkali,  which  has  been  extracted 
from  the  seeds,  and  received  the  name  of  daturia.  In  its  sensible,  chem- 
ical, and  physiological  properties,  this  bears  so  close  a  resemblance  to 
atropia  as  to  have  led  to  the  supposition  that  the  two  principles  are 
identical ;  and  if  their  composition  be,  as  stated  by  Von  Planta,  precisely 
the  same,  the  supposition  must  be  considered  as  correct.  Upon  this 
ground  we  can  explain  the  extraordinary  resemblance  of  stramonium 
and  belladonna  in  their  effects  upon  the  system,  and  their  remedial  appli- 
cation.  Daturia,  like  hyoscyamia  and  atropia,  is  rendered  inert  by 
admixture  with  even  a  weak  solution  of  caustic  potassa  or  soda,  but  is 
not  affected  by  their  carbonates. 

Effects  on  the  System.  The  operation  of  stramonium  on  the  system  so 
closely  resembles  that  of  belladonna,  that  it  is  necessary  to  do  little  more 
than  refer  to  the  account  of  the  latter  medicine.  (See  page  785.)  It  is 
sufficient  to  say,  in  reference  to  the  effects  of  stramonium  in  full  medicinal 
doses,  that  it  produces  dryness  and  uneasy  sensations  in  the  throat,  dim- 
ness or  perversion  of  vision,  sometimes  dilatation  of  the  pupil,  not  unfre- 
quently  vertigo,  headache,  mental  confusion  or  slight  delirium,  and,  in 
some  rare  instances,  sleep;  and  that  its  operation  on  the  brain  is  at- 
tended with  little  or  no  disturbance  of  the  circulation,  and  no  tendency 
to  constipation,  but  with  an  occasional  increase  of  perspiration  or  urine. 
In  poisonous  quantities,  it  causes  great  uneasiness  of  the  throat  with  a 
feeling  as  of  strangulation,  anxiety  and  faintness,  partial  or  complete 
blindness,  great  dilatation  of  the  pupil,  sometimes  deafness,  flushing  X)f 
the  face,  vertigo,  headache,  hallucinations,  delirium  of  a  whimsical,  ludi- 
crous, or  more  rarely  furious  character,  tremors,  paralysis,  and  at  last 
stupor,  with  convulsions  in  rare  instances.  There  is  usually,  in  the  ad- 
vanced stage,  great  prostration,  as  indicated  by  the  very  feeble  pulse, 
and  cool  skin;  and  sometimes  the  local  irritant  influence  of  the  poison 
is  evinced  by  a  burning  pain  at  the  stomach,  nausea,  and  vomiting. 
From  the  worst  symptoms  mentioned,  recovery  has  often  taken  place  ;  but 
not  unfrequently  they  have  ended  fatally,  in  a  period  varying  from  six 


810  GENERAL    STIMULANTS.  [PART  II. 

to  twenty-four  hours.  In  case  of  recovery,  the  poisonous  symptoms  are 
of  variable  duration,  but  generally  begin  to  disappear  within  twenty-four 
hours ;  and  the  patient,  upon  rising  out  of  his  lethargy,  has  no  recollec- 
tion of  what  has  passed.  Little  definite  is  known,  as  to  the  smallest 
quantity  that  may  cause  death.  A  child  two  years  old  was  killed  by 
100  seeds,  which  were  swallowed  whole,  and  were  afterwards  found  in 
the  stomach  and  bowels.  Dr.  Young  states  that  a  single  capsule  with 
its  contents  proved  fatal  to  a  child.  It  is  the  seeds  which  are  most  fre- 
quently taken  in  poisonous  quantities,  and  generally  by  children,  who 
gather  them  from  the  plant.  Stupor  in  a  child,  with  extraordinarily 
dilated  pupil,  should  lead  to  the  suspicion  of  this  kind  of  poisoning,  if 
access  to  the  cause  was  possible.  The  late  Dr.  Dorsey  used,  in  his  lec- 
tures, to  relate  a  case  in  which  this  symptom  induced  him  to  suspect 
narcotic  poisoning,  and,  upon  this  suspicion,  to  administer  an  emetic, 
which  caused  the  discharge  of  numerous  stramonium  seeds,  with  the 
effect  apparently  of  saving  life.  Alarming  symptoms  have  followed  the 
external  application  of  the  leaves  to  a  burn. 

Herbivorous  animals  are  less  affected  than  man.  Five  ounces  of  the 
fresh  juice  produced  only  slight  drowsiness  in  a  horse ;  and  two  pounds 
and  a  half  of  the  seeds,  given  to  another  horse,  though  they  proved  fatal, 
did  not  destroy  life  until  after  fifty-two  hours.  (Pereira's  Mat.  Med.) 
Upon  dogs  the  poison  acts  as  in  the  human  subject. 

The  treatment  of  poisoning  by  stramonium  is  the  same  as  that  for 
opium.  Animal  charcoal  may  be  given  at  the  same  time,  as  an  antidote 
to  the  poison  remaining  in  the  stomach. 

Like  belladonna,  stramonium  produces  its  peculiar  effects,  no  matter 
to  what  part  of  the  body  it  may  be  applied;  and,  in  like  manner,  the 
expressed  juice,  an  infusion  of  the  leaves,  or  the  extract  dilates  the  pupil, 
when  introduced  into  the  eye,  or  rubbed  upon  the  eyelids  and  neighbour- 
ing parts.  There  is  little  doubt  that  it  acts  on  the  brain  exclusively 
through  the  blood. 

Therapeutic  Application.  This  medicine  is  not  known  to  have  been 
employed,  before  it  was  introduced  to  the  notice  of  the  profession  by  the 
famous  Storck,  who  used  it  in  insanity,  chorea,  and  epilepsy.  It  is 
capable  of  fulfilling  the  same  indications  as  belladonna;  that  is,  to  iv- 
liftve  pain,  relax  spasm  and  muscular  rigidity,  stimulate  the  depressed 
cerebral  centres,  diminish  the  susceptibility  of  the  retina,  and  dilate  the 
pupil.  There  is  not,  perhaps,  one  of  the  therapeutic  uses  of  belladonna, 
in  reference  to  which  stramonium  might  not  be  substituted  for  it,  with 
the  same  or  very  similar  results.  The  following,  however,  are  the  dis- 
eases in  which  it  has  actually  been  employed,  with  more  or  less  sup- 
posed success;  namely,  neuralgia,  syphilitic  pains,  rheumatism  and 
gout,  dysmenorrhoea,  painful  tumours  and  ulcers,  tetanus,  epilepsy, 
hooping-cough,  spasmodic  asthma,  puerperal  convulsions,  mania,  de- 


CHAP.  I.]  CEREBRAL   STIMULANTS. — STRAMONIUM.  811 

lirium  tremens,  and  nymphomania  It  is  also  occasionally  used  by 
American  oculists  to  dilate  the  pupil.  To  enter  into  a  minute  account 
of  its  uses  in  each  of  these  affections,  would  be  merely  to  repeat  what 
has  been  said  under  the  head  of  belladonna;  and  I  must  content  myself 
with  referring  the  reader  to  the  article  on  that  subject.  But  the  use  of 
stramonium  in  asthma  deserves  a  more  particular  consideration. 

The  smoking  of  the  root  of  Datura  ferox,  in  the  paroxysms  of  asthma, 
has  long  been  a  common  practice  among  the  natives  in  the  East  Indies. 
An  English  general  officer,  having  derived  great  benefit  in  his  own  case 
from  the  remedy,  was  induced,  on  his  return  to  England,  to  try  the  ef- 
fects of  the  common  stramonium,  which  he  found  to  answer  the  same 
purpose.  The  remedy,  having  been  made  known,  was  soon  extensively 
employed,  and  received  the  highest  commendation  from  various  respect- 
able sources.  Objection,  however,  was  afterwards  made  to  it,  on  the 
score  that  it  endangered  disease  of  the  brain,  and  had  frequently  caused 
mischievous  results.  The  same  nia}r  be  said  of  every  active  remedy. 
In  its  application  to  asthma,  stramonium  requires  to  be  judiciously  em- 
ployed; but,  with  proper  precautions,  there  is  little  or  no  danger;  and 
the  greatest  benefit  may  often  be  obtained.  In  dyspnoea  arising  from 
organic  disease  of  the  heart  or  lungs,  it  can  generally  be  productive  of 
little  good,  and  should  not  be  employed  unless  to  alleviate  the  affection, 
when  'dependent,  not  on  congestion  of  the  pulmonary  organs,  but  on 
mere  nervous  irritation  connected  with  the  disease.  Neither  is  it  adapted 
to  cases  of  gouty  asthma,  in  which  there  is  a  disposition  to  translation 
from  one  organ  to  another,  and  especially,  when  experience  has  shown 
that  there  is  any  tendency  of  the  disease  to  the  brain.  In  such  cases, 
by  stimulating  the  cerebral  centres,  the  medicine  renders  them  a  point  of 
afflux  for  the  gouty  irritation,  which  may  fix  upon  them  with  great  vio- 
lence ;  and,  though  the  patient  may  be  relieved  of  the  dyspnoea,  he  is 
liable  to  die  of  coma.  But  in  the  pure  spasmodic  asthma,  unconnected 
with  any  other  organic  disease  than  such  as  has  been  induced  by  the 
asthma  itself,  as  emphysema  of  the  lungs,  for  example,  the  smoking  of 
stramonium  is  often  extremely  useful,  and,  if  care  be  taken  not  to  carry 
it  too  far,  is  perfectly  safe.  It  is  applicable  only  to  the  paroxysms,  and 
should  be  confined  to  these,  lest  its  influence  should  wear  out  too  rapidly. 
The  relief  afforded  by  it  is  sometimes  immediate  and  entire;  the  patient 
falling  quietly  to  sleep,  not  because  of  the  soporific  effect  of  the  remedy, 
but  in  consequence  of  the  removal  of  the  cause  of  his  wakefulness.  It 
does  not  prevent  subsequent  paroxysms,  and  will  not  cure  the  complaint, 
which,  after  being  completely  established,  is  seldom  cured  by  any  means 
that  can  be  employed  ;  but  it  is  an  object  of  great  importance  to  miti- 
gate the  sufferings  of  the  patient,  and  prolong  his  life,  as  probably  may 
be  done  by  preventing  the  rapid  increase  of  emphysema,  which  is  the 
inevitable  result  of  the  excessive  dyspnoea.  Unfortunately  the  remedy 


812  GENERAL   STIMULANTS.  [PART  II. 

has  not  been  found  equally  effectual  in  all  cases  of  the  disease  ;  and, 
even  in  those  in  which  it  at  first  operates  most  effectually,  though  it  may 
continue  to  yield  relief  for  years,  yet  its  influence  gradually  diminishes  ; 
so  that  at  length  it  sometimes  ceases  to  be  felt.  It  is  said  that  General 
Gent,  who  was  most  instrumental  in  introducing  the  remedy  into  Eng- 
land, at  last  suddenly  died  with  coma  from  the  effects  of  it,  probably 
owing  to  his  over-confidence.  Either  the  root  or  the  dried  leaves  may  be 
used.  The  former  should  be  quickly  dried,  cut  in  pieces,  and  beaten  so 
as  to  render  its  texture  loose.  Fifteen  grains  may  be  smoked  at  once, 
and  the  pipe  may  be  renewed  several  times  a  day,  if  necessary,  care 
being  taken  to  stop  when  any  decided  narcotic  effect  is  produced.  The 
leaves  may  also  be  used  in  the  form  of  a  cigar ;  and,  as  in  the  case  of 
belladonna,  they  may  sometimes  be  advantageously  impregnated  with 
nitre  previously  to  being  rolled  into  the  required  shape.  (See  page  799.) 
The  smoke  is  said  to  cause  a  feeling  of  warmth  in  the  lungs,  which  is 
soon  followed  by  copious  expectoration,  and  often  by  some  temporary 
vertigo  and  drowsiness,  and  sometimes  nausea.  In  the  intervals  between 
the  paroxysms,  the  extract  may  be  taken  internally  in  such  doses  as 
moderately  to  affect  the  system. 

As  an  external  remedy  also,  stramonium  is  susceptible  of  the  same 
applications  as  belladonna,  and  may  be  used  in  the  same  way.  In  the 
form  of  cataplasm,  or  of  ointment  made  with  the  extract,  it  has  been  used 
in  inflamed  or  painful  tumours,  irritable  ulcers,  rheumatism  in  the  joints 
or  muscles,  swelled  mamma,  painful  hemorrhoids,  and  irritating  cuta- 
neous affections. 

Administration.  The  dose  of  the  powdered  leaves  is  two  or  three  grains, 
twice  or  thrice  daily.  That  of  the  powdered  seeds  is  one  grain,  repeated 
as  often.  Should  this  dose  produce  no  effect  in  a  day  or  two,  it  should 
be  gradually  increased  until  it  gives  rise  to  some  evidence  of  its  action, 
as  dimness  of  vision,  dryness  and  stricture  of  the  throat,  etc.  Fifteen 
or  twenty  grains  of  the  leaves  have  often  been  given  without  unpleasant 
effects.  The  medicine,  however,  is  more  frequently  administered  in  ex- 
tract. The  U.  S.  Pharmacopoeia  directs  two  extracts,  one  of  which  is 
the  inspissated  juice  of  the  leaves,  and  the  other  is  prepared  by  evapo- 
rating a  tincture  of  the  seeds. 

The  Extract  of  the  Leaves  (EXTRACTUM  STRAMONII,  U.  S.)  is  made 
by  expressing  the  juice  of  the  leaves,  heating  to  coagulate  the  iilbumen, 
then  filtering,  and  evaporating.  The  preparation  is  of  unequal  strength. 
The  commencing  dose  is  one  grain,  to  be  repeated  and  increased  in  the 
same  manner  as  the  powder. 

An  Alcoholic  Extract  (EXTRACTUM  STRAMONII  ALCOHOLICUM,  U.  S.) 
is  prepared  from  the  leaves,  by  the  U.  S.  Pharmacopoeia,  by  first  forming 
a  tincture  by  percolation,  and  then  evaporating.  The  dose  is  a  grain. 

The  Extract  of  the  Seeds  (EXTRACTUM  STRAMONII  SEMINIS,  U.  S.; 


CHAP.  I.]  CEREBRAL   STIMULANTS. — STRAMONIUM.  813 

EXTRACTUM  STRAMONII,  Br.)  is  prepared  by  evaporating  a  tincture  of 
the  seeds.  It  is  a  stronger  and  more  equable  preparation  than  the  pre- 
ceding, and  may  be  given  in  the  dose  of  one-quarter  or  one-half  a  grain, 
to  be  repeated  and  increased  in  the  same  manner. 

The  Tincture  of  Stramonium  (TINCTURA  STRAMONII,  U.  S.,  Br.)  is 
made  from  four  ounces  of  the  seeds  and  two  pints  of  diluted  alcohol.  It 
is  an  excellent  preparation,  and  may  be  administered  in  the  commencing 
dose  of  ten  minims  or  twenty  drops. 

The  Ointment  (UNGUENTUM  STRAMONII,  U.  S.)  is  prepared  by  simply 
mixing  a  drachm  of  the  extract  with  an  ounce  of  lard;  the  extract 
having  been  first  rubbed  with  half  a  fluidrachrn  of  water.  It  may  be 
used  for  frictions  over  painful  surfaces,  as  an  application  to  hemorrhoidal 
tumours,  and  as  a  dressing  to  irritable  ulcers. 

Daturia,  the  alkaloid  of  stramonium,  upon  which  its  virtues  probably 
depend,  has  been  used  in  a  few  instances  for  obtaining  the  effects  of  the 
medicine;  but  its  action  is  so  precisely  that  of  atropia  that  sufficient  in- 
ducement is  not  offered  for  its  preparation,  and  it  is  comparatively  little 
employed. 


814  GENERAL    STIMULANTS.  [PART  II. 


C3L.A.SS    I'V. 
SPINAL   STIMULANTS. 

OF  all  the  medicines  in  common  use,  only  the  products  of  the  genus 
Strychnos  belong  properly  to  this  class.  Some  others  have  a  stimulant 
influence  over  the  spinal  functions,  but  they  have  also  properties  which 
class  them  elsewhere,  and  there  is  no  one  which  approaches  in  power 
those  here  referred  to.  The  products  of  the  two  species,  Strychnos  Nux 
vomica  and  S.  Ignatia,  are  so  similar,  I  might  say  identical  in  character, 
that  it  is  scarcely  advisable  to  consider  them  distinctly.  They  are, 
therefore,  united  in  the  following  article. 


NUX  VOMICA 

AND 

BEAN  OF  ST.  IGNATIUS. 

I.  NUX  VOMICA.   U.  S.,  Br. 

Origin.  This  name  has  been  given  to  the  seeds  of  Strychnos  Nux 
vomica,  a  middling-sized  tree,  growing  in  various  parts  of  the  East 
Indies.  The  bark  is  intensely  bitter,  containing  the  same  alkaloids  which 
characterize  the  seeds,  and  is  thought  to  be  identical  with  a  product  which 
at  one  time  attracted  considerable  attention,  under  the  name  of  False 
Angmlura  bark.  The  seeds  are  embedded  in  the  juicy  pulp  of  the  fruit, 
which  is  a  round  berry,  about  the  size  of  an  orange,  arid  covered  with  a 
-inooth,  yellowish,  or  orange-coloured  rind. 

Properties.  The  seeds  are  circular,  about  three-quarters  of  an  inch  in 
diameter  and  two  lines  thick,  somewhat  concave  on  one  side  and  convex 
on  the  other,  externally  presenting  a  thin  coat  closely  invested  with  very 
short,  silky,  ash-coloured  hairs,  internally  whitish,  translucent,  very  hard 
and  tough,  and  difficult  to  pulverize.  They  are  inodorous  and  intensely 
bitter,  and  yield  their  bitterness  and  medical  virtues  to  water,  but  more 
readily  to  diluted  alcohol. 


CHAP.  I.]  SPINAL   STIMULANTS. — NUX   VOMICA.  815 

II.  BEAN  OF  ST.  IGNATIUS.  — FABA    SANCTI   IGNATII. — 

IGNATIA.  U.S. 

Origin.  This  is  the  seed  of  Slrychnos  Ignatia,  the  Ignatia  amara  of 
the  younger  Linnaeus,  a  tree  of  moderate  size,  growing  in  the  Philippine 
Islands.  The  seeds  are  embedded  in  the  dry  pulp  of  a  fruit  resembling 
a  pear  in  size  and  shape. 

Properties.  The  bean  of  St.  Ignatius  is  about  an  inch  long,  of  less 
thickness,  convex  on  one  side,  obscurely  angular  on  the  other,  of  a  pale- 
brown  colour,  externally  covered  with  a  very  short  down,  internally 
translucent,  hard,  and  horny.  In  its  sensible  properties  of  odour  and 
taste,  and  its  relations  to  water  and  alcohol,  it  is  closely  analogous  to 
nux  vomica. 


Active  Principles.  Both  nux  vomica  and  the  bean  of  St.  Ignatius 
owe  their  medicinal  virtues  mainly  to  two  alkaloids,  denominated  strych- 
nia and  brucia ;  and  claims  have  been  advanced  to  the  discovery  of  a 
third,  to  which  the  name  of  igasuria  has  been  given.  These  bases  are 
supposed  to  exist  naturally  in  combination  with  a  peculiar  acid,  called 
igasuric  or  strychnic.  The  alkaloids  differ  greatly  in  strength,  strych- 
nia being  estimated  as  having  at  least  twelve?  times  the  strength  of 
brucia,  and  igasuria  being  intermediate.  For  practical  purposes,  strych- 
nia may  be  considered  as  the  active  principle,  and  is  the  only  one  much 
used  in  an  isolated  state.  Though  similar  in  virtues,  nux  vomica  and 
bean  of  St.  Ignatius  probably  differ  greatly  in  power ;  at  least,  the  latter 
contains  a  much  larger  proportion  of  strychnia  than  the  former;  the  per- 
centage of  that  alkaloid  being  given  at  0.4  in  nux  vomica,  and  1.2  in 
the  bean  of  St.  Ignatius. 

Incompatible^.  Alkalies,  their  carbonates,  and  alkaline  earths,  and  the 
vegetable  astringents,  throw  down  precipitates  from  watery  solutions  of 
these  medicines,  the  former  separating  the  insoluble  alkaloids,  the  latter 
forming  insoluble  tannates  ;  but,  if  the  precipitated  matter  is  swallowed, 
it  is  capable  of  acting  energetically,  though  probably  somewhat  more 
slowly  than  the  solution. 

1.  Effects  on  the  System. 

The  effects  of  nux  vomica,  in  small  doses,  are  those  of  a  bitter  tonic, 
roinbiin'd,  when  the  quantity  taken  is  sufficient  to  affect  the  system,  with 
an  influence  on  the  nervous  functions  which  is  quite  peculiar,  and  which, 
in  its  higher  degrees,  is  so  violent  and  dangerous  as  to  give  the  medicine 
a  place  among  the  poisons. 

From  very  small  doses  no  effects  are  at  first  experienced ;  but,  if  re- 
peated every  six  or  eight  hours,  they  will  be  found  in  the  course  of  a 
day  or  two  to  increase  the  appetite,  hasten  the  digestion,  and  act  gen- 


816  GENERAL    STIMULANTS.  [PART  II. 

erally  the  part  of  a  simple  tonic;  and,  by  carefully  managing  the  dose, 
diminishing  it,  or  suspending  the  medicine  for  a  time  when  the  slightest 
sign  of  its  peculiar  action  upon  the  nervous  system  is  evinced,  the  effects 
may  be  confined  within  the  tonic  limits.  Often,  however,  there  will  be 
some  increase  of  the  urinary  secretion,  with  more  frequent  micturition  ; 
and  it  is  said  that  the  medicine  sometimes  proves  diaphoretic  or  laxa- 
tive. In  large  doses,  its  operation  upon  the  stomach  becomes  irritant, 
causing  loss  of  appetite,  epigastric  uneasiness,  cardialgia,  and  sometimes 
vomiting  or  purging. 

When  it  is  taken  more  largely  than  requisite  for  the  tonic  effect,  an 
entirely  new  series  of  phenomena  are  developed.  The  first  observable 
effect  in  this  series  is  generally  a  feeling  of  stiffness  or  stricture  in  the 
muscles  of  the  jaw,  or  at  the  back  of  the  neck,  or  of  weight  or  weak- 
ness with  trembling  of  the  limbs.  Some  resistance  is  apparently  felt  in 
opening  the  mouth  widely;  there  is  difficulty  in  taking  a  full  inspiration; 
and  after  a  time  the  feeling  of  stiffness  may  be  experienced  more  or  less 
*  elsewhere,  upon  any  attempt  at  movement.  Along  with  this  symptom, 
there  is  an  increased  sensitiveness  to  external  impressions,  especially  of 
the  touch ;  so  that  a  slight  tap  upon  the  skin  will  produce  sudden  and 
involuntary  startings  of  the  muscles ;  and  twitchings  or  catching  move- 
ments in  the  limbs  are  not  unfrequcntly  the  first  symptom  which  attracts 
particular  notice.  If,  under  these  circumstances,  the  individual  try  to 
walk,  there  will  be  a  sense  of  tottering  or  staggering,  not  from  vertigi- 
nous feelings,  but  as  if  from  want  of  power  to  regulate  the  action  of  the 
muscles.  After  some  days  there  is  often  a  feeling  of  formication,  ting- 
ling, or  itching  on  different  parts  of  the  surface,  such  as  is  commonly 
felt  when  the  foot  is  said  to  be  asleep.  Sometimes  this  sensation  is 
among  the  earliest  phenomena ;  and  it  is  occasionally  so  severe  as  to 
constitute  the  most  prominent  symptom.  An  eruption  upon  the  skin 
has  been  noticed  in  some  instances. 

Under  a  somewhat  more  energetic  influence  of  the  medicine,  the  spas- 
modic startings  become  more  frequent  and  severe  ;  horripilations  and 
shiverings,  with  darting  sensations  like  electric  shocks,  are  not  unfrc- 
quently  experienced ;  and  the  muscular  stiffness  increases  and  extends, 
so  that  the  patient  complains  not  only  of  rigidity  of  the  limbs,  but  also 
of  tightness  about  his  throat,  difficulty  of  deglutition,  stricture  of  the 
chest  and  abdomen,  and  even  involuntary  erections  of  tin:  penis;  those 
muscles  now  becoming  affected  which  belong  but  partially  to  the  volun- 
tary class. 

With  the  powerful  effects  upon  the  nervous  system  above  referred  to, 
the  circulation  is  little  affected;  the  pulse  being  often  slo\v  and  calm; 
and,  when  accelerated,  as  sometimes  happens,  it  is  so,  in  all  probability, 
secondarily.  The  brain,  too,  i.s usually  undisturbed  ;  (lie  mental  functions 
being  quite  sound  ;  though  occasionally  there  may  be  temporary  attacks 


CHAP.  I.]  SPINAL    STIMULANTS. NUX    VOMICA.  817 

of  pain  in  the  head,  vertigo,  tinnitus  aurium.  contraction  or  dilatation  of 
the  pupils,  and  sparkling  or  dimness  of  vision.  A  tendency  to  drowsi- 
ness or  stupor  has  also  been  observed  in  some  rare  instances.* 

Poisonous  Effects.  Beyond  the  condition  above  described,  the  effects 
of  the  medicine  become  poisonous.     The  spasms  are  more  frequent,  ex- 
tensive, and  severe,  sometimes  involving  almost  the  whole  frame,  and 
are  attended  with  a  tetanic  rigidity  which  is  probably  the  most  charac- 
teristic symptom.     The  attacks  come  on  suddenly,  like  electric  shocks, 
last  usually  from  a  quarter  of  a  minute  to  two  or  three  minutes,  and, 
after  a  longer  or  shorter  interval,  seldom  exceeding  ten  minutes,  recur 
with  increased  violence,  and  at  last,  if  not  relieved,  with  fatal  effect.     If 
the  patient  is  seized  with  them  when  attempting  to  walk,  he  staggers 
and  falls.     During  the    spasms,  the  muscles  affected  feel   hard  like  a 
board,  and  different  parts  of  the  body  are  drawn  fixedly  into  various  ab- 
normal positions,  from  which  they  cannot  be  removed.     Thus,  the  head 
may  be  thrown  backward,  the  jaws  firmly  closed,  the  face  distorted,  the 
arms  or  lower  limbs  extended  outward,  the  hands  clenched,   the  toes 
flexed,  and  the  trunk  bent  backward,  forward,  or  to  either  side,  or  stifly 
erect.     The  respiratory  muscles  become  involved,  and  the  breathing  is 
hurried  or  imperfect,  and  temporarily  suspended,  with  a  purple  hue  of 
the  face,  lips,  and  extremities,  coolness  of  the  surface,  and  a  pulse  which 
is  sometimes  slow,  sometimes  quickened,  but  always  feeble,  and  occa- 
sionally almost  or  quite  imperceptible.     In  some  instances,  there  are  in- 
voluntary discharges  of  urine  or  feces.     The  attacks  are  often  brought 
on  by  very  slight  causes  affecting  the  surface,  as  by  a  fresh  contact  of 
the  bedclothes,  or  a  gentle  touch  with  the  finger.     As  in  tetanus  and 
hydrophobia,  an  attempt  to  swallow,  or  even  the  idea  of  swallowing, 
will  sometimes  induce  spasms  of  the  respiratory  muscles  f     The  spasms 
are  often  attended  with  a  violent  shivering  or  tremulous  movement 
through  the  body;  and  the  muscles  may  be  felt  vibrating  as  it  were 
under  the  hand.     Sometimes  the  patient,  when  asked  if  he  has  suffered 
pain  in  the  spasms,  answers  in  the  negative;  in  other  instances,  they  are 
more  or  less  painful,  and  in  others,  again,  extremely  so.     In  the  inter- 
vals, there  is  often  a  feeling  of  trepidation,  alarm,  or  anxiety  strongly 
expressed  on  the  countenance  ;  the  stomach  is  sometimes  nauseated ;  the 
pulse  is  feeble  and  often  agitated,  or  even  fluttering ;  and  the  patient 
complains  of  thirst,  sweats  profusely,  and,  after  a  severe  attack,  has  a 
feeling  of  fatigue  and  exhaustion.     At  length,  in  one  of  the  spasmodic 
attacks,  respiration  is  quite  arrested,  the  pulse  ceases  to  beat,  and  the 

*  See  remarks  by  W.  G.  Thomas,  M.D.,  in  the  3r.  Jersey  Med.  and  Surg.  Reporter, 
Jan.  1857,  p.  3. 

f  See  the  account  of  a  case  by  Mr.  Hennel  in  the  Lond.  Med.  Times  and  Gaz., 
April,  1855,  p.  414. 

VOL.  i. — 52 


818  GENERAL    STIMULANTS.  [PART  II. 

patient  dies  with  asphyxia.  The  mind  is  usually  clear  throughout  the 
case,  until  near  the  fatal  issue,  which  is  preceded  for  a  short  period  by 
insensibility  and  unconsciousness.  When  the  poisoning  has  resulted 
from  one  large  dose,  the  characteristic  symptoms  make  their  appear- 
ance from  ten  minutes  to  half  an  hour  after  it  has  been  taken,  and  death 
generally  occurs  very  quickly,  sometimes  in  the  course  of  a  few  minutes, 
after  the  third,  fourth,  or  fifth  paroxysm.  One  instance  is  on  record,  in 
which  death  followed  in  fourteen  minutes  after  the  poison  was  swallowed  ; 
and  from  half  an  hour  to  an  hour  and  a  half  is  not  an  uncommon  period. 
Under  other  circumstances,  the  poisonous  phenomena  ID  ay  be  developed 
much  later,  and  the  termination  be  much  longer  postponed.  When  the 
case  is  to  end  favourably,  which  not  unfrequently  happens,  there  is  a 
gradual  subsidence  of  the  violent  symptoms;  but  more  or  less  rigidity 
may  linger  for  a  day  or  longer;  and  soreness  of  the  muscles,  as  if  they 
had  been  bruised,  is  felt  after  other  symptoms  have  ceased. 

After  death,  the  muscles  often  remain  in  a  state  of  tetanic  rigidity,  and 
there  is  frequently  more  or  less  blueness  or  lividity  about  the  face,  hands. 
and  feet.  Internally  the  ordinary  signs  of  venous  congestion  are  pre- 
sented, as  of  persons  dying  from  asphyxia.  This  is  especially  observa- 
ble in  the  lungs ;  and  the  bronchial  mucous  membrane,  as  well  as  that  of 
the  stomach  and  bowels,  sometimes  exhibits  hemorrhagic  spots  or 
patches.  The  heart  has  in  some  instances  been  found  firmly  contracted, 
in  others  quite  relaxed,  and  either  empty,  or  distended  with  blood.  The 
blood  itself  has  by  some  examiners  been  seen  coagulated;  while  In 
others  no  clot  could  be  anywhere  discovered.  Congestion  of  the  brain 
and  its  vessels,  redness  and  increased  vascularity  of  the  membranes  of 
the  spinal  cord,  patches  of  extravasated  blood  in  these  membranes,  and 
effusion  into  the  spinal  sheath  have  been  noticed:  and  both  the  brain 
and  the  spinal  marrow  are  said  to  have  been  found  in  a  softened  state ; 
but  nothing  has  yet  been  discovered  by  post-mortem  examination  which 
can  throw  a  very  clear  light  on  the  action  of  the  poison.  Though  evi- 
dences of  inflammation  of  the  stomach  are  stated  to  have  been  exhibited 
in  several  cases,  yet  in  the  great  majority  nothing  of  the  kind  has  been 
noticed ;  and  the  poisonous  effects  must,  therefore,  be  quite  independent 
of  gastric  irritation.  The  bulk  of  the  spleen  has  been  observed  to  be 
strikingly  diminished,  after  death  from  strychnia  in  the  lower  animals. 
Strychnia  may  usually  be  detected  in  the  stomach  and  bowels  if  not 
evacuated  or  absorbed  during  life,  in  the  urine  if  it  has  had  time  to  pass 
off  by  the  kidneys,  in  the  blood,  and  in  some  of  the  tissues,  especially  in 
the  liver;  but  the  absence  of  any  discoverable  chemical  evidences  of 
strychnia  in  these  positions,  though  a  presumption,  should  not  be  con- 
sidered as  a  positive  proof  that  the  death  did  not  result  from  the  poison 

Quantity  requisite  for  Poisoning.   The  quantity  of  nux  vomica  or  of 
ita  preparations  requisite  to  destroy  life  is  very  uncertain.     The  suscep- 


CHAP.  I.]  SPINAL    STIMULANTS. — NUX   VOMICA.  819 

tibility  to  its  influence  is  extremely  different  in  different  persons.  A  case 
is  on  record  in  which  fifteen  grains  of  the  powder  are  stated  to  have 
proved  fatal;  another  in  which  the  same  effect  was  produced  by  thirty 
grains  in  two  dose*  ;  and  in  two  others,  which  occurred  in  1839  in  Lon- 
don, death  resulted  from  fifty  grains  (Taylor  on  Poisons,  p.  775)  ;  yet 
the  last-mentioned  quantity  has  been  repeatedly  administered  without 
inconvenience;  and,  as  a  general  rule,  the  poisonous  dose  would  proba- 
bly much  exceed  a  drachm.  Recoveries  have  frequently  taken  place, 
under  proper  treatment,  after  quantities  had  been  swallowed  varying 
from  half  an  ounce  to  an  ounce.  As  the  bean  of  St.  Ignatius  contains 
probably  three  times  as  much  strychnia  as  mix  vomica,  it  may  be  con- 
sidered as  in  an  equal  degree  more  poisonous.  The  extract  of  nux 
.vomica  is  said  to  have  proved  fatal  in  the  quantity  of  three  grains  (Ibid.)  ; 
and  as  M.  Recluz  obtained  from  the  seeds  an  average  product  of  about 
one-twelfth  of  extract,  this  would  be  equivalent  to  somewhat  more  than 
half  a  drachm  of  the  powder.  The  .smallest  quantity  of  strychnia,  known 
to  have  caused  death  in  an  adult,  is  half  a  grain ;  which  is  much  larger 
relatively  than  the  smallest  fatal  doses  above  mentioned  of  the  powder 
and  extract. 

Treatment  of  Poisoning.  The  most  important  point  of  treatment  in 
poisoning  from  nux  vomica,  bean  of  St.  Ignatius,  or  any  of  their  prepa- 
rations, is  to  empty  the  stomach  as  speedily  and  as  thoroughly  as  possi- 
ble. An  active  and  prompt  emetic  should  be  administered  immediately. 
Sulphate  of  zinc,  tartar  emetic,  or  ipecacuanha  may  be  given  severally 
or  combined  ;  and  their  influence  may  be  aided,  if  necessary,  by  pow- 
dered mustard.  During  the  spasmodic  paroxysms,  it  is  usually  impos- 
sible for  the  patient  to  swallow,  and  the  jaws  are  often  so  firmly  closed 
that  medicines  cannot  be  readily  introduced  into  the  mouth  ;  but  relaxa- 
tion in  general  takes  place  in  a  short  time,  and  the  opportunity  thus 
afforded  should  be  instantly  seized  for  the  exhibition  of  the  emetic. 
Should  it  be  impracticable  to  introduce  the  medicine  into  the  mouth,  it 
might  possibly  be  injected  through  a  catheter  or  other  small  tube  inserted 
into  one  of  the  nostrils.  When  the  stomach  pump  can  be  employed,  it 
should  be  brought  in  aid  of  the  emetic,  so  as  thoroughly  to  wash  out  the 
poison  ;  but  it  should  not  be  relied  on  to  the  exclusion  of  the  latter  rem- 
edy, which  has  often  proved  efficient.  I  have  been  informed  of  a  case  in 
which,  after  the  strongest  emetics  had  been  taken  without  effect,  a  cur- 
rent of  electricity  directed  through  the  body  at  the  epigastrium  wa.- 
quickly  followed  by  vomiting,  probably  in  consequence  of  the  suscepti- 
bility of  the  stomach  being  aroused  by  the  measure.  The  patient  wa> 
saved.  Unfortunately  there  is  no  antidote  to  strychnia  which  has  thus 
far  been  sufficiently  tried  to  be  confidently  relied  on  ;  yet  the  experiments 
of  Dr.  Garrod  with  animal  charcoal  would  seem  to  prove,  that  the  power 
which  this  substance  has  of  absorbing  the  vegetable  alkaloids,  and  even 


GENERAL    STIMULANTS.  [PART  II. 

of  separating  them  from  their  combinations,  may  be  made  available  in 
obviating  the  poisonous  effects  of  strychnia,  if  brought  into  contact  with 
it  in  the  stomach  before  enough  has  been  absorbed  to  cause  death.  In 
these  experiments  of  Dr.  Garrod,  when  strychnia  previously  mixed  with 
animal  charcoal  was  administered  to  animals,  they  were  not  in  the  least 
affected  by  it ;  and  a  case  is  recorded  by  Mr.  W.  Chippendale,  in  which, 
an  hour  after  four  grains  of  strychnia  had  been  taken,  three  or  four  ounces 
of  animal  charcoal,  mixed  with  water,  were  injected  by  means  of  the 
stomach-pump,  and  the  stomach  thoroughly  washed  out,  with  the  effect 
of  saving  the  life  of  the  patient,  which  appeared  to  be  in  imminent 
danger.  (Lond.  Med.  Times  and  Gaz.,  April,  1855,  p.  423.)  Other  sub- 
stances have  been  proposed  as  antidotes,  on  the  ground  that  they  render 
strychnia  insoluble;  but  none  has  sufficient  experience  in  its  favour  to, 
justify  a  reliance  on  it.  For  an  account  of  them  the  reader  is  referred  to 
the  U.  S.  Dispensatory  (12th  ed.,  p.  1356.)  Among  them  is  tannic  acid, 
which  Prof.  Kurzak  infers,  from  experiments  on  dogs,  to  be  an  excellent 
antidote,  requiring,  however,  to  be  given  in  very  large  proportion,  at 
least  from  20  to  25  times  as  much  as  of  the  poison  taken.  ( Am.  J.  of 
Med.  Sci.,  Jan.  1863,  p.  258.)  Perhaps  the  best  emetic  would  be  sul- 
phate of  zinc  or  tartar  emetic,  in  connection  with  ipecacuanha. 

But  the  evacuation  of  the  stomach  will  not  obviate  the  effects  of  the 
portion  of  the  poison  absorbed.  For  this  purpose  medicines  must  be 
resorted  to  calculated  to  diminish  irritation  of  the  spinal  nervous  centres. 
Opium,  conium,  camphor,  chloroform,  ether,  and  alcohol  have  been  em- 
ployed, and  each  with  asserted  advantage.  Considerable  doses  are 
required;  as  the  susceptibility  to  the  narcotic  influence  seems  to  be  di- 
minished, as  in  tetanus,  by  the  violence  of  the  nervous  derangement. 
One  of  these  medicines,  or  some  combination  of  them  should  be  exhib- 
ited after  the  stomach  has  been  emptied;  and  they  may  even  be  exhib- 
ited by  the  rectum  during  the  use  of  emetic  measures,  with  the  exception 
perhaps  of  opium,  which  might  tend  to  retard  or  prevent  vomiting.  In 
the  Boston  Medical  and  Surgical  Journal  (li.  476),  Dr.  J.  II.  Tewks- 
bury,  of  Portland,  Maine,  records  two  cases  in  which  camphor  appears 
to  have  been  employed  successfully  without  other  measures,  two  flui- 
drachms  of  the  saturated  tincture  having  been  given  by  the  stomach  in 
one  ease;  while  in  the  other,  in  which  the  patient  could  not  swallow,  the 
same  preparation  was  injected  into  the  rectum,  and  the  patient  at  the 
same  lime  immersed  in  a  warm  camphor  bath.  It  is  probable,  however, 
that,  in  these  cases,  the  camphor  merely  moderated  symptoms  which 
would  not  have  proved  fatal ;  for  Dr.  J.  E.  Thompson,  in  repeated  ex- 
periments with  dogs,  found  that  the  tincture  of  camphor  was  quite  una- 
vailing to  obviate  the  fatal  effects  of  the  poison.  (Ibid.,  liii.  163.)  Sub- 
sequently, however,  Prof.  Rochester,  of  Buffalo,  N.  Y.,  has  reported  two 
successful  cases,  in  which  he  ascribes  the  result  to  the  camphor  used. 


CHAP.  I.]  SPINAL   STIMULANTS. — NUX   VOMICA.  821 

(Buffalo  Med.  Journ.,  March,  185G.)  In  the  Medical  and  Surgical  Re- 
porter (Nov.  18,  1865,  p.  339),  a  case  is  recorded  in  which  severe  poison- 
ing from  strychnia  yielded  to  half  a  pint  of  strong  gin,  exhibited  in  di- 
vided, but  quickly  repeated  doses.  Dr.  Dresbach,  of  Tiffin,  Ohio,  relates 
a  case  in  the  Western  Lancet  for  February,  1850,  in  which  the  most 
alarming  symptoms,  caused  by  swallowing  three  grains  of  strychnia,  were 
completely  relieved  in  fifteen  minutes  by  two  drachms  of  chloroform  ad- 
ministered by  the  mouth  Within  a  few  years,  inhalation  of  chloroform 
has  been  much  used  in  poisoning  by  this  alkaloid,  and  with  encouraging 
success;  many  cases  having  recovered  under  its  use.  It  very  much  re- 
lieves the  pain  and  spasm,  and  to  a  considerable  extent  counteracts  the 
effects  of  the  poison,  often  preventing  a  fatal  issue,  until  time  has  been 
allowed  for  the  elimination  of  the  strychnia  by  the  kidneys.  It  should 
never  be  permitted  to  supersede  the  evacuation  of  the  stomach  by 
emetics  or  the  stomach-pump,  or  the  use  of  any  substance  which  may  be 
supposed  to  act  as  a  proper  antidote  to  the  strychnia.  The  inhalation 
of  ether,  however,  would  be  preferable,  if  found  to  produce  the  same 
effect,  as  it  is  not  liable,  like  chloroform,  to  act  as  a  fatal  poison.  To- 
bacco has  also  been  employed  with  supposed  success.  The  infusion 
should  be  given  by  enema.  One  instance,  however,  is  recorded,  in  which 
it  was  exhibited  by  the  stomach,  so  as  to  produce  excessive  vomiting,  and 
with  complete  success.  (Brailh waiters  Retrospect,  No.  46,  p.  185.)  M. 
Cl.  Bernard  recommends  the  use  of  woorari,  which,  besides  contributing 
to  relieve  the  spasms,  favours  the  elimination  of  the  poison  by  its  stimu- 
lant influence  on  the  various  emunctories,  especially  the  kidneys.  (Arch. 
Gen.,  A  out,  1865,  p.  203.)  Aconite  also  is  thought  to  be  antagonistic 
to  strychnia,  and  has  acted  successfully  as  an  antidote  in  experiments  on 
dogs.  (Dr.  Woaks,  British  Med.  Journ.,  Oct.  26,  1861,  quoted  in  Am. 
J.  of  Ned.  Sci.,  Jan.  1862,  p.  276.) 

2.  Mode  of  Operating. 

Nux  vomica  and  its  preparations  are  locally  somewhat  irritant ;  but 
not  powerfully  so. 

There  can  be  no  doubt  that  the  active  matter  is  absorbed,  and  oper- 
ates through  the  circulation.  This  is  proved  by  an  experiment  of  Ver- 
nierc,  who  found  that,  when  a  ligature  was  applied  around  the  leg  of  an 
animal  so  as  to  check  the  flow  of  blood  in  the  veins,  but  not  in  the  ar- 
teries, and  extract  of  nux  vomica  was  introduced  into  a  wound  in  the  foot, 
blood  taken  from  the  vein  proceeding  from  the  wound  towards  the  liga- 
ture, and  injected  into  the  veins  of  another  animal,  caused  the  death  of 
the  latter  with  the  characteristic  symptoms  of  poisoning  by  this  drug. 
The  same  inference  may  be  drawn  from  the  facts,  that  strychnia  pro- 
duces its  peculiar  constitutional  effects,  to  whatever  part  capable  of  ab- 
sorption it  may  be  applied,  and  that  the  rapidity  with  which  these  eflVct> 
occur  is  proportionate  to  the  facility  of  absorption  in  the  part.  Thus,  in 


822  GENERAL   STIMULANTS.  [PART  II. 

contact  with  the  lungs,  it  operates  more  quickly  than  when  swallowed, 
and  in  the  stomach  more  quickly  than  when  applied  to  the  skin.  Dr. 
Christison  killed  a  dog  in  two  minutes  by  the  injection  of  one-sixth  of 
a  grain  in  alcoholic  solution  into  the  cavity  of  the  chest.  Inserted  into 
a  wound  it  operates  still  more  quickly;  and,  when  injected  into  the 
veins,  its  effects  are  almost  instantaneous.  In  all  these  instances,  too, 
the  effects  are  identical ;  proving  that,  in  all,  the  blood  is  the  vehicle  by 
which  the  poison  is  conveyed  to  the  part  affected.  Besides,  Dr.  A.  I. 
Spence,  of  Edinburgh,  has  proved  by  experiment  that  strychnia  is  wholly 
unable  to  act  by  means  simply  of  nervous  communication.  (Ed.  Med. 
Journ.,  July,  1866,  p.  45.) 

The  medicine,  when  absorbed,  has  not  been  found  to  produce  any 
change  in  the  blood  itself;  and  the  phenomena  of  its  action  evince  that 
its  influence  is  exerted  mainly  at  least  upon  the  solid  tissues.  Upon 
these  it  seems  to  operate,  in  very  small  doses,  as  a  moderate  stimulus  of 
the  tonic  character,  closely  resembling  the  simple  bitters  in  the  modifica- 
tion of  the  functions  it  induces.  But  it  may  be  inferred,  from  its  effects 
in  larger  doses,  that  even  this  tonic  influence  is  exerted  specially  upon 
the  nervous  centres ;  and  important  therapeutic  inferences  may  be  de- 
duced from  this  view  of  its  action. 

When  given  so  as  to  produce  the  peculiar  effects  above  enumerated, 
all  the  phenomena  go  to  show  that  it  is  mainly  upon  the  nervous  centres 
of  the  spinal  marrow,  including  the  medulla  oblongata,  that  the  medicine 
operates.  The  functions  of  the  brain  are  often  wholly  unimpaired,  even 
when  the  spasms  are  frightfully  violent ;  and  the  division  of  the  spinal 
marrow  near  the  occiput,  or  even  the  decapitation  of  the  animal,  does  not 
prevent  them.  That  it  is  not  upon  the  muscles  directly  that  the  medicine 
acts  may  be  inferred  from  their  simultaneous  contraction,  and  simultane- 
ous relaxation,  showing  that  the  influence  modifying  their  condition  flows 
from  a  common  source;  and  this  can  only  be  in  the  nervous  centres 
which  preside  over  them.  Besides,  Matteucci  observed  that,  after  death 
from  strychnia,  the  muscles  could  be  made  to  contract  by  the  direct  ap- 
plication to  them  of  an  electric  current,  but  refused  to  respond  to  the 
same  stimulus  applied  to  their  nerves;  the  latter  having  been  exhausted 
of  their  excitability  by  the  stimulus  of  the  poison,  while  that  of  the 
former  remained  unimpaired.  Another  fact  confirmatory  of  the  special 
spinal  influence  of  nux  vomica,  is  the  almost  exact  resemblance  of  its 
poisonous  phenomena  to  those  of  tetanus,  which  i-  generally  admitted 
to  have  its  essential  seat  in  the  spinal  marrow. 

ilui  what  is  the  nature  of  the  action  thus  shown' to  have  its  seat  in 
the  medulla  spinalis?  It  appears  to  me  oliviously  to  be  merely  an  ex- 
•.  c-  excitement,  or,  in  other  words,  irritation  of  the  nervous  centres 
of  this  structure,  extended  no  doubt  thence  to  the  nerves  proceeding  firott 
them.  The  first  effect  is  to  exalt  the  sensitiveness  of  these  centres. 
Hence,  even  before  the  spasmodic  movements  commence  spontaneously, 


CHAP.  I.]  SPINAL    STIMULANTS. — NUX   VOMICA.  823 

they  may  often  be  induced  by  the  slightest  impressions  upon  the  surface, 
such  as  would  ordinarily  produce  no  effect.  An  increase  of  the  stim- 
ulus irritates  the  centres  into  excessive  action,  without  the  aid  of  any 
additional  exciting  cause ;  and  the  characteristic  spasms  now  occur  with 
a  violence  proportioned  to  the  central  irritation.  But  in  this,  as  in  all 
other  cases  of  over-excitement,  the  excitability  itself  is  more  or  less 
rapidly  exhausted;  and,  if  death  be  not  produced  by  the  interference  of 
the  spasms  with  some  vital  function,  there  follows  a  condition  of  greater 
or  less  prostration  of  the  spinal  power,  and  consequently  of  depression 
in  the  functions  dependent  upon  it.  There  is  reason  to  believe  that 
death  is  not  always  induced  by  the  rigid  immovability  of  the  respiratory 
muscles,  rendering  breathing  impossible,  and  thereby  inducing  asphyxia; 
for  it  has  been  found  that  respiration,  artificially  sustained,  does  not  pre- 
vent the  fatal  consequences  of  poisoning  with  nux  vomica.  The  exhaus- 
tion of  the  whole  medulla  oblongata  by  its  over- excitement  will  explain 
the  result.  It  has  been  conjectured  that  among  the  causes  of  death  may 
be  a  direct  influence  of  the  poison  on  the  heart,  either  causing  a  spas- 
modic contraction  of  that  organ,  or  exhausting  its  excitability  through 
previous  stimulation.  In  support  of  this  opinion,  an  experiment  of  M. 
Briquet  may  be  adduced,  who,  having  injected  extract  of  nux  vomica  into 
the  veins  of  a  dog,  observed  the  first  effect  to  be  considerably  to  elevate 
the  haemadynameter  of  Poiseuille,  which  subsequently  fell  lower  and 
lower  until  death,  indicating  first  an  augmentation  of  the  heart's  force, 
and  afterwards  a  reduction  with  exhaustion  of  its  excitability.  After 
death,  the  heart  could  not  be  excited  to  contraction.  (Briquet,  Trait. 
Therap.  du  Quinquina,  p.  87.)  It  may  be  that  there  is  a  conjoint  ex- 
citant action  upon  the  respiratory  nervous  centres  and  the  heart,  fol- 
lowed by  a  conjoint  failure  of  power  in  both.  It  has  been  supposed  that 
the  sympathetic  nervous  centres  are  affected  in  like  manner  with  those 
of  the  spinal  marrow ;  but  we  have  no  sufficient  evidence  upon  this  point. 
That  the  nerves  conveying  the  spinal  influence  to  the  muscles  participate 
in  the  irritation  and  subsequent  depression  or  exhaustion  of  the  centres, 
would  seem  to  be  shown  by  the  experiment  of  Matteucci  before  referred 
to,  which  proves  that  at  least  they  lose  the  susceptibility  to  galvanic 
influence,  while  the  muscles  themselves  remain  sensible  to  it. 

It  is  probable  that  the  influence  of  nux  vomica  extends  to  the  whole 
spinal  marrow,  including  the  medulla  oblongata;  for  there  is  no  muscle 
in  the  body,  supplied  from  that  source,  which  is  not  liable  to  be  thrown 
by  it  into  spasm. 

Some  suppose  that  the  medicine  acts  on  the  cerebellum;  and  it  has 
been  noticed,  by  several  observers,  that  this  structure  occasionally  ex- 
hibits post-mortem  evidences  of  having  suffered  in  cases  of  poisoning. 
With  those  who  believe  that  the  cerebellum  is  the  special  seat  of  the 
sexual  propensities,  the  excitation  of  the  genital  organs  which  has  been 


824  GENERAL   STIMULANTS.  [PART  II. 

occasionally  noticed  under  the  influence  of  nux  vomica,  will  afford  further 
proof  of  the  correctness  of  this  supposition. 

Though  the  cerebral  lobes  are  seldom  affected  by  this  agent,  and  per- 
hup-i  never  by  a  direct  influence,  yet  thesensorial  region  at  its  base  often 
participates  in  the  irritation,  as  shown  by  the  frequent  itching  and  tin- 
gling sensations  experienced,  and  the  occasional  occurrence  of  irregu- 
larities of  sight  and  hearing,  contraction  or  dilatation  of  the  pupil,  etc. 
These  may  be  owing  either  to  a  direct  action  of  the  medicine,  or,  what 
is  quite  as  probable,  to  a  radiation  of  the  original  and  direct  spinal  irri- 
tation from  the  medulla  oblongata  to  the  contiguous  parts  of  the  cerebrum. 

3.  Therapeutic  Application. 

Nux  vomica  has  long  been  used  as  a  medicine  in  India,  and  was  de- 
scribed by  the  early  Arabian  writers,  by  whom  it  was  made  known  to 
modern  Europe.  The  name  is  not  appropriate:  for  in  ordinary  doses  the 
medicine  is  not  apt  to  irritate  the  stomach,  and,  when  given  largely,  sel- 
dom vomits,  and  could  never  be  given  with  propriety  in  reference  to  an 
» -nit 'tic  effect. 

The  bean  of  St.  Ignatius,  though  supposed  by  some  to  be  the  nux 
vomica  of  Serapion,  was  probably  first  made  known  in  Europe  after  the 
discovery  and  settlement  of  the  Philippine  Islands,  where  the  tree  pro- 
ducing it  is  indigenous,  and  the  seeds  were  used  as  a  medicine  by  the 
natives.  It  was  from  their  supposed  value  in  the  treatment  of  intermit- 
tent fever,  and  various  other  complaints,  that  the  Jesuit  missionaries  to 
those  islands  were  induced  to  honour  the  medicine  with  the  name  of  the 
founder  of  their  order. 

Both  nux  vomica  and  the  bean  of  St.  Ignatius  have,  at  various  times, 
been  used  in  numerous  complaints,  but,  it  must  be  confessed,  rather  em- 
pirically. Intermittent  fever,  the  plague,  gout,  rheumatism,  cholera, 
diarrhoea,  dysentery,  colic,  constipation,  worms  in  the  bowels,  the  pois- 
onous effects  of  snake-bites,  scorbutic  ulcers,  insanity,  hypochondriasis, 
hysteria,  epilepsy,  chorea,  hydrophobia,  neuralgia,  hemicrauia,  palsy,  and 
impotence  are  among  the  affections  in  which  one  or  the  other,  or  both 
of  these  medicines  have  been  recommended.  Better  acquainted  than 
our  predecessors  with  their  mode  of  operating,  we  can  now  prescribe 
them  more  intelligently,  and  with  more  accurate  discrimination. 

It  will  be  remembered  that  the  medicine  is  in  Hnall  doses  simply  tonic, 
though  probably  with  a  special  ti-ndency  to  the  nervous  centres,  and, 
more  hirgely  given,  acts  with  great  energy  upon  the  spinal  marrow,  and 
to  a  certain  extent  also  on  the  buse  of  tin-  brain,  stimulating  both  the 
-msitive  and  motor  functions.  Hence  arise  two  distinct  indications  for 
its  use,  one  as  a  tonic  in  local  or  gem-nil  debility,  particularly  when  the 
nervous  functions  are  involved:  and  the  other  as  a  dirrct  siiiimlant  of 
the  nervous  centres  in  cases  of  loss  of  sensation  or  the  power  of  motion. 


CHAP.  I.]  SPINAL    STIMULANTS. — NUX   VOMICA.  825 

or  of  both,  in  other  words,  in  paralytic  affections.      Under  these  two 
heads  will  be  arranged  the  practical  remarks  which  are  to  follow. 

1.  Use  as  a  Tonic.  As  a  mere  stimulant  to  the  stomach,  in  ordinary 
dyspepsia,  though  probably  equally  efficient  with  the  simple  bitters,  nux 
vomica  has  no  advantage  over  them,  while  any  accidental  abuse  of  it 
would  be  attended  with  inconveniences  to  which  they  are  not  liable.  Hence 
they  should,  as  a  general  rule,  be  preferably  employed  in  this  complaint. 
But,  when  there  is  reason  to  think  that,  from  want  of  due  nervous  influ- 
ence, the  muscular  coat  of  the  stomach  is  unable  to  perform  efficiently  its 
share  in  the  process  of  digestion,  nux  vomica  may  be  resorted  to  with 
the  hope  of  special  benefit.  In  nervous  disorder  of  the  gastric  sensibil- 
ity, connected  with  debility  of  stomach,  it  is  decidedly  indicated,  and 
has  been  found  highly  beneficial.  Hence  its  use  in  pyrosis,  and  that 
most  painful  affection  denominated  gastralgia  or  gastrodynia. 

Upon  the  same  principles  exactly  it  may  be  employed  in  bowel  com- 
plaints.    In  constipation  dependent  on  torpor  of  the  peristaltic  muscles, 
it  proves  often  of  great  service,  especially  in  connection  with  tonic  laxa- 
tives, such  as  rhubarb  or  aloes.     In  obstinate  flatulence  from  the  same 
cause,  it  would  probably  be  among  our  most  efficient  remedies.  We  now 
and  then  meet  with  cases  of  excessive  accumulation  of  flatus,  amounting 
to  tympanites,   especially  in  debilitated  states  of  the  system,  and  in 
nervous  persons,  and  wholly  independent  of  any  discoverable  lesion, 
which  resist  all  ordinary  remedies.     Some  of  these  may  depend  on  a 
certain  laxity  or  torpor  of  the  muscular  coat,  and  would  be  very  likely 
to  yield  to  nux  vomica.     When  the  flatulence  is  attended  with  copious 
discharge  of  air,  whether  from  the  stomach  or  bowels,  it  may  possibly 
arise  from  an  extrication  of  gas  from  the  mucous  tissue  itself,  owing  to 
insufficient  innervation  ;   and  here  too  the  remedy  is  indicated.     In  en- 
teralgia  or  neuralgic  pains  of  the  bowels,  connected  as  this  often  is  with 
debility  of  the  parts,  nux  vomica  has  been  used  advantageously ;  as  also 
in  colica  piclonum,  and  in  pure  nervous  colic  independent  of  the  poison 
of  lead.     The  remedy  has  been  recommended  in  diarrhoea  and  in  dys- 
entery, having  been  employed  in  the  latter  complaint  particularly  by  the 
German  physicians,  some  of  whom  speak  highly  in  its  favour.      These 
complaints  are  sometimes  connected  with  a  relaxation  of  the  bowels,  in 
which  a  defect  of  innervation  is  probably  concerned,  permitting  an  excess 
of  secretion  from  the  flaccid  vessels,  or  deranging  the  due  relation  be- 
tween the  contents  of  the  bowels  and  the  expulsive  power.     In  such 
cases  tin-  medicine  may  sometimes  prove  useful;  but,  as  a  general  rule, 
little  good  can  be  expected  from  it  in  these  complaints,  and  it  would 
probably  often  do  harm  by  adding  to  the  existing  irritation  of  the  mu- 
cous membrane. 

The  medicine  has  been  little  used  in  complaints  of  the  chest;  but  M. 
Homolle  has  recently  recommended  it  in  the  asthmatic  paroxysm,  and 


826  GENERAL    STIMULANTS.  [PART  II. 

in  suffocative  catarrh,  believing  that,  in  both  these  affections,  the  diffi- 
culty lies  in  a  want  of  proper  contractility  of  the  bronchial  tubes  and 
perhaps  the  air-vesicles,  and  that  mix  vomica  operates  by  restoring-  this 
contractility.  (Ann.  de  Therap.  par  Bouchardat,  1854,  p.  18.)  Though 
not  disposed  to  admit  the  pathological  view  of  M.  Homolle,  I  am  quite 
willing  to  hope  that  the  therapeutic  advantages  claimed  for  the  remedy 
may  prove  well  founded  on  future  trial.  If  nux  vomica  does  good  in 
these  complaints,  it  is  probably,  in  asthma,  by  so  affecting  the  nervous 
centres  as  to  overcome  the  existing  spasm  of  the  tubes,  and  in  the  suf- 
focative catarrh,  by  giving  increased  tone  to  the  mucous  membrane,  and 
thereby  checking  the  excess  of  secretion  poured  out  from  the  relaxed 
vessels. 

In  defect  of  the  generative  function,  M.  Trousseau  was  inclined  to 
make  a  trial  of  nux  vomica,  from  having  observed  its  effects  in  produc- 
ing erections,  and  exciting  the  venereal  propensity.  He  has  found  it 
useful  in  impotence  in  both  sexes.  (Trait,  de  Therap.,  4e  ed.,  i.  714.) 
It  has  also  been  employed  with  supposed  advantage  in  spermatorrhoea. 

In  general  nervous  debility,  manifested  by  tremulousness,  and  uncon- 
nected with  positive  cerebral  lesion,  and  particularly  when  dependent  on 
previous  excesses,  as  from  intemperate  drinking,  abuse  of  opium,  or 
excess  in  sexual  indulgences,  good  may  be  expected  from  nux  vomica  in 
supporting  the  nervous  functions,  while  the  patient  is  endeavouring  to 
regain  health  by  abstinence  from  the  cause.  Any  apparent  good  which 
might  arise  from  it,  without  an  abandonment  of  the  indulgences  referred 
to,  must  be  merely  temporary,  and  might  indeed  do  harm  by  still  further 
exhausting  the  excitability  of  tne  centres. 

In  chronic  states  of  debility  connected  with  the  various  cachexiae,  as 
in  atonic  gout,  scrofula,  atonic  dropsy,  etc.,  good  may  result  from  the 
use  of  nux  vomica  as  of  most  other  tonics ;  but,  unless  a  special  indica- 
tion exist  in  some  functional  defect  of  nervous  power,  it  would  be  better 
to  trust  the  case  to  medicines  less  liable  to  produce  serious  injury  if 
abused.  It  has  been  recommended  in  albuminuria.  (Ann.  de  Therap., 
1863,  p.  65.) 

The  asserted  efficacy  of  the  medicine  in  different  forms  of  nervous  dis- 
ease, not  paralytic,  must  be  referred  to  the  same  tonic  influence  over  the 
nervous  centres,  either  directly  stimulating  them  to  a  more  energetic  exer- 
cise of  their  function,  or  strengthening  them  against  irritating  iniliieners 
calculated  to  throw  them  into  disorder.  Spasmodic  asthma  has  already 
been  referred  to.  The  remedy  is  asserted  to  have  proved  ell'ertual  in  neu- 
ralgia in  the  face,  and  may  be  employed  against  this  alleetion  wherever 
•  d.  whether  externally  or  internally,  with  some  hope  of  henelit.  In 
hysteria,  c/i<>ri:a,  and  f/^Vry/s//  it  was  long  since  used,  but  attracted  little 
attention  until  recently  revived  as  a  remedy  in  the  two  latter  of  these 
complaints.  M.  Trousseau,  and  MM.  Fouilhoux  and  Kougier,  about  the 


CHAP.  I.]  SPINAL   STIMULANTS. — NUX    VOMICA.  827 

year  1841,  simultaneously  announced  the  great  efficiency  of  this  medicine 
in  chorea;  and  since  that  period  it  has  come  to  be  one  of  the  remedies 
most  relied  on  in  this  affection  among  the  French  physicians.  (Trousseau 
et  Pidoux,  Traite  de  Therap.,  4e  ed.,  i.  715.)  In  chorea,  the  involun- 
tary movements  are  not  dependent  on  excess  of  action  in  the  nervous 
centres,  but  upon  irregularity  of  action,  which  is  often  connected  with 
debility.  It  may,  therefore,  be  readily  understood  how  a  medicine  may 
prove  efficient  in  its  cure,  by  elevating  the  powers  and  actions  of  these 
centres.  But  it  is  not  so  easy  to  explain  the  asserted  usefulness  of  nux 
vomica  in  epilepsy.  Bayle  speaks  of  it  as  having  been  used  advantage- 
ously in  this  disease;  and  in  the  N.  Y.  Medical  Times  for  April,  1855 
(iv.  229),  Dr.  Elisha  Harris  has  reported  several  cases,  in  which  it  ap- 
pears to  have  acted  very  favourably.  As  the  epileptic  irritation  is  in  the 
brain,  while  nux  vomica  acts  specially  on  the  spinal  marrow,  we  can  con- 
ceive that  the  remedy  may  prove  useful  by  a  revulsive  influence  from 
the  former  to  the  latter;  but  great  care  should  be  taken,  before  using  it, 
to  ascertain  that  the  system  is  not  plethoric,  and,  as  a  cerebral  irritation 
superadded  to  that  already  existing  might  result  in  serious  consequences, 
to  begin  with  it  very  cautiously,  lest  it  might,  as  it  sometimes  excep- 
tionally does,  act  upon  the  brain.  A  case  of  epilepsy  is  recorded  in 
which  paralysis  and  death  followed  the  use  of  strychnia.  (Pereira,  Mat. 
.Med  ,  3d  ed.,  p.  1492.)  Headache,  mental  dejection,  hypochondriacal 
feelings  and  notions,  and  general  or  local  uneasiness  of  a  nervous 
character,  when  connected  with  general  debility,  may  be  treated  with 
nux  vomica  with  a  reasonable  hope  of  benefit.  Perhaps  the  asserted 
usefulness  of  the  medicine  in  bronchocele,  may  be  traced  to  its  action  on 
the  nerve-centres. 

2.  Use  as  a  Spinal  and  Sensorial  Stimulant.  M.  Fouquier,  a  French 
physician,  was  the  first  who  regularly  employed  nux  vomica  in  the  treat- 
ment of  palxy.  He  was  very  naturally  led  to  this  application  of  the 
medicine  by  the  consideration  of  its  physiological  operation,  as  shown 
by  its  effects  as  a  poison,  and  fully  developed  and  established  by  the  ex- 
periments of  Magendie  and  others  on  inferior  animals.  In  palsy  there 
is  a  loss  of  the  power  of  voluntary  motion.  One  of  the  most  striking 
effects  of  nux  vomica  is  muscular  contraction.  It  seemed  a  very  fair 
inference  that  the  medicine  would  prove  useful  in  the  disease.  On  trial 
it  was  found  to  be  so  in  many  instances,  and  nux  vomica  is  now  an 
established  remedy  in  paralytic  affections. 

A  curious  circumstance  in  the  treatment  of  paralysis  by  nux  vomica 
is,  that  the  first,  effects  of  the  medicine  are  felt  in  the  paralyzed  part.  It 
is  in  tiiis  that  the  muscular  twitclfmgs,  the  electric-like  shocks,  the  for- 
mication, tingling,  t'tc.,  characteristic  of  its  action,  are  in  general  first 
experienced,  especially  in  cases  which  are  to  end  favourably.  I  know 
not  how  better  to  explain  this  curious  fact  than  by  supposing  that  each 


828  GENERAL    STIMULANTS.  [PART  II. 

portion  of  the  system,  when  under  its  ordinary  healthful  influences,  is 
best  able  to  resist  disturbing  causes  ;  and  that  consequently  the  nervous 
centres  which  preside  over  the  unparalyzed  parts,  being  in  the  healthy 
.state,  arc  less  readily  thrown  into  disorder  by  contact  with  the  medicine 
circulating  with  the  blood,  than  the  diseased  nervous  centres  corre- 
sponding with  the  external  seat  of  paralysis.  Of  course,  this  explanation 
implies  that  the  diseased  centres  are  only  functionally  affected;  for,  if 
disorganized,  they  become  either  insensible,  or  sensible  only  in  an  ab- 
normal way,  to  the  action  of  the  medicine;  and  the  fact  is  that,  in  cases 
of  the  latter  kind,  that  is,  when  the  nervous  centres  are  organically 
affected,  the  paralyzed  limb  is  not  apt  to  exhibit  this  peculiarity,  and  the 
disease  is  not  likely  to  yield  to  the  remedy.  It  may,  therefore,  be  re- 
garded as  an  unfavourable  sign,  in  reference  to  the  remedial  influence  of 
nux  vomica  in  palsy,  when  the  effects  referred  to  are  displayed  first  in 
the  sound  parts,  and  little  or  not  at  all  in  the  diseased. 

But,  though  nux  vomica  was  found  to  possess  unquestionable  powers 
over  many  cases  of  palsy,  experience  soon  demonstrated  that  there  were 
also  many  which  were  in  no  degree  benefited  by  it,  and  that  it  some- 
times proved  positively  injurious.  This  is  what  might  have  been  antici- 
pated from  a  consideration  of  the  ordinary  causes  of  palsy,  and  the  mode 
of  action  of  the  medicine.  In  most  paralytic  affections  the  real  seat  of 
disease  is  in  the  nervous  centres  of  the  paralyzed  part,  or  in  the  course 
of  the  connecting  nerves ;  and  this  disease  is  very  often  of  an  organic 
character,  that  is,  such  as  deranges  or  destroys  the  structure  of  the  part 
affected.  Most  frequently  it  is  hemorrhagic  or  inflammatory.  Now  to 
expect  to  restore  to  its  healthy  function,  by  the  stimulant  influence  of 
nux  vomica,  a  nerve  or  a  nervous  centre,  already  actively  congested,  or 
positively  inflamed,  or  lacerated  by  effused  blood,  would  be  in  the  highest 
degree  unreasonable.  What  might  rationally  be  expected,  under  such 
circumstances,  would  be  an  increase  of  the  inflammation  or  of  the  hem- 
orrhage, and  consequently  a  confirmation  of  the  paralysis.  When  palsy, 
therefore,  follows  hemorrhage  within  the  encephalon  or  spinal  column, 
or  attends  inflammation  of  the  cerebral  substance  or  the  medulla  spinalis. 
nux  vomica  and  its  preparations  should  be  scrupulously  avoided,  until 
the  immediate  effects  of  the  injury  shall  have  been  remedied,  and  the 
nervous  tissue  have  been  restored  ;is  nearly  as  possible  to  its  normal 
organic  condition.  Being  now  merely  enfeebled,  and  unable  to  perform 
its  function  in  consequence  of  this  feebleness,  all  that  is  needed  is  a 
stimulus  calculated  to  rouse  it  into  action ;  and  such  a  stimulus  is  happily 
afforded  in  the  nux  vomica.  In  the  pal-ies,  whether  hemiplegic.  para- 
plegic, or  local,  which  are  believe.!  to  originate  in  inllamnution  or  hem- 
orrhage, or  other  organic  mischief,  ample  time  should  be  allowed  for  the 
subsidence  of  the  inflammation  under  suitable  appliances,  or  for  the  ab- 
>orption  or  isolation  of  the  effused  blood,  and  the  repair  of  the  injury  in- 


CHAP    I.]  SPINAL    STIMULANTS. — NUX    VOMICA.  829 

dieted  by  it,  or  for  the  removal  of  whatever  other  disorganizing  condition 
may  exist,  before  recourse  is  had  to  mix  vomica.  There  can  be  no  doubt 
that  injury  has  often  accrued  from  a  neglect  of  this  caution.  Weeks  or 
months,  and  sometimes  many  months,  must  be  allowed  to  pass  before  the 
remedy  is  used.  Hemorrhage  generally  requires  a  longer  delay  than  acute 
inflammation,  because  a  longer  time  is  requisite  to  repair  the  mischief  done. 
In  hemiplegia  following  hemorrhagic  apoplexy,  it  will  in  most  cases  be 
prudent  to  wait  from  four  to  six  months,  or  even  longer.  When,  moreover, 
under  these  circumstances,  the  medicine  is  begun  with,  the  smallest  doses 
should  be  first  prescribed,  and  a  careful  watch  kept  so  as  to  note  the  first 
sign  of  injury,  and  when  it  is  presented,  to  suspend  the  remedy  for  a  time. 
How  far  a  complete  restoration  of  the  palsied  part  is  to  be  accomplished 
in  these  cases  of  organic  affection,  depends  upon  the  degree  of  permanent 
injury  which  the  nervous  tissue  has  suffered.  When  it  recovers  without 
injury,  but  merely  debilitated,  the  palsy  may  be  cured;  but  in  very  many 
instances  there  is  only  a  partial  restoration,  and  consequently  only  a  par- 
tial relief  of  the  paralyzed  part. 

Hemiplegia  yields  much  less  frequently  and  less  completely  to  nux 
vomica  than  paraplegia;  chiefly,  in  all  probability,  because  the  former, 
connected  as  it  generally  is  with  disease  of  the  brain,  is  much  more  fre- 
quently dependent  on  a  destructive,  and  often  irreparable  hemorrhage, 
than  the  latter,  which,  proceeding  usually  from  disease  of  the  spinal 
marrow,  where  hemorrhage  is  less  common,  is  more  apt  to  be  a  result  of 
inflammation,  or  other  curable  affection.  There  is,  however,  another 
reason  why  cerebral  palsy  yields  less  readily  to  nux  vomica  than  spinal. 
It  is  upon  the  spinal  medulla  that  the  remedy  specially  acts;  and,  even 
when  the  cerebral  centres  are  sound,  though  debilitated,  they  may  be 
without  the  circle  of  its  influence,  and  thus  remain  unaffected  by  it.  But 
even  in  paraplegia,  though,  when  suitably  employed,  it  often  does  much 
good,  it  often  also  fails  altogether,  in  consequence  of  the  disorganized 
condition  of  the  spinal  marrow,  from  inflammation,  degeneration,  soft- 
ening, etc.,  or  irremovable  pressure  upon  it,  as  by  displaced  bone,  aneu- 
risms, organized  tumours,  etc. 

Though  nux  vomica  acts  most  powerfully  as  a  stimulus  to  the  motor 
power,  it  is  by  no  means  without  influence  over  the  sensibility  or  im- 
pressibility of  the  nervous  centres,  and  therefore  proves  useful  in  palsy 
of  sensation  as  well  as  in  that  of  motion,  though  perhaps  in  an  inferior 
degree.  When  the  loss  of  sensibility  depends  upon  a  want  of  due 
power  of  action  in  the  conducting  fibres  of  the  spinal  marrow,  it  is  highly 
probable  that  these  are  stimulated  in  like  manner  with  the  spinal  cen- 
tres by  the  direct  influence  of  the  medicine.  Hence  in  paraplegia  there 
is  very  generally  a  restoration  jointly  of  sensibility  and  the  power  of 
motion.  When  the  cause  of  the  palsy  of  sensation  is  in  the  seasonal  cen- 
tres at  the  base  of  the  brain,  there  is  still  hope  of  benefit  from  the  rem- 
edy, which,  as  before  stated,  acts  often  with  considerable  energy  on  these 


830  GENERAL    STIMULANTS.  [PART  II. 

centres,  either  directly  or  through  emanation  from  the  medulla  oblongata. 
Hence,  mix  vomica  may  be  used,  with  reasonable  prospect  of  advant- 
age, in  exclusive  palsy  of  sensation,  whether  the  general  sensibility  i> 
affected,  or  only  the  special  senses,  as  of  tact,  taste,  smell,  hearing,  and 
sight. 

But  the  kind  of  palsies  to  which  mix  vomica  is  most  appropriate  are 
those  of  function  merely,  without  organic  injury  of  the  nervous  fibrils  or 
centres.  It  may  be  very  difficult  to  decide  during  life  upon  the  nature 
of  such  cases ;  but  when,  upon  the  most  careful  examination,  no  source 
of  organic  mischief  can  be  discovered  or  reasonably  suspected,  the  prac- 
titioner will  be  quite  justifiable  in  presuming  upon  its  absence,  and  in 
giving  at  least  a  trial  to  nux  vomica.  Palsy  commencing  with  hysteri- 
cal phenomena,  or  of  rheumatic  origin,  if  persistent,  may  be  treated  in 
this  way;  and  in  the  various  forms  of  lead-palsy  nux  vomica  is  among 
the  most  efficient  agents.  It  has  also  proved  especially  useful  in  diph- 
theric paralysis. 

Of  the  varieties  of  palsy,  as  connected  with  the  seat  of  the  affection, 
little  need  be  said.  Of  hemiplegia  and  paraplegia  enough  has  been  said 
in  the  preceding  general  remarks.  General  palsy  too  often  fails  to  yield 
to  any  remedy;  but  it  is  among  those  in  which  nux  vomica  is  particu- 
larly indicated;  for,  if  obscure  in  its  origin,  it  would  obviously  call  for  a 
trial  of  means  calculated  to  stimulate  the  defective  function ;  and  if 
traceable,  as  it  often  is,  to  degeneration  of  the  nervous  tissue  under 
depressing  influences,  it  is  to  be  remedied,  if  at  all,  by  the  joint  influence 
of  a  tonic  and  of  a  stimulant  to  the  enfeebled  tissue,  such  as  is  exerted 
by  the  medicine  under  examination.  In  local  palsies,  such  as  those 
dependent  on  injuries,  the  use  of  the  remedy  is  to  be  governed  by  the 
same  principles  as  in  the  other  forms.  There  are  a  few  of  these  local 
affections  which  require  particular  notice. 

Retention  of  urine  from  palsy  of  the  bladder,  and  incontinence  of 
urine  from  a  similar  condition  of  the  sphincter  muscles,  are  frequently 
treated  with  advantage  by  nux  vomica  or  its  preparations;  and  it  is 
among  the  most  efficacious  remedies  in  the  nocturnal  incontinence  of 
children,  which  frequently  depends  upon  debility  of  these  muscles. 

In  prolapsus  ani  in  children,  depending  on  debility  of  the  sphincter 
ani,  it  would  seem  to  be  indicated.  M.  Duchanssoj  reports  a  very 
obstinate  c:ise,  in  a  child  of  eleven  years,  in  which  a  complete  cure  was 
ejected,  in  le-s  than  a  week,  by  the  daily  application  of  about  one-fourth 
of  a  grain  of  strychnia  upon  blistered  surfaces  near  the  anus  ( Ardi 
Qt'-n.  de  M<d.,  Scptemb.  1853,  p.  328);  and  a  somewhat  similar  case  is 
recorded  in  the  London  Medical  Times  and  Gazette  (Nov.  1854,  p.  521). 
Might  not  the  remedy  be  prescribed  with  equal  effect  by  the  stomach,  or 
in  the  form  of  injection  with  or  without  a  little  laudanum?  Of  course, 
if  given  in  this  way,  the  dose  must  be  diminished.  It  has  been  used 


CHAP.  I.]  SPINAL    STIMULANTS. — NUX   VOMICA.  831 

successfully  by  the  injection  of  the  solution  into  the  subcutaneous  tissue 
near  the  anus. 

Functional  aphonia  is  another  example  of  muscular  relaxation  or 
paralysis  in  which  mix  vomica  is  clearly  indicated. 

Loss  of  taste,  or  of  smell,  deafness,  and  amaurosis,  when  purely  nerv- 
ous or  functional,  may  possibly  be  benefited  by  the  medicine;  and  the 
practitioner  would  always  be  justified  in  employing  it  in  these  affections: 
nor,  even  when  they  may  have  originated  in  active  congestion,  hemor- 
rhage, or  inflammation,  provided  that  all  acute  symptoms  have  ceased, 
and  time  has  been  allowed  for  the  repair  of  the  injury  inflicted,  need  the 
remedy  be  withheld,  though  it  would  probably  prove  less  efficacious 
than  in  the  functional  cases.  In  amaurosis  it  has  been  used  locally 
with  great  supposed  advantage,  being  sprinkled,  in  the  form  of  powdered 
>trychnia.  upon  blistered  surfaces  upon  the  temples,  as  near  the  seat  of 
the  complaint  as  possible.  Experience  has  not  fully  confirmed  the  san- 
guine hopes  that  were  at  one  time  entertained  of  its  efficacy;  but,  with 
the  caution  above  given,  in  relation  to  any  possibly  existing  organic  dis- 
order, it  may  be  used  with  great  propriety  either  endermically,  or  by  the 
stomach.  Used  hypodermically,  by  injection  into  the  supra-orbital  areo- 
lar  tissue,  the  solution  has  proved  successful  in  a  case  under  the  care  of 
M.  Freminau.  (Med.  T.  and  Gaz.,  Jan.  21,  1865.) 

4.  Administration. 

In  reference  to  the  administration  of  nux  vomica  and  its  prepara- 
tions, a  few  preliminary  observations  regarding  certain  peculiarities  in 
the  operation  of  the  remedy  are  necessary,  in  order  properly  to  regulate 
its  exhibition. 

In  the  first  place,  it  has  been  often  noticed  that  the  system  becomes 
less  rapidly  habituated  to  this  remedy  than  to  most  others,  and  that  con- 
sequently it  is  not  requisite,  in  order  to  maintain  a  given  impression,  to 
go  on  increasing  the  dose,  as  is  necessary  with  the  narcotics.  After  it 
1ms  been  ascertained  how  much  is  required  to  produce  the  characteristic 
effects,  the  dose  may  often  be  continued  without  augmentation  for  a  long 
time.  I  have  had  patients  for  several  weeks,  if  not  for  months,  under 
the  use  of  strychnia,  without  being  able  to  increase  the  dose,  unless  at 
the  risk  of  inducing  troublesome  muscular  contractions.  Nevertheless, 
it  is  probably  only  in  degree  that  nux  vomica  differs  from  other  medicines 
in  this  respect ;  and  if,  after  having  given  evidence  of  its  action,  it  should 
at  length  cease  to  do  so,  the  dose  should  be  cautiously  increased  up  to 
the  amount  requisite  for  sensible  effect. 

It  occasionally  happens  that,  instead  of  becoming  less  susceptible  to 
the  influence  of  the  medicine  with  its  continued  use,  the  system  is  ap- 
parently more  so,  and  the  same  doses  cannot  be  borne  as  at  first  This 
can  be  explained,  v.  '.tli<"it  the  necessity  of  considering  nux  vomica  as  an 


832  GENERAL   STIMULANTS.  [PART  II. 

absolute  exception  to  the  otherwise  almost  universal  rule.  In  the  event 
referred  to,  the  medicine  may  be  conceived  to  have  induced  a  positive 
irritation  of  the  spinal  mamnv,  perhaps  in  consequence  of  an  existing 
predisposition,  which  irritation,  having  thus  been  set  on  foot  by  it,  will 
continue  altogether  independently  of  its  further  influence,  just  as  if  it  had 
been  induced  by  cold,  which  does  sometimes  give  rise  to  a  similar  condi- 
tion, as  in  idiopathic  tetanus.  This  irritation  may  continue  for  several 
days,  giving  rise  to  phenomena  similar  to  those  produced  by  the  medi- 
cine, which  seems  therefore  to  sustain  its  action  for  a  long  period,  though 
really  at  the  time  quite  inoperative.  In  this  condition,  a  further  dose 
would  aggravate  the  irritation,  and  seem,  therefore,  to  be  operating  on 
an  increased  susceptibility;  whereas  the  susceptibility  might  remain  un- 
altered, or  possibly  even  be  lessened.  The  occasional  result,  therefore, 
above  referred  to,  must  be  considered  as  exceptional,  and  by  no  means 
authorizing  the  conclusion,  as  a  law  of  the  action  of  mix  vomica,  that 
the  longer  it  is  given  the  greater  is  the  susceptibility  to  its  action. 

A  second  very  important  consideration  is  the  vast  difference  of  sus- 
ceptibility to  its  influence  in  different  individuals.  In  this  respect,  though 
not  quite  peculiar,  for  there  are  several  substances  of  which  the  same 
fact  holds  true,  and  some  even  to  a  greater  extent  than  nux  vomica,  yet 
it  differs  so  much  from  ordinary  medicines  that  the  greatest  caution  is 
requisite  in  regulating  the  dose.  I  have  known  a  lady  to  be  thrown  into 
violent  and  even  alarming  spasms,  almost  threatening  suffocation,  by  one- 
twelfth  of  a  grain  of  strychnia  ;  and  instances  have  already  been  referred 
to  of  death  from  fifteen  grains  of  the  powder,  and  three  grains  of  the 
extract  of  nux  vomica;  while  Pereira  once  gave  to  a  patient  a  grain  and 
a  half  of  the  alkaloid,  which  w;is  repeated  several  times,  before  the 
symptoms  indicating  that  the  system  was  affected  came  on.  Though  he 
began  with  smaller  quantities,  and  gradually  increased  to  that  mentioned, 
and  although  no  serious  consequences  ensued  in  the  case,  yet  he  slates 
that  subsequent  experience  had  convinced  him  that  so  large  a  dose  was 
dangerous.  With  our  present  knowledge  of  the  action  of  this  medicine, 
I  do  not  think  that  a  practitioner  would  be  justifiable  in  administering 
such  quantities,  however  cautiously  they  may  have  been  readied.  1  have 
noticed  the  extreme  susceptibility,  above  referred  to,  most  frequently  in 
nervous  females. 

A  third  point  worthy  of  attention  is  the  question  whether  nux  vomica 
is  cumulative  ;  that  is,  whether,  after  having  been  given  for  some  time 
in  repeated  doses,  at  the  ordinary  intervals,  without  any  apparent  effect,  it 
can  ever  break  forth  suddenly  with  the  full  influence  of  the  accumulated 
doses,  and  with  danger  to  life.  It  has  generally  been  thought  not  to  be 
so;  and  no  danger  has  been  apprehended  upon  this  score.  But  a  case 
has  been  recorded  by  Dr.  Pereira,  which  shows  that  the  use  of  it  is  not 
so  exempt  from  this  danger  as  had  been  supposed.  Strychnia  was  given 


CHAP.  I.]  SPINAL   STIMULANTS. — NUX   VOMICA.  833 

to  a  man  first  in  the  dose  of  one-eighth  of  a  grain,  then  of  one-quarter, 
and  finally  of  half  a  grain,  in  each  instance  being  repeated  three  times 
a  day,  and  the  last  dose  was  continued  many  days  without  perceptible 
effect.  At  length  he  was  seized  suddenly  with  violent  spasms,  and  died 
with  asphyxia  in  a  very  short  time.  (Mat.  Med.,  3d  ed.,  p.  149t.)  Un- 
combined  strychnia  is  of  extremely  slight  solubility  in  cold  water,  while 
in  acidulated  water  it  is  readily  dissolved.  It  might  happen  that  acid  in 
the  primse  vise  should  be  wanting  for  a  time,  and  the  strychnia  thus  re- 
main undissolved  and  accumulating;  but  at  length  the  gastric  juice, 
reacquiring  its  normal  acidity,  might  dissolve  the  whole  at  once,  and 
enable  it  to  be  absorbed.  The  effects  in  the  above  case  may  thus  be 
conjecturally  explained.  The  lesson  deducible  from  it  is  never  to  ven- 
ture upon  so  large  a  dose ;  as  present  impunity,  even  though  lasting  for 
many  days  during  the  administration  of  the  medicine,  affords  no  certain 
guarantee  against  ultimate  danger. 

From  all  that  has  been  stated  above  it  is  to  be  inferred  that,  in  using 
any  of  the  forms  of  nux  vomica,  we  should  begin  with  a  very  small  dose, 
especially  in  persons  of  great  nervous  irritability,  as  nervous  females  and 
young  children,  and  increase  by  minute  increments,  and  at  intervals  not 
shorter  than  a  day  or  two,  until  we  have  ascertained  the  active  dose,  and 
then  increase  no  further,  but  rather  fall  back  somewhat,  or  suspend  for 
a  time,  especially  if  the  symptoms  should  be  of  a  rather  decided  charac- 
ter. If  the  first  dose  produce  observable  effect,  it  should  not  be  repeated 
till  these  effects  have  ceased,  and  then  in  diminished  amount.  In  no  case 
should  the  quantity  be  increased,  however  cautiously  the  augmentation 
may  be  conducted,  to  an  amount  adequate  to  the  destruction  of  life  in 
ordinary  persons. 

When  the  medicine  is  administered  as  a  tonic  simply,  it  may  be 
pushed,  with  the  precautions  just  mentioned,  to  the  point  of  observable 
effect  on  the  system,  and  then  diminished,  so  as  to  be  maintained  just 
within  that  point. 

The  following  are  the  different  forms  which  may  be  resorted  to  for 
exhibition. 

The  Powder.  Nux  vomica  is  not  readily  reduced  to  fine  powder,  and 
from  this  cause,  as  well  as  from  its  extremely  bitter  taste,  and  its  uncer- 
tainty as  regards  strength,  is  seldom  administered  in  that  form.  The 
dose  is  five  grains  three  times  a  day,  to  be  gradually  increased  till  its 
effects  are  produced ;  but  in  no  case  should  it  be  pushed  beyond  fifty 
grains ;  and  it  would  be  better  to  stop  short  at  twenty  or  thirty  graius. 
The  dose  of  the  bean  of  St.  Ignatius  should  not  be  more  than  one-third 
that  of  nux  vomica.  Either  of  these  may  be  given  in  pill  if  deemed 
advisable. 

ALCOHOLIC  EXTRACT. — Extraction  Nucis  Vomicse.  U.  S.  1850,  Br. — 
Extractum  Nucis  Vomicx  Alcoholicum.  U.  S. — This  contains  all  the 
VOL.  i. — 53 


834  GENERAL    STIMULANTS.  [PART  II. 

virtues  of  the  seeds.  It  is  more  convenient  and  efficacious  than  the 
powder,  but  like  it  is  liable  to  the  objection  of  inequality  of  strength. 
If  the  estimate  of  M.  Recluz  as  to  the  average  product  obtained  from 
the  seeds  is  to  be  relied  on,  it  is  about  twelve  times  as  strong;  as  the 
powder.  The  dose  is  from  half  a  grain  to  two  grains,  and  in  no  case 
should  exceed  four  or  five  grains.  In  persons  of  an  irritable  nervous 
constitution,  it  would  be  best  to  begin  with  the  smallest  quantity  men- 
tioned. For  a  child  from  four  to  eight  years  old,  the  commencing  dose 
may  be  one-eighth  or  one-sixth  of  a  grain,  which  should  not  be  increased 
beyond  one,  or  at  the  furthest,  two  grains.  At  first,  one  or  two  doses 
may  be  given  daily,  which  should  be  increased  to  three  or  four  doses, 
before  augmenting  the  size  of  each.  The  extract  is  most  conveniently 
given  in  the  form  of  pill. 

ALCOHOLIC  EXTRACT  OF  IGXATIA.  —  Extractum  Tgnatise  Alcoholi- 
cum,  IT.  S.  —  Under  the  name  of  ignatia  amara,  an  extract  of  the  bean 
of  St.  Ignatius  was  a  few  years  since  used  empirically  or  popularly  to 
a  considerable  extent.  It  is  needless  to  say  that  so  powerful  a  medicine 
should  never  be  tampered  with,  and  never  employed  unless  under  proper 
medical  supervision.  The  revisers  of  the  U.  S.  Pharmacopeia  for  the 
present  edition,  sensible  of  this  inconvenience,  have  introduced  a  formula 
for  the  extract  under  the  name  at  the  head  of  this  paragraph.  It  is  pre- 
pared by  first  forming  a  tincture  by  percolation  and  then  evaporating 
the  tincture  to  dryness.  The  dose  is  stated  at  from  half  a  grain  to  a 
grain  and  a  half,  three  times  a  day ;  but,  considering  the  relative  rich- 
ness in  strychnia  of  the  nux  vomica  and  the  bean  of  St.  Ignatius,  it 
would  probably  be  safer  to  commence  with  a  dose  not  exceeding  at  most 
one-half  of  that  of  the  extract  of  the  former  medicine. 

TINCTURE. —  Tinctura  Nucis  Vomicse.  U.S.  —  This  is  seldom  used 
internally,  on  account  of  its  excessive  bitterness,  while  it  has  no  advant- 
age in  relation  to  equability  of  strength  over  the  powder  or  extract.  If 
the  nux  vomica  be  completely  exhausted  by  the  alcohol,  the  quantity 
equivalent  to  five  grains  of  the  powder  will  be  twenty  minims.  This, 
therefore,  may  be  considered  as  the  proper  commencing  dose  for  an  adult. 
As  hitherto  stated  in  most  books,  the  dose  is  too  small  for  effect,  unless 
it  may  be  as  a  tonic.  The  tincture  is  chiefly  employed  externally,  by 
friction  or  as  an  embrocation  to  paralyzed  parts.  It  may  be  conveniently 
diluted  with  the  camphorated  tincture  of  soap,  or  used  as  an  addition  to 
the  liniment  of  ammonia. 

STRYCHNIA.  U.  S.,  Br.  —  All  that  has  been  said  of  the  effects  of 
mix  vomica  on  the  system,  and  of  its  uses  as  a  medicine,  may  be  consid- 
ered as  applying  also  to  strychnia.  When  pure  it  has  the  advanta^- 
over  the  powder,  extract,  or  tincture,  of  perfect  uniformity  of  strength. 
The  only  objection  to  it  is  the  extreme  danger  from  over-doses,  which 
therefore  should  be  avoided  with  the  greatest  -care. 


CHAP.  I.]  SPINAL   STIMULANTS. — NUX   VOMICA.  835 

Strychnia  is  usually  procured  from  the  bean  of  St.  Ignatius,  in  conse- 
quence of  its  greater  richness  in  this  principle  than  nux  vornica.  The 
seeds,  properly  comminuted,  are  treated  with  acidulated  water  till  ex- 
hausted; the  liquid  thus  obtained  is  precipitated  by  means  of  lime;  the 
precipitate  is  treated  with  alcohol,  which  dissolves  out  the  alkaloid  ;  the 
alcohol  is  distilled  off  from  the  tincture;  the  residue  is  dissolved  with 
sulphuric  acid;  the  solution  having  been  purified  by  animal  charcoal,  is 
filtered,  evaporated,  and  crystallized;  and  the  resulting  sulphate  is  redie- 
solved  and  precipitated  by  ammonia.  As  thus  obtained,  the  strychnia 
contains  some  brucia;  from  which  it  may  be  freed  by  repeated  crystal- 
lization from  its  alcoholic  solution;  the  brucia  being  left  behind  in  the 
mother  liquor,  in  consequence  of  its  greater  solubility  in  cold  alcohol. 
The  only  disadvantage  of  brucia  is  that  it  renders  the  preparation  weaker 
in  proportion  to  the  quantity  present.  A  little  of  it  does  no  harm. 

Though  crystallizable  from  its  alcoholic  solution,  and  sometimes  crys- 
talline as  sold  in  the  shops,  strychnia  is  more  frequently  in  the  form  of  a 
white  powder,  inodorous,  excessively  bitter,  fusible  by  heat,  but  not  vol- 
atilizable  without  decomposition,  entirely  dissipated  when  thrown  on  red- 
hot  iron,  almost  insoluble  in  cold  water,  soluble  in  2000  parts  of  boiling 
water,  freely  soluble  in  officinal  alcohol  when  hot,  but  much  less  so  when 
cold,  and  very  sparingly  soluble  in  ether.  It  may  be  known,  in  connec- 
tion with  the  above  properties,  by  yielding  a  violet  colour,  when  a  minute 
proportion  of  solution  of  bichromate  of  potassa  is  added  to  a  solution  of 
the  strychnia  in  concentrated  sulphuric  acid.  If  reddened  by  nitric 
acid,  it  may  be  assumed  to  contain  brucia.  With  the  acids  it  forms  salts, 
most  of  which  are  soluble  in  water  and  crystallizable.  The  watery  solu- 
tion of  salt  of  strychnia  is  precipitated  by  the  alkalies  and  their  carbon- 
ates, and  by  tannic  acid;  but  the  precipitated  matter  is  medicinally 
active.  Perhaps,  however,  the  most  delicate  test  of  strychnia  is  the  phy- 
siological test  of  Dr.  Marshall  Hall ;  its  powerful  effect,  namely,  in  pro- 
ducing tetanic  spasms  in  the  frog.  One  of  these  animals,  put  into  a 
liquid  containing  but  an  extremely  small  proportion  of  strychnia,  say 
one-fiftieth  of  a  grain  in  the  fluidounce,  speedily  becomes  affected  with 
violent  tetanic  spasms,  and  perishes.  (See  Med.  and  Surg.  Reporter, 
June  24,  1865,  p.  85.) 

To  a  very  considerable  degree,  strychnia  has  superseded  nux  voniica 
and  its  other  preparations.  Being  one  of  the  most  violent  poisons  known, 
it  requires  to  be  prescribed  and  administered  with  the  greatest  caution. 
Many  instances  of  death  are  upon  record,  arising  from  carelessness  in 
the  dispensing  or  use  of  it. 

The  commencing  dose  of  strychnia,  when  quite  pure,  should  not  ex- 
ceed the  sixteenth  or  twelfth  of  a  grain;  and,  in  patients  of  irritable 
nervous  systems,  it  would  be  best  to  commence  with  the  twenty-fourth 
of  a  grain.  This  dose  may  be  repeated  twice  or  three  times  a  day,  aad 


836  GENERAL    STIMULANTS.  [PA11T  II. 

gradually  increased,  if  necessary,  in  order  to  obtain  its  sensible  effects. 
As  death  has  resulted  from  half  a  grain,  repeated  two  or  three  times  a 
day  for  several  days,  it  would  be  best  never  to  allow  the  augmentation 
of  the  dose  to  reach  this  point.  But,  as  the  strychnia  of  the  shops  is 
often  impure,  larger  doses  than  those  mentioned  are  often  necessary  for 
effect.  Less  than  one-sixth  of  a  grain  of  commercial  .strychnia  will 
often  produce  no  effect;  but,  as  the  strength  is  generally  known  only  by 
trial,  the  dose  of  any  untried  parcel  should  not  at  first  exceed  that  of  the 
pure  alkaloid.  A  very  important  caution,  in  prescribing  strychnia, 
arises  out  of  its  variable  degree  of  purity  as  kept  in  the  shops.  When 
the  parcel  is  changed,  unless  the  one  first  used  is  of  known  purity,  the 
dose  should  be  diminished  to  a  point  at  which  no  possible  injury  could 
accrue,  whatever  might  be  the  strength  of  the  new  parcel.  For  children 
from  four  to  eight  years  old,  the  commencing  dose  should  not  exceed  the 
thirtieth  or  fortieth  of  a  grain.  The  best  form  of  administration  is  in 
pill,  which  may  be  made  with  the  crumb  of  bread,  or  the  conserve  of 
roses.  Should  no  effect  proceed  from  ordinary  doses,  the  patient  should 
take  a  little  acidulated  drink,  as  diluted  acetic  acid,  in  order  to  favour  its 
solubility  in  the  stomach ;  or,  should  the  bitterness  not  be  objectionable, 
the  strychnia  may  be  exhibited  in  solution,  made  by  slowly  dropping 
into  the  water  in  which  it  is  suspended  enough  acetic,  diluted  sulphuric, 
or  muriatic  acid,  to  render  the  liquid  clear.  For  children,  the  solution 
may  sometimes  be  advantageously  incorporated  with  syrup,  so  as  to 
make  the  dose  a  teaspoonful. 

One  of  the  salts  of  strychnia,  as  the  muriate,  sulphate,  acetate,  or 
nitrate,  may  be  substituted  for  the  uncombined  alkaloid.  The  only 
advantage  of  the  salts  is  their  solubility,  so  that  they  may  be  used  in 
the  pilular  form,  without  the  necessity,  in  any  case,  of  following  them 
with  an  acid.  The  dose  is  the  same  as  that  of  strychnia. 

The  Sulphate  of  Strychnia  (STRYCHNINE  SULPHAS,  U.  S.)  is  directed, 
in  the  U.  S.  Pharmacopoeia,  to  be  prepared  by  mixing  the  alkaloid  with 
distilled  water,  gently  heating  the  mixture,  and  gradually  adding  diluted 
sulphuric  acid  until  the  strychnia  is  neutralized  and  dissolved.  The 
liquid,  now  filtered  and  evaporated,  yields  the  sulphate  in  crystals.  The 
salt  is  in  prismatic  crystals,  colourless  and  inodorous,  but  extremely  bit- 
ter, readily  dissolved  by  water,  sparingly  by  alcohol,  and  not  at  all  by 
ether.  It  melts  with  heat,  and  at  a  high  heat  is  completely  dissipated. 
The  dose  is  the  same  as  that  of  uncombined  strychnia. 

Strychnia,  or  one  of  its  salts,  may  be  used  externally  by  sprinkling 
it,  in  the  form  of  powder,  upon  a  surface  denuded  of  the  cuticle.  The 
solubility  of  the  salts  here  gives  them  an  advantage.  The  quantity  first 
used,  if  the  preparation  be  pure,  should  not  exceed  half  a  grain  of  the 
strychnia,  or  a  quarter  of  a  grain  of  one  of  the  salts.  It  may  be  applied 
also  to  the  sound  skin  in  the  vicinity  of  the  palsied  part,  in  the  way  of 


CHAP.  I.]  SPIXAL    STIMULANT?. — NUX   VOMICM.  837 

embrocation ;  the  strychnia  or  one  of  its  salts  being  incorporated  pre- 
viously with  glycerin  or  oleic  acid.  One  part  of  strychnia,  with  a  minute 
quantity  of  diluted  sulphuric  acid  (a  drop  or  two  for  each  grain),  may  be 
rubbed  up  with  fifty  parts  of  glycerin,  and  a  teaspoonful  of  the  mixture 
rubbed  over  the  paralyzed  limb,  or  along  the  spine  in  chorea.  (Journ,  de 
Pharm.  et  de  Chim.,  xxvi.  65,  91,  and  303.)  Dr.  I.  Hays,  of  Philadel- 
phia, has  used,  with  advantage,  a  solution  of  acetate  of  strychnia, 
dropped  into  the  eye,  in  order  to  produce  contraction  of  the  pupil,  and 
to  excite  the  muscle  of  accommodation.  (Am.  Journ.  of  Med.  Sci.,  July, 
1863,  p.  266  )  Strychnia  has  been  used  hypodermically  in  amaurosis 
and  prolapsus  ani,  and  might  be  similarly  employed  in  other  local  para- 
lytic affections ;  the  quantity  injected  at  first  not  exceeding  one-half  the 
commencing  dose  by  the  mouth. 

BRUCIA. — This  alkaloid  is  extracted  in  the  same  manner  as  strych- 
nia, and  accompanies  it  in  the  first  steps  of  the  process,  but  is  in  great 
measure  separated  on  the  crystallization  of  the  latter  from  the  alcoholic 
solution,  remaining  behind  in  the  mother  liquors  in  consequence  of  its 
much  greater  solubility  in  alcohol  when  cold.  Still,  it  is  with  difficulty 
entirely  separated  from  strychnia,  and  is  very  apt  to  contain  it  as  exist- 
ing in  commerce.  It  should  be  procured  in  the  state  of  crystals.  It  is 
bitter,  but  less  so  than  strychnia,  and  much  more  soluble  in  water  and 
cold  alcohol.  It  is  reddened  by  nitric  acid.  Its  claims  to  be  considered 
as  a  distinct  principle  have  been  denied ;  and  Dr.  Fuss  supposes  it  to  be 
a  compound  of  strychnia  and  resin.  It  forms,  however,  distinct  salts 
with  the  acids,  which  are  for  the  most  part  soluble  and  crystallizable. 

From  experiments  of  Magendie,  Andral,  and  others,  brucia  is  believed 
to  be  identical  in  its  effects  with  strychnia,  only  much  weaker.  M.  Le- 
pelletier,  however,  who  had  ample  opportunities  of  noting  its  effects  in 
the  hospital  practice  of  M.  Bricheteau,  though  he  considers  its  physio- 
logical action  analogous  to  that  of  the  stronger  alkaloid,  has  yet  found  it 
to  be  in  some  respects  peculiar.  Thus,  the  fingers  and  great  toe  are 
rapidly  extended  and  flexed,  sometimes  even  producing  a  friction  sound 
in  the  articular  surfaces,  but  are  never  affected  with  that  tetanic  rigidity 
so  characteristic  of  the  action  of  strychnia.  Moreover,  the  muscles  of 
the  jaws,  pharynx,  and  oesophagus,  which  participate  in  the  spasmodic 
effects  of  the  latter  principle,  remain  almost  always  unaffected  under  the 
influence  of  brucia.  On  the  organs  of  generation,  however,  brucia  acts 
with  considerable  energy.  But,  according  to  M.  Lepelletier,  the  great 
advantage  of  brucia  is  its  comparative  safety;  and,  if  it  be  true  that  it 
does  not  produce  the  tetanic  rigidity,  as  he  asserts,  the  danger  of  as- . 
phyxia,  at  least  from  the  immovability  of  the  respiratory  muscles,  is 
avoided.  M.  Bricheteau,  though  he  has  employed  brucia  for  a  very 
long  time,  has  never  known  serious  consequences  to  result.  It  may  be 
used  for  the  same  purposes  as  strychnia,  its  great  advantage  being,  ac- 


838  GENERAL    STIMULANTS.  [PART  II. 

cording  to  the  author  just  cited,  its  comparative  safety.  He  considers 
its  influence  over  the  generative  organs,  in  connection  with  its  entire 
harmlosm-ss,  a  peculiar  recommendation.  But,  as  it  is  often  combined 
with  strychnia,  it  is  indispensable,  in  order  to  obtain  due  results,  that 
attention  should  be  paid  to  its  purity,  and  that  it  should  be  employed 
only  when  iu  the  crystalline  state.  (Ann,  de  Therap.,  1852,  p.  50,  etc.) 

Statements  vary  as  to  the  comparative  strength  of  brucia.  Andral 
considers  it  as  having  only  one-twenty-fourth  of  the  strength  of  pure 
strychnia,  Magendie  the  one-twelfth.  M.  Lepelletier  gives  the  com- 
mencing dose  of  it,  when  quite  pure,  at  two  centigrammes  (about  one- 
third  of  a  troy  grain),  to  be  increased  progressively  to  five,  ten,  twenty 
centigrammes  (about  three  grains  troy),  or  even  more,  if  necessary  to 
obtain  its  physiological  effect.  (Ibid.,  p.  62.) 


DATE  DUE 


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JUL  2 

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PRINTED  IN  U    S    A 

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1867 
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on  therapeutic 
pharmacology 


and 


Wood,  George  B 


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186? 
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colo^186  °n  theraPeutics  and  pharma- 


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